Oncology

Question 1

List examples of tumors cured w/ chemotherapy

Answer 1

Childhood acute leukemia, choriocarcinoma, ovarian germ cell tumors, testicular cancer, wilm’s tumor

Question 2

List tumors that have improved survival w/ chemo

Answer 2

BC, ewing sarcoma, osteosarcoma, ovarian cancer

Question 3

Mention common toxicities with cytotoxic chemo

Answer 3

1. Hematological: neutropenia (most significant dose limiting CCC, thrombocytopenia
2. Cardiotoxicity: acute or chronic
3. Renal toxicity
4. Hepatotoxicity
5. GIT toxicity (mucositis, NVD)
6. Pulmonary toxicity
7. Ototoxicity, dermatological, ocular

Question 4

Mention uses of hormone therapy in cancer pts

Answer 4

1. For cancer derived from hormonally responsive tissues as breast (SERM) & prostate
2. TTT of paraneoplastic syndromes to dec certain cancer & chemo ass symptoms as anorexia
3. Steroid hormones are useful bec poweful drivers of gene expression in certain cells & change level of activity of certain hormones
4. Surgical removal of endocrine organs

Question 5

Cell is most sensitive to radiation when…..while resistant if…..

Answer 5

Undergoing mitosis
Cells in G0 and late S phase

Question 6

Mention side effects of radiation

Answer 6

Acute: due to effect of radiation on dividing normal cells as skin
Late: due to microvascular damage similar to that caused by DM, loss of parenchymal cell function & scarring (endsrteritis obliterans)

Question 7

What do radiation oncologists prefer to fractionate radiation?

Answer 7

Reoxygenation (makes cells that were resistant sensitive), repair, redistribution (cells move into different phases of cell cycle), repopulation

Question 8

Mention INV for SVCO

Answer 8

CXR (mediastinal widening), doppler US of jugular or subclavian vein (diff thrombus from extrinsic compression), CT scan of chest, bronchoscopy & thoracoscopy, needle biopsy from mediastinal mass

Question 9

MC site for VC mets is….

Answer 9

Thoracic (70%)

Question 10

Describe management of anaphylaxis

Answer 10

Remove responsible drug, immediate assessment of airway, administartion of epinepherine subcuatneously, depending on seveity IV fluid for hypotension, ICU may be required, steroids & antihistamines

Question 11

Define tumor lysis $ desribe its pathology

Answer 11

Malignant cell lysis in rapidly grwoing chemi-sensitive tumors after chemo resulting in release of intracellular components into bloodstream of pt
Hyperuricemia, hyperkalemia, hyperphosphatemia end in renal failure & hypocalcemia as 2ry ccc

Question 12

What is prophylaxis against tumor lysis syndrome

Answer 12

Vigorous prehydration
Metabolic monitoring
Allopurinol 300mg/day

Question 13

What is active TTT for tumor lysis $

Answer 13

Hydration by normal saline w/ monitoring UOP at least 100 ml/hr, oral NaHCO3 unless CI, allopurinol, rasburicase (r/urate oxidase), better in allopurinol in controlling hyperuricemia, electrolytes correction, dialysis if (RF, severe hyperphosphatemia, persistent hyperkalemia, azotemia, hyperuricemia, oligo/anuria, refractory acidosis, volume overload.