Oncology

Question 1

Adjuvant therapy

Answer 1

Given after definitive treatment

Question 2

Neo-adjuvant

Answer 2

given before the main treatment to shrink the cancer

Question 3

Concurrent

Answer 3

Two or more cancer therapies given simultaneously

Question 4

Time limit by which radiotherapy should be started.

Answer 4

10 days

few days if palliative

Question 5

Early side effects of radiotherapy

Answer 5

Fatigue 
pain 
oesophagitis 
pneumonitis 
skin reaction 
diarrhoea 
nausea 
cystitis 
raised ICP 
hair loss

Question 6

Late SE of radiotherapy

Answer 6

Fibrosis 
Stricture 
Osteonecrosis 
Fib fracture 
Secondary malignancy

Question 7

When might emergency radiotherapy be used?

Answer 7

Spinal cord compression

Question 8

What is radiosensitive chemo

Answer 8

Low dose given to increase the efficacy of radical radiotherapy

Question 9

Chemo administered every ….

Answer 9

2-4 weeks to allow for blood count recovery

Question 10

When is blood count lowest in chemo

Answer 10

2 weeks in

Question 11

How many cycles usually

Answer 11

6 cycles - 5 m

Question 12

2 conditions caused by chemo in bone marrow

Answer 12

Neutropenia

Thrombocytopenia

Question 13

Skin changes with chemo - 2

Answer 13

hand and foot syndrome

rash

Question 14

GI conditions caused by chemo - 3

Answer 14

Mucositis
N&V
Diarrhoea

Question 15

Chemo and heart - 2

Answer 15

Heart failure

Angina / MI

Question 16

Lungs and chemo

Answer 16

pulmonary fibrosis

Question 17

Kidneys and chemo

Answer 17

Renal impairment

Question 18

Nerves and chemo

Answer 18

Peripheral neuropathy

Hearing loss

Question 19

triad of neutropenic sepsis

Answer 19

neutropenia, anaemia and thrombocytopenia

Question 20

in which cancers is neutropenic sepsis more common

Answer 20

lymphoma / leukaemia

Question 21

neutropenia definition =

Answer 21

neutrophil count <1.0

Question 22

sepsis 6

Answer 22

ABG - lactate 
IV Abx - Tax / Gent, Mero + Vanc 
Blood cultures 
Urine output 
IVF 
Oxygen 

Consider inotropic support early

Question 23

How would hypersensitivity reaction to chemo present

Answer 23

Fever 
Hypotension 
Tachy
Low SpO2 
Wheese 
oro-pharnygeal oedema

Question 24

Manage hypersensitivity reaction to chemo

Answer 24

Stop infusion  
O2 
IV fluid stat 
Anti-histamine - 10mg chlorephinramine 
IV steroid - hyrocortisone 200mg 
Adrenaline 0.5ml of 1:1000 IM

Question 25

Risk factors for tumour lysis syndrome - 4

Answer 25

Treatment of bulky chemosensitive tumours Any use of anti-cancer therapy Pre-exisiting renal impairement Malignant biochem abnormalities

Question 26

TLS diagnosis (5)

Answer 26

``` Hyperuricaemia Hyperkalaemia Hyperphospataemia Hypocalcaemia Renal failure ```

Question 27

Drug used to prevent TLS

Answer 27

Allopurinol

Question 28

Scale used to measure fitness in oncology

Answer 28

ECOG 0 = fully active 5 = deceased

Question 29

When to refer using suspected lung cancer pathway referral (2)

Answer 29

CXR findings suggest lung cancer | Aged 40+ and have unexplained haemoptysis

Question 30

Urgent (2 weeks) CXR in 40+ if...

Answer 30

2+ unexplained symptoms / smoke +1 US - cough - fatigue - SOB - Chest pain - Weight loss - Appetite loss

Question 31

Fitness investigations for possible treatments 1) Surgery 2) Chemo 3) Radio

Answer 31

1) lung and cardiac 2) renal and liver 3) ability to lie flat and pacemaker

Question 32

staging of lung cancer

Answer 32

thorax and abdomen VT with contrast Then bronchoscopy and biopsy

Question 33

Important social Hx in context of lung cancer

Answer 33

Smoking Alcohol Occupation FH

Question 34

How quickly is an MR needed if - MSCC suspected - bony mets suspected but no compression

Answer 34

24hrs | 1 weeks

Question 35

Treatment of SCC

Answer 35

``` Nursed flat High dose dex (16mg orally BD) + PPI Opioid analgesia Catheter Neurosurgical discussion Radiotherapy considered ```

Question 36

Investigations pre surgery for SCC

Answer 36

CXR | CT thorax and abdo

Question 37

Treatment for acute hypercalcaemia

Answer 37

rehydration (3-4L per day) + Zolendronic acid

Question 38

Tamoxifen mech of action

Answer 38

selective oestrogen receptor modulator

Question 39

Aromatase inhibitors mechanism of action and what can they cause as a SE

Answer 39

prevent androgen - oestrogen conversion Osteoporosis

Question 40

4 causes of hypercalcaemia in oncology patients

Answer 40

paraneoplastic syndrome osteolytic tumours tumours producing vit D metastatic bone disease

Question 41

Presentation of hypercalacaemia

Answer 41

``` confusion hypertension bone pain renal stones abdo pain N&V polyuria psychiatric overtones ```

Question 42

The information given to people with suspected cancer and their families and/or carers should cover, among other issues:

Answer 42

1) Where the person is being referred to. 2) How long they will have to wait for the appointment. 3) How to obtain further information about the type of cancer suspected or help before the specialist appointment. 4) What to expect from the service the person will be attending. 5) What type of tests may be carried out, and what will happen during diagnostic procedures. 6) How long it will take to get a diagnosis or test results. 7) Whether they can take someone with them to the appointment. 8) Who to contact if they do not receive confirmation of an appointment. 9) Other sources of support.