Oncology Flashcards
(153 cards)
1
Q
What is a-fetoprotein a tumour marker for?
A
Hepatocellular carcinoma (liver) Germ cell/testicular
2
Q
What is b-HCG a tumour marker for?
A
testicular germ cell carcinoma
Gestational trophoblastic tumours
3
Q
What is inhibin a tumour marker for?
A
Ovarian carcinoma
4
Q
What is estridiol a tumour marker for?
A
Ovarian germ cell carcinoma
5
Q
What is CA 19.9 a tumour marker for?
A
Pancreatic carcinoma
6
Q
What is carcinoembryonic antigen (CEA) a tumour marker for?
A
Colorectal
7
Q
What is Sex Hormone Binding Globulin a tumour marker for?
A
Breast carcinoma
8
Q
What is Lactose Dehydrogenase a tumour marker for?
A
Testicular germ cell and gastric carcinoma
9
Q
What is CA-125 a tumour marker for?
A
Ovarian carcinoma
10
Q
Carrying BRCA1 or BRCA2 mutations confers what lifetime risk of cancers?
A
BRCA1-
65% risk of breast cancer
40% risk of ovarian cancer
BRCA2-
45% risk of breast cancer
11% for ovarian cancer
11
Q
What kind of surveillance should women aged 30-50 with BRCA mutations be offered?
A
Yearly MRI (more sensitive than mammogram)
12
Q
What prophylaxis can women with BRCA1/2 be offered to reduce risk of cancer?
A
Bilateral mastectomy (decreases risk by 90%) ±oophrectomy
13
Q
What mutation is associated with Familial Adenomatous Polyposis?
How can cancer be avoided?
A
APC gene in germline cells
Total colectomy (100% of those with the gene get cancer by 50)
14
Q
What is Peutz Jeghers syndrome?
Inheritance, features?
A
Autosomal dominant mutation of STK11 (tumour supressor)
Dark freckles on lips, oral mucosa, palms + soles
GI cancer risk
15
Q
Hereditary non-polyposis colorectal cancer- inheritance pattern? Type of genes involved?
A
Autosomal dominant (but not everyone who has the mutation gets the cancer) DNA mismatch repair genes
16
Q
Investigation and treatment of oncology patient where spinal cord compression is suspected?
A
MRI whole spine
Dexamethasone 16mg OD
17
Q
Harry has a diagnosis of prostate cancer and has noticed worsening back pain and ‘numbness’ in his lower leg. What diagnosis needs to be excluded?
A
Spinal cord compression
Do spine MRI
18
Q
What test can you perform in suspected superior vena cava obstruction?
A
Pemberton’s test: lift arms over head for 1 minute = facial plethora/cyanosis, raised JVP and inspiratory stridor
19
Q
Investigation of choice for suspected SVC obstruction?
A
Contrast enhanced CT (venogram)
20
Q
Rx of superior vena cava obstruction?
A
Dexamethasone
Balloon venoplasty/SVC stenting
(More rapid relief of symptoms than chemo/radiotherapy)
21
Q
Patient with multiple myeloma comes in confused and weak with polyuria and complaining of nausea, what needs to be ruled out?
Rx if positive?
A
Malignancy associated hypercalcaemia (occurs in 40% of myeloma patients)
Rehydration then IV bisphosphonate
22
Q
Which cancer types may lead to tumour lysis syndrome when treated?
What electrolyte disturbance occurs?
A
Leukaemia, lymphoma or myeloma
Germ cell tumours
Rise in serum urate and potassium
23
Q
What can be given prior to chemo to reduce the chance of getting tumour lysis syndrome?
A
Allopurinol 24 hours before (xanthine oxidase inhibitor)
Tumour lysis syndrome leads to raised urate- crystallisation in nephrons causes renal failure
24
Q
How soon after chemo are patients at risk of neutropenia?
A
10-14 days later
Or 7 days later for taxanes
25
Which three types of cancers commonly use bone scans for staging?
Prostate
Breast
Lung
26
What scan can you use to demonstrate a cancer with somatostatin receptors?
Which types of cancer can have such receptors?
Octreotide scan
Pancreas
Medullary thyroid
Neuroblastoma (CNS)
Carcinoid
27
What cancer type are MIBG scans used for localising?
Phaeochromocytoma
Localise noradrenaline production
28
What are Beau's lines?
Horizontal depressions in the nail plate from interruption to keratin synthesis due to infection, trauma, systemic illness or chemo
29
How many weeks does it take for palliative radiotherapy to exert it's effect?
Around 3 weeks
30
Rx for cancer patients complaining of xerostomia during radiotherapy?
Xerostomia = dry mouth
| Pilocarpine (ACh agonist)
31
When a patient is taking 5a-reductase inhibitors, how much should you adjust their PSA value?
Multiple by 2
32
What is the tumour marker for medullary thyroid cancers?
Calcitonin
33
For breast cancer what tumour marker can you use?
CA 15.3
```
CA 19-9 (=pancreatic)
CA 125 (=ovarian)
```
34
What is the tumour marker for thyroid cancers of follicular or papillary types?
Thyroglobulin
| Calcitonin for medullary thyroid
35
Adjuvant chemo means?
After surgery if at risk of reoccurrence
36
When do you give patients granulocyte colony-stimulating factor?
May give it day 2 or 3 post chemo if white blood cell counts are low to try to stimulate the bone marrow, but the WBCs that are produced may not be good quality
37
Rx of neutropenic sepsis?
IV broad spectrum antibiotics (within 1 hour)
Not GCS-factor in the acute setting
38
Young patient with SVC obstruction due to cancer, what is the most likely type of cancer causing the problems?
Lymphoma
| Lung cancer commoner in older patients
39
Cancers typically going to bone?
```
Thyroid
Lung
Breast
Renal
Prostate
```
40
What needs to be considered for treating brain metastases?
Not chemo- may not be able to cross the blood brain barrier
Consider surgery if focal lesion (need MRI head to confirm)
Whole brain radiotherapy / Stereotactic radiotherapy (specific)
Palliative
41
Management of bowel obstruction in cancer patients?
Drugs?
Conservative:
Drip and suck
Steroids
Antiemetics SC
Motility agents (if subacute, like metoclopramide)
Antisecretory agent (octreotide)
42
When would you consider surgical management for someone with cancer and bowel obstruction?
If it hasn't resolved after 48 hours of conservative management
43
Cancer patient on active treatment + VTE, what anticoagulant to use?
LMW heparin whilst on active treatment
| Unstable INR with chemo makes management difficult.
44
Patient with liver mets from an unknown primary, what imaging modalities would be useful?
CT
PET scan to look for primary
Tend to give combination chemo if fit for it.
45
What proportion of those with benign prostatic hyperplasia have a PSA greater than 10?
1%
46
What are the three mechanisms for nausea and the chemicals mediating these?
Visceral stimulation: dopamine + serotonin
Vestibular + CNS: histamine + acetylcholine
Chemoreceptor trigger zone: dopamine + serotonin
47
Why does cyclizine (an antihistamine) work on motion sickness?
Histamine + ACh stimulate vestibular centres to cause nausea
48
What type of antiemetic is most effective for post-op or GI irritation?
Anti-serotonin (ondansetron)
As serotonin and dopamine trigger nausea via the stomach
49
Which antiemetics are dopamine antagonists and what is the risky SE?
Domperidone (peripheral so no dystonic SEs)
Metoclopramide (central and peripheral)
Chlorpromazine
Haloperidol
Not suitable for Parkinson's, may cause extrapyramidal SEs or orthostatic hypotension
50
Name a serotonin antagonist antiemetic?
Ondansetron
51
Which antiemetic is good for gastric stasis (ie after surgery)?
Metoclopramide
52
Give an example for each of the common types of antiemetic
Antidopaminergics: domperidone, metoclopramide, haloperidol
Antiserotonin: Ondansetron
Antihistamine: Cyclizine
Vestibular pathway= ACh + histamine
Visceral stomach pathway = 5-HT + dopamine
Chemoreceptor trigger zone = 5-HT + dopamine
53
What are the four different types of laxative?
Bulking agents- increase faecal mass (bran, ispaghula husk)
Stimulant laxatives- increase intestinal motility (biascodyl, senna)
Stool softeners- for painful anal conditions
Osmotic laxatives- retain fluid (lactulose, macrogel)
54
Patient has constipation from intestinal obstruction, which type of laxatives should be avoided?
Stimulant laxatives as they increase intestinal motility, will just lead to further impaction of obstruction
Ie docusate, bisacodyl, senna, glycerol
55
Prolonged use of stimulant laxatives may cause...?
Colonic atony
| or hypokalaemia
56
Which laxative type is best for use in constipation related to anal fissures? (Pre-surgery)
Stool softeners- le liquid paraffin (although not for long term use)
57
1st line for acute or opiate-related constipation?
Senna (stimulant laxative)
58
1st line for chronic constipation or elderly patients?
Ispaghula husk (bulk forming laxative)
59
Laxative used for faecal impaction?
Macrogol (osmotic laxative)
60
Palliative treatment for agitation near death?
Midazolam
61
What is the difference between hyoscine hydrobromide and hyoscine butylbromide?
Palliative:
Hyoscine hydrobromide- respiratory secretions
Hyoscine butylbromide- bowel colic (spasmodic pain)
62
Cancer patient has itch and jaundice after treatment, what Rx?
Colestyramine (1 hour after other drugs)
| Sequesters bile acids in gut
63
What opioid can be given in suppository form?
Oxycodone 30mg PR
64
Pain killers for neuropathic pain?
Pregabalin
Amitrypyline
Gabapentin
65
Examples of weak opioids
Codeine
Dihydrocodeine
Tramadol? (Possibly abit strong)
66
To convert an codeine dose to morphine what should you divide the dose by roughly?
10 x
67
What histological type of cancer is anal cancer predominantly?
Squamous cell
68
Apart from squamous cell, what other types of anal cancer can you get?
Squamous 85%
Melanoma
Adenocarcinoma
Basaloid
69
What features are associated with a good or bad prognosis in anal cancers?
Good:
About anal margins
Keratinizing
Bad:
Above dentate line
Non-keratonizing
70
How does the position of an anal cancer affect which lymph nodes it spreads to?
Above dentate line- pelvic lymph nodes (deep)
| Below dentate line- inguinal lymph nodes
71
What are the main histological types of breast cancers?
Ductal carcinoma (70%)
```
Lobular carcinoma (15%)
Medullary cancer- in young, not aggressive
```
72
Is oestrogen receptor +ve a good prognostic sign in breast cancer?
Yes, +ve in 70%
73
Which receptor expression is associated with a bad prognosis in breast cancer?
HER2 overexpression
| Growth factor receptor
74
What does the triple assessment for breast consist of?
Clinical examination
Histology/cytology
Mammography/ultrasound
75
What are the risks associated with lymph node clearance in surgical treatments of breast cancer?
Brachial plexopathy
| Lymphoedema
76
If a breast cancer is oestrogen receptor positive, what medication is often used for 5 years post-op?
Tamoxifen- competitive oestrogen receptor antagonist
77
For post-menopausal women with an oestrogen receptor positive breast cancer, what hormone therapy may help?
Aromatase inhibitor ANASTRAZOLE
Prevents oestrogen synthesis peripherally in extra-gonadal tissues
(Hence won't work when ovaries can make oestrogen instead of the adrenals)
78
What are the options for breast reconstruction following mastectomy?
Implants
Latissimus dorsi flap (back muscle)
Transverse rectus abdominus myocutaneous flap
79
Which monoclonal therapy is available for HER2+ breast cancers?
Trastuzumab
HER2- growth factor receptor
80
What scale predicts prognosis in breast cancer?
| What variables are required?
Nottingham Prognostic Index
| 0.2 x tumour size x histological grade x nodal status
81
What is a fibroadenoma?
On EHx?
Benign overgrowth of collagenous stromal and epithelial tissue occurring in the breast
EHx: firm smooth mobile painless lump
82
24 year old with a smooth firm lump in the breast, no pain. What IHx to do to rule out breast cancer?
Ultrasound scan
| ± fine needle aspiration
83
For cystic lumps in the breast what do you find on fine needle aspiration?
Clear fluid
| mass collapses as fluid is drained
84
Woman aged 52 notices green discharge of her breast with some nipple retraction. What could be the cause?
```
Breast cancer
Duct ectasia (blockage of the ducts, can be associated with green/bloody discharge ± lump)
```
85
How should you image women under 35 with suspected breast cancer?
Ultrasound, as breast tissue is denser in younger women making mammogram's less effective
86
What imaging is better for visualising posterior fossa masses in suspected brain tumours?
MRI
CT tends to get a bone artefact
87
For glioma's what can you place in the brain for localised chemotherapy?
Carmustine wafers
=Alkylating agent that crosslinks DNA
88
What is the hot new drug that can be used for glioblastoma?
What gene needs to be methylated (epigenetically inactive) for efficacy?
Temozolamide
Alkylating agent causes DNA damage
MGMT gene needs to be methylated (mediates DNA repair)
89
Obese woman has a headache, blurring of vision, signs of raised intracranial pressure + papilloedema. On imaging no mass can be found. What could be the cause?
```
Idiopathic intracranial hypertension
Secondary to:
venous sinus thrombosis
tertracycline
nitrofurantoin
other drugs
```
90
Rx for idiopathic intracranial hypertension
Weight loss
Acetazolamide- carbonic anhydrase inhibitor
Loop diuretics
Prednisolone
Surgical management if symptoms worsen or medications fail
91
Histological type of colorectal cancer predominantly?
Adenocarcinoma
92
Risk factors for colorectal cancer?
Ulcerative colitis + Crohns
FHx- FAP = HNPCC
Diet= low fibre and red meat
Alcohol
93
Which common medication seems to reduce incidence of colorectal cancer by inhibiting polyp growth?
Aspirin 75mg
94
How do symptoms suggest whether there is left or right sided colorectal cancer?
Left:
PR- bleeding/mucus or mass
Altered bowel habit/obstruction
Tenesmus
Right:
Weight loss
Anaemia
Abdo pain
95
What is the difference between Sigmoid Colectomy and an Anterior Resection surgery for colorectal cancer?
Sigmoid colectomy removes sigmoid colon only, anterior resection resects upper rectum and sigmoid colon
96
Chemo agents used as adjuvant chemotherapy for colorectal cancer?
FOLFOX:
Folinic acid
5-fluorouracil (pyramidine analogue)
Oxaliplatin (platinum + crosslinks DNA)
97
Which gene mutation in colorectal cancer suggests whether Cetuximab or Panitumumab (anti EGFR antibodies) will work?
KRAS and EGFR mutations tend to be mutually exclusive, so if a cancer has KRAS mutations they will be unlikely to have EGFR mutations and thus the Rx won't work
98
Who is applicable for the NHS Bowel Cancer Screening Programme?
60-76 year olds, every two years
| Send off faecal occult blood testing kit, sample 3 stools
99
When is a cancer patient considered neutropenic?
When neutrophils are 0.5 x10/L or below
100
What hygiene regime may be useful in a neutropenic patient?
| Skin, mouth, bum
Swab moist skin with chlorhexidine
Use hydrogen peroxide mouth washes every 2 hours
Candida prophylaxis (fluconazole)
Wash perineum after pooping
101
What parameters suggest neutropenic sepsis?
Temp above 38 degrees
| Or above 37.5 degrees on tests one hour apart
102
Example Rx for neutropenic sepsis?
And if Hickman line?
Piperacillin- tazobactam
If Hickman line looks infected, or suspect gram +ve organisms- Vancomycin
103
Neutropenic patient continues to have a fever despite antibiotic regimen, what else could be the cause?
CMV
Fungi- candida, aspergillus
Central line infection
104
What is hyperviscosity defined as and what are the risks?
WCC > 100 x10/L
| WBC thrombi may form in brain, lung or heart (leukostasis)
105
Need to transfuse a patient but they currently have WCC above 100 (putting them at risk of hyperviscosity) how can the WCC be lowered?
```
Leukopheresis
Hydroxycarbamide (used in sickle cell also, may be interferring with DNA repair?)
```
106
FBC and clotting features that can occur in Disseminated Intravascular Coagulation?
```
FBC: low platelets, low fibrinogen
APTT raised (intrinsic pathway, factor 12, 11, 9, 8)
PT raised (extrinsic, factor 7)
```
Blood film: broken RBCs, schistocytes
107
You give antibiotics to someone with neutropenic sepsis. Which blood measurement helps indicate if treatment is working?
Decline in CRP
108
Commonest cancer in childhood?
Acute lymphoblastic leukaemia
| T and B lymphocyte cell lines
109
Child keeps getting infections and is found to be anaemic, with lymphadenopathy around the cervical lymph nodes. What investigations needed to confirm diagnosis?
Blood film- blast cells with large nucleus
Bone marrow aspirate/biopsy
FBC- bone marrow failure so low platelets + RBCs, but high WCC
CXR/CT- mediastinal/abdo lymphadenopathy
Lumbar puncture- CNS involvement
110
Rx for acute lymphoblastic leukaemia
```
VPAD
Vincristine (microtubules)
prednisolone
L-asparinase (Deprives of asparagine amino acid)
daunorubicin (crosslinks)
```
111
Features of acute lymphoblastic leukaemia with a bad prognosis?
Adults (commonly occurs in children)
B-cell leukaemia (rather than T cell or precursor-B cell)
Philadelphia chromosome BCR-ABL gene from chromosome translocation 9 and 22
112
What is the philadelphia chromosome about?
Targeted treatment for it?
BCR-ABL fusion gene formed by reciprocal translocation of chromosomes 9 and 22.
Imatinib is the small molecular inhibitor for it
Associated with CML and rarely ALL (poor prognosis if so)
113
Which leukaemia type is DIC most associated with?
Acute myeloid leukaemia,
specifically acute promyelocytic leukaemia- where thromboplastin is released by the white cells to trigger coagulation activation
114
Acute myeloid leukaemia chemo Rx?
Daunorubicin- intercalates DNA
| Cytarabine- damages DNA
115
What structure in cells indicates on a blood film that you have AML rather than ALL?
Auer rods (crystals of coalesced granules of lysosomes and enzymes)
116
3 causes of enlarged spleen?
M's
Myelofibrosis (marrow fibrosis)
Chronic Myeloid leukaemia
Malaria
117
What are the three phases of chronic myeloid leukaemia?
Chronic- months to years, few symptoms
Accelerated- more symptoms, spleen, cell counts
Blast transformation- turns into acute leukaemia, death
118
What is the commonest leukaemia?
Chronic lymphocytic leukaemia
119
Which blood cancer is gum hypertrophy associated with?
Acute myeloid leukaemia AML
120
Which leukaemias are associated with lymphadenopathy?
ALL + CLL
| Also lymphomas
121
What complication of chronic lymphocytic leukaemia may lead to rising bilirubin?
```
Autoimmune haemolysis
IgM mediated (cold agglutination)
```
122
What is Richter's syndrome?
Transformation that occurs in 7% of chronic lymphocytic leukaemia, into an aggressive diffuse large B-cell lymphoma.
= Fever without infection
LDH increase
Enlarging lymph nodes
123
What marker can be used to track progression in chronic lymphoblastic leukaemia?
CD23 or beta2-microglobulin
124
What histological cell type found on blood film is characteristic of hodgkins lymphoma?
Reed-Steinburg cell with mirror-image nuclei
125
What side effects do you get from hormone therapy in treatment of prostate cancer?
Like a male menopause
Loss of libido, sexual dysfunction, hot flushes, mood swings
OSTEOPOROSIS
126
TTF1 +ve immunohistochemistry on a cancer biopsy if metastatic suggests which organ origin of the tumour?
Lung cancer
127
How can you remember which primaries metastasize to the lungs?
Paired organs- thyroid, breast, kidneys, testes, colon/gi cancers
128
What cancers put a patient at risk of tumour lysis syndrome during treatment?
IHx if suspected?
Acute leukaemia
Non-Hodgkins lymphoma
U+E, calcium, uric acid, ECG
129
Which schizophrenia medication improves negative symptoms?
Clozapine- like apathy and paucity of speech
130
Most important risk factor in bladder cancer?
Smoking
131
Abdominal mass in a 2 year old, which different cancers could be the cause?
```
Wilm's tumour (nephroblastoma)
Neuroblastoma (found by adrenals or head + neck)
Rhabdomyosarcoma
Lymphoma
Ovarian tumours
```
132
What cell type do neuroblastomas (childhood cancer) originate from?
Neural crest cells that form the adrenal medulla and sympathetic ganglions
133
Nephroblastoma is due to a mutation in what type of gene?
Tumour suppressor WT1 found on chromosome 11
134
How is neuroblastoma graded?
Mitotic rate (low or high)
N-myc mutations = aggressive
135
What mechanism gives rise to a tumour that does not have gradings or different levels of differentiation and mutation but simply has a mutation giving rise to a tumour or not?
Tumour-specific translocation
Activator translocated next to an oncogene, acts as an on-off switch
(Examples are sarcoma or PNET)
136
Commonest neonatal tumour?
Teratoma
| Can lead to haemorrhage during delivery or ano-rectal malformations
137
Patients with ALK +ve non-small cell lung cancer may want to consider which recently approved therapy?
Crizotinib
In NSCLC for patients who do not have an aberrant EGFR form, crizotinib targets the EML4-ALK fusion protein that acts as an oncogene
138
Which cancer therapies target angiogenesis?
Antibodies: bevacizumab
Small molecules: sunitinib, axitinib
(Also thalidomide, integrin inhibitors)
139
In the unit dose of radiotherapy, 1 gray = ?
1 Joules/kg
140
Someone with xeroderma pigmentosa or ataxic telangiectasia can't have what kind of cancer therapy?
Radiotherapy as they have a defect in their DNA repair mechanisms so could not counter the damage in normal cells
141
When switching from immediate release morphine to sustained release, when should the first sustained-release dose be taken?
At the same time as the immediate dose was due (can take both together if in pain)
Continue to give breakthrough doses if needed
142
Morphine stimulates nausea via which pathway?
Chemoreceptor trigger zone (D2 + 5-HT3)
| High Ca and uraemia also stimulate this area
143
Which types of cancer therapies do renal cell carcinoma tend to be resistant to?
Radiotherapy + chemotherapy
So use surgery and immunotherapy (IL-2, tyr kinase inhibitors for VEGF)
NB not true for Wilms which is Rx-ed with chemo
144
What is the difference between the staging of Wilms and other cancers of the kidney/bladder/prostate?
T3- normally means outside the prostate capsule/bladder wall/into fascia surrounding kidney
But in Wilms extrarenal disease is T2
145
What is the difference between phimosis and paraphimosis?
Phimosis is constriction of the opening in the foreskin, so it can't be retracted over the glans.
Paraphimosis is when a tight foreskin is retracted and can't be replaced so venous return is occluded and the glans becomes oedematous or even ischaemic
146
Migratory thrombophlebitis (Trousseau's sign) occurs in which two cancers?
Lung + Pancreatic
147
What does B3 deficiency cause?
3 things that are not nice (niacin = B3)
Dementia
Diarrhoea
Dermatitis
148
What does B1 deficiency cause?
Beriberi (or ber1ber1)
Is this thigh mine? (Thiamine) = polyneuropathy
```
Heart failure (Wet)
Wernicke Korsakoff (Dry0
```
149
In spinal cord compression, what types of cancer metastasizing in the spine to cause it are associated with a bad prognosis?
Lung or melanoma
150
Drugs that can be given to someone with bowel obstruction secondary to cancer?
Steroids- reduce bowel wall oedema
Antiemetics SC
Motility agents if subacute- metoclopramide
Octreotide- antisecretory
151
IHx for cancer of unknown primary?
CT abdo, pelvis, head
Consider PET to look for primary and mets, help decide how radical to go with surgery or when to go palliative
No endoscopy + colonoscopy unless suggests GI origin
No mammogram unless breast is likely
No tumour marker testing
152
What are the different stages of performance status?
```
0- fully active
1- can carry out light work
2- up and above 50% of waking hours
3- confined to bed/chair 50% of time
4- completely confined to bed or chair
```
153
Which are the different ectopic hormones that different types of lung cancer can produce?
Small cell- ACTH (cushings) + ADH (SIADH)
Squamous- PTH (high Ca)
