Oncology

Question 1

What are the indications for testing for BRCA1 and 2?

Answer 1

Tumour supressor genes

1st degree relative under 40 years OR male OR bilateral
More than one 1st degree relative OR two 2nd degree

Question 2

What are the screening rules for known BRCA mutations?

Answer 2

Annual MRI 30-49 years

Annual mammogram 50-69 years

Question 3

What is the risk of breast and ovarian cancer with BRCA mutations?

Answer 3

BRCA1 - 60% and 40%

BRCA2 - 45% and 10%

Question 4

What are the criteria for testing for hereditary bowel cancer?

Answer 4

Two first degree relative under 60 years

Question 5

What are the red flags for lung cancer?

Answer 5

Over 40 years and haemoptysis, suggestive CXR

Urgent CXR:
Over 40 and recurrent chest infections OR finger clubbing OR 2 of: SOB, cough, fatigue, weight loss, smoker

Question 6

What are the red flags for upper GI cancer?

Answer 6

Over 40 + jaundice or abdo mass
Over 55 + weight loss + abdo pain or reflux
Dysphagia
Over 60 + weight loss + one of: diarrhoea, abdo pain, constipation, new onset diabetes

Question 7

What are the red flags for lower GI cancer?

Answer 7

Positive faecal occult blood
Over 40 + abdo pain + weight loss
Over 50 + rectal bleeding
Over 60 + IDA or change in bowel habit

Question 8

What are the red flags for gynaelogocial cancer?

Answer 8

Ascites
Pelvic mass (fibroids excluded)
Post-menopausal bleeding

Question 9

What are the red flags for breast cancer?

Answer 9

Over 30 + breast lump

Over 50 + symptoms or nipple change

Question 10

What are the red flags for urological cancer?

Answer 10

Irregular prostate
Abnormal age specific PSA
Over 40 + visible haematuria
Over 60 + non-visible haematuria + dysuria

Question 11

What are the criteria for neutropenic sepsis?

Answer 11

Temperature over 38, neutrophils less than 0.5/10x9/L

Question 12

Which cancers metastasise to bone?

Answer 12

Lung, prostate, breast, myeloma, melanoma

Question 13

What are the red flags for spinal cord compression?

Answer 13

Cancer history, thoracic back pain, nocturnal pain, sensory loss, bowel/bladder dysfunction

Question 14

What is the treatment for spinal cord compression?

Answer 14

Admit for bed rest and urgent MRI
Dexamethasone 16mg + PPI
Decompressive surgery/radiotherapy

Question 15

What are the signs of SVC obstruction?

Answer 15

SOB, orthopnoea, stridor
Plethora or cyanosis
Oedema of face and arm
Engorged neck and chest veins

Question 16

How is SVC obstruction treated?

Answer 16

Prop up, assess for hypoxia, O2 if needed
16mg dexamethasone
CT
Balloon venoplasty and stenting

Question 17

What is the treatment of hypercalcaemia?

Answer 17

Aggressive rehydration

Bisphosphonates e.g. zolendronic acid

Question 18

When does tumour lysis occur?

Answer 18

During chemotherapy for rapidly proliferating tumours

Leukaemia, lymphoma, myeloma

Question 19

What are the affects of tumour lysis syndrome?

Answer 19

Cell death
High urate, hyperkalaemia, hyperphosphataemia, hypocalcaemia
Risk of arrhythmias and renal failure

Question 20

What is AFP a marker for?

Answer 20

Germ cell/testicular cancer

Hepatocellular carcinoma

Question 21

What is calcitonin a marker for?

Answer 21

Medullary thyroid tumours

Question 22

What is Ca125 a marker for?

Answer 22

Ovarian cancer

Question 23

What is Ca19-9 a marker for?

Answer 23

Pancreatic cancer

Question 24

What is Ca15-3 a marker for?

Answer 24

Breast cancer

Question 25

What is CEA a marker for?

Answer 25

Colorectal cancer

Question 26

What are paraproteins a marker for?

Answer 26

Myeloma

Question 27

What cancer screening pathways are available?

Answer 27

Mammography - every 3 years, age 50-75 Cervical smear - every 3 years, age 25-64 Faecal occult blood - every 2 years, age 60-74

Question 28

How should opioids for palliative care be started?

Answer 28

5mg every 4 hours + 5mg PRN Increase by 30-50% every 24 hours till pain controlled Divide daily dose into 2x12hr modified releases Allow 1/10th-16th as PRN

Question 29

What are the signs of opioid toxicity?

Answer 29

Sedation, respiratory depression, hallucination, jerks, delirium

Question 30

Which anti-emetic is contraindicated in PD?

Answer 30

Metoclopramide

Question 31

How should breathlessness in be treated in palliative care?

Answer 31

Check for underlying effusion, infection, anaemia, VTE If distressed give opioids If anxiety related give benzodiazepines

Question 32

Which drugs can be used for end of life care?

Answer 32

``` Haloperidol for agitation Midazolam for agitation and anxiety Levomepromazine for nausea Glycopyronium for respiratory secretions Morphine for pain ```