Oncology

Question 1

back pain
may be worse on lying down and coughing
lower limb weakness
sensory changes: sensory loss and numbness
neurological signs depend on the level of the lesion

Answer 1

Neoplastic spinal cord compression

Question 2

Neoplastic spinal cord compression investigation

Answer 2

urgent whole spine MRI

Question 3

Neoplastic spinal cord compression management

Answer 3

high-dose oral dexamethasone
urgent oncological assessment for consideration of radiotherapy or surgery

Question 4

SVC presentation

Answer 4

SOB (main symptom)
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension

Question 5

SVC causes

Answer 5

common: small cell lung cancer, lymphoma
other: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis

Question 6

SVC management

Answer 6

endovascular stenting for symptom relief
radical chemotherapy or chemo-radiotherapy
steroids

Question 7

Anti-nausea drugs in chemo

Answer 7

low risk of s/e: metoclopramide
high risk of s/e: ondansetron

Question 8

Risk factors for N&V in chemo

Answer 8

anxiety
age less than 50 years old
concurrent use of opioids
the type of chemotherapy used

Question 9

What chromosome is BRCA 1

Answer 9

17

Question 10

What chromosome is BRCA 2

Answer 10

13

Question 11

BRCA 1 and 2 associated with what cancers?

Answer 11

Both linked to breast cancer
Ovarian cancer (BRCA 1 higher risk than BRCA2)
BRCA2 linked to prostate cancer

Question 12

Lynch Syndrome

Answer 12

AD
colonic cancer and endometrial cancer at young age
80% of affected individuals will get colonic and/ or endometrial cancer
Amsterdam criteria

Question 13

Amsterdam Criteria

Answer 13

Three or more family members with a confirmed diagnosis of colorectal cancer, one of whom is a first degree (parent, child, sibling) relative of the other two.
Two successive affected generations.
One or more colon cancers diagnosed under age 50 years.
Familial adenomatous polyposis (FAP) has been excluded.

Question 14

FAP

Answer 14

AD familial colorectal polyposis (variant of FAP)
Multiple colonic polyps
Extra colonic diseases include: skull osteoma, thyroid cancer and epidermoid cysts
Desmoid tumours are seen in 15%
Mutation of APC gene located on chromosome 5
Due to colonic polyps most patients will undergo colectomy to reduce risk of colorectal cancer

Question 15

Li-Fraumeni

Answer 15

AD
Consists of germline mutations to p53 tumour suppressor gene
High incidence of malignancies particularly sarcomas and leukaemias
Diagnosed when: