Oncology Flashcards
(28 cards)
Residual Tumour Classification
RX- The presence of residual tumor cannot be assessed.
R0- No residual Tumour
R1- Microscopic Residual Tumour
R2- Macroscopic Residual Tumour
Anthracyclines e.g Doxorubicin
Dilated Cardiomyopathy
Li- Fraumani syndrome
Mutations in the p53 gene result in a high risk of developing invasive cancer (about 50% by age 30 and 90% by age 70), particularly early-onset breast cancer, sarcoma, brain tumours (particularly glioblastoma), leukaemia and adrenocortical carcinoma.
P53 mutation
Bronchial Carcinoma
HER 2 Negative metastatic breast cancer and germline BRCA1/2 mutation
PARP inhibitors, Olaparib
Prostate Cancer
Gleason Grading System
PCR
Polymerase chain reactions are used to detect mutated oncogenes
Bombesin
Bombesin is a tumour marker in small cell lung carcinomas
SIGN guidelines for pain management
-The breakthrough dose of morphine is one-sixth the daily dose of morphine
- all patients who receive opioids should be prescribed a laxative
- opioids should be used with caution in patients with chronic kidney disease
- oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
- if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
- metastatic bone pain may respond to strong opioids, bisphosphonates or radiotherapy.
Oral codeine to Oral morphine
Divide by 10
Oral tramadol to Oral morphine
Divide by 10
Oral morphine to Oral oxycodone Divide by 1.5-2
Oral morphine to Subcutaneous morphine
Divide by 2
Oral morphine to Subcutaneous diamorphine
Divide by 3
Oral oxycodone to Subcutaneous diamorphine
Divide by 1.5
- a transdermal fentanyl 12 microgram patch equates to approximately 30 mg oral morphine daily
- a transdermal buprenorphine 10 microgram patch equates to approximately 24 mg oral morphine daily.
CLL
Chronic lymphocytic leukaemia (CLL) is caused by a monoclonal proliferation of well-differentiated lymphocytes which are almost always B-cells (99%).
Investigations
full blood count:
lymphocytosis
anaemia: may occur either due to bone marrow replacement or autoimmune hemolytic anaemia (AIHA)
Thrombocytopenia: may occur either due to bone marrow replacement or immune thrombocytopenia (ITP)
Blood film: smudge cells (also known as smear cells)
Immunophenotyping is the key investigation
most cases can be identified using a panel of antibodies specific for CD5, CD19, CD20 and CD23
HRT
Side-effects
nausea
breast tenderness
fluid retention and weight gain
Potential complications
1- increased risk of breast cancer
increased by the addition of a progestogen
2- increased risk of endometrial cancer
oestrogen by itself should not be given as HRT to women with a womb
3- increased risk of venous thromboembolism
increased by the addition of a progestogen
4- increased risk of stroke
5- increased risk of ischaemic heart disease if taken more than 10 years after menopause
Mild to moderate Renal impairment
Oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment.
Severe renal impairment
- If renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
VHL syndrome
Von Hippel-Lindau (VHL) syndrome is an autosomal dominant condition predisposing to neoplasia. It is due to an abnormality in the VHL gene located on short arm of chromosome 3.
Features
- cerebellar haemangiomas: these can cause subarachnoid haemorrhages
retinal haemangiomas: vitreous haemorrhage
- renal cysts (premalignant)
phaeochromocytoma
- extra-renal cysts: epididymal, pancreatic, hepatic
- endolymphatic sac tumours
- clear-cell renal cell carcinoma
Translocations
t(14;18) is associated with Follicular lymphoma.
t(9;22) is associated with chronic myeloid leukaemia
t(8;14) is associated with Burkitt lymphoma
t(11;14) is associated with mantle cell lymphoma
t(15;17) is associated with acute promyelocytic leukaemia
Myelofiobrosis
- Approximately 6-10% of patients with polycythaemia vera develop myelofibrosis due to marrow exhaustion.
-Overview
a myeloproliferative disorder
thought to be caused by hyperplasia of abnormal megakaryocytes
The resultant release of platelet-derived growth factor is thought to stimulate fibroblasts
Haematopoiesis develops in the liver and spleen
Features
e.g. elderly person with symptoms of anaemia e.g. fatigue (the most common presenting symptom)
massive splenomegaly
hypermetabolic symptoms: weight loss, night sweats etc
Laboratory findings
anaemia
high WBC and platelet count early in the disease
‘tear-drop’ poikilocytes on blood film
unobtainable bone marrow biopsy - ‘dry tap’ therefore trephine biopsy needed
high urate and LDH (reflect increased cell turnover)
Renal transplant : HLA typing and graft Failure
Renal transplant: HLA typing and graft failure.
The human leucocyte antigen (HLA) system is the name given to the major histocompatibility complex (MHC) in humans. It is coded for on chromosome 6.
Some basic points on the HLA system
class 1 antigens include A, B and C. Class 2 antigens include DP,DQ and DR
when HLA matching for a renal transplant the relative importance of the HLA antigens are as follows DR > B > A
Graft survival
1 year = 90%, 10 years = 60% for cadaveric transplants
1 year = 95%, 10 years = 70% for living-donor transplants
Post-op problems
ATN of graft
vascular thrombosis
urine leakage
UTI
Hyperacute rejection (minutes to hours)
due to pre-existing antibodies against ABO or HLA antigens
an example of a type II hypersensitivity reaction
leads to widespread thrombosis of graft vessels → ischaemia and necrosis of the transplanted organ
no treatment is possible and the graft must be removed
Acute graft failure (< 6 months)
usually due to mismatched HLA. Cell-mediated (cytotoxic T cells)
usually asymptomatic and is picked up by a rising creatinine, pyuria and proteinuria
other causes include cytomegalovirus infection
may be reversible with steroids and immunosuppressants
Causes of chronic graft failure (> 6 months)
both antibody and cell-mediated mechanisms cause fibrosis to the transplanted kidney (chronic allograft nephropathy)
recurrence of original renal disease (MCGN > IgA > FSGS)
Palliative care
Breakthrough dose = 1/6th of daily morphine dose
Bone metastases
Most common tumour causing bone metastases (in descending order)
prostate
breast
lung
Most common site (in descending order)
spine
pelvis
ribs
skull
long bones
Other than bone pain, features may include:
pathological fractures
hypercalcaemia
raised ALP
Differentiating feature of MGUS from Multiple Myeloma
- normal immune function
- normal beta-2 microglobulin levels
- lower level of paraproteinaemia than myeloma (e.g. < 30g/l IgG, or < 20g/l IgA)
- stable level of paraproteinaemia
- no clinical features of myeloma (e.g. lytic lesions on x-rays or renal disease)
CA Breast
Anastrozole and letrozole are aromatase inhibitors that reduces peripheral oestrogen synthesis
SERM
Tamoxifen is a SERM which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer.
Adverse effects
menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
- endometrial cancer
Aromatase Inhibitors
Anastrozole and letrozole are aromatase inhibitors that reduces peripheral oestrogen synthesis. This is important as aromatisation accounts for the majority of oestrogen production in postmenopausal women and therefore anastrozole is used for ER +ve breast cancer in this group.
Adverse effects
osteoporosis
NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer
hot flushes
arthralgia, myalgia
insomnia
