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Year 4 CCC > Oncology > Flashcards

Oncology Flashcards

(85 cards)

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1
Q

Give 5 examples of inherited conditions that can cause cancer?

A
  1. neurofibromatosis (6+ cafe au lait spots)
  2. adenomatous polyposis coli
  3. Von Hippel Lindau syndrome
  4. Li Fraumeni syndrome (mutation in p53)
  5. BRCA 1 and 2
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2
Q

How can chemicals cause cancer?

A

damage cellular DNA and produce mutations in oncogenes and tumour suppressor genes

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3
Q

which type of cancer can vinyl chloride cause?

A

angiosarcomas

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4
Q

which type of cancer does benzene cause?

A

leukaemia

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5
Q

Which type of cancer do aromatic amines cause?

A

bladder

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6
Q

which type of cancer does wood dust cause?

A

nasal adenocarcinoma

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7
Q

How does radiation cause cancer?

A

increases DNA damage leading to the accumulation of mutations in tumour suppressor and oncogenes

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8
Q

How does HPV cause cancer?

A

produces E6 which inctivates p53

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9
Q

which types of cancer does HPV cause?

A
  • cervical
  • anal
  • oropharyngeal
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10
Q

Which two strains of HPV are the cancerous ones?

A
  • 16 and 18
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11
Q

which type of cancer can EBV cause?

A

non-hodgkins lymphoma

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12
Q

Which type of cancer is hCG (as a tumour marker) raised in?

A

Testicular

non-seminomatous testicular cancer
seminoma

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13
Q

Which benign conditions can lead to a raise in PSA?

A
  • BPH
  • rectal exam
  • prostatitis
  • UTI
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14
Q

what is the common clinical use of carcinoemryonic antigen (CEA) tumour marker?

i.e. which cancer?

A

colorectal cancer

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15
Q

Which conditions is CA125 raised in?

A
  • ovarian cancer
  • pregnancy
  • pancreatic ca
  • lung cancer
  • colorectal cancer
  • breast cancer
  • endometriosis
  • PID
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16
Q

which cancer is AFP raised in?

A

Hepatocellular carcinoma

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17
Q

For staging cancer which 2 areas do you use CT for and which 4 areas do you use MRI for?

A

CT:

  • chest
  • abdomen

MRI

  • bone
  • soft tissue
  • pelvis
  • posterior cranial fossa
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18
Q

Using imaging- what is the definition of a partial response to treatment?

A

all lesions shrunk by >= 30%

disease is still present

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19
Q

Using imaging- what is the definition of stable disease?

A

<20% increase in size OR

<30% decrease in size

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20
Q

Using imaging- what is the definition of progressive disease?

A

new lesions

lesions increased in size by >20%

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21
Q

what is CT/ what images does it take?

A
  • rotating x-ray tube

- axial cross-sectional images

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22
Q

What is the principle concern with CT?

A

the dose of radiation

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23
Q

MRI is the golf standard for which 4 types of tumours (locations)?

A
  • neurospinal tumours
  • rectal tumours
  • prostate tumours
  • MSK tumours
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24
Q

What is the principle concern with MRI?

A
  • magnetic field

- therefore check pacemakers, metal in body, equipment in the area

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25
What is ultrasound/ how does it work?
high frequency sound waves
26
give 4 uses of ultrasound in cancer care?
1. detecting mets in solid visceral abdo organs 2. doppler--> assess tumour blood flow 3. soft tissue 4. guidance of biopsies and procedures
27
What is the principle behind bone scintography and what is it most commonly used for?
- radioisotope labelled drugs given IV | - main investigation for skeletal mets
28
What type of images do PET scans produce and what tracer is commonly used?
- produces functional images - tracer used in FDG-18 ( fluorine 18 deoxyglucose) - PET has potential to differentiate between malignant and benign pathologies - PET usually combined with CT to map functional images to detailed anatomy
29
4 advantages to screening programmes?
1. reduction of mortality 2. less radical treatment ( decreases morbidity) 3. saving health resources by increased cure rates 4. reassurance given by a negative test
30
6 disadvantages to screening programmes?
1. increased anxiety if no effective intervention possible 2. over investigation of false positive cases 3. over treatment of borderline cases 4. false reassurance from a false negative 5. possible harmful side effects of the screening test 6. cost of screening a large population
31
for which 3 cancers are there screening programmes in place?
1. cervical 2. breast 3. colorectal
32
What is the current cervical cancer screening programme?
- cervical smears for all women between 25-64 - every 3 years for women 25-49 - every 5 years for women 50-64
33
What is the current breast cancer screening programme?
- mammogram every 3 years for women aged 50-70 | - screen younger patients if high risk e.g. FHx
34
What is the current colorectal cancer screening programme?
- foecal occult blood (FOB) every 2 years 60-69 - 69-74 can request screening kit - high risk patients reviewed regularly e.g. UC
35
is there a screening programme for prostate cancer?
- no | - but informed choice programme with PSA
36
4 different types of biopsy that can be done to diagnose cancer?
1. fine needle aspiration cytology 2. tru-cut needle biopsy (under local) 3. incisional biopsy 4. excisional biopsy
37
what is cytoreductive surgery?
reducing the bulk of the disease
38
What is radiation? when is it used?
- use of ionising radiation in the management of cancer - has curative potential in the absence of mets - can be used in a neo-adjuvant, adjuvant or palliative setting
39
how is radiotherapy delivered most commonly in UK?
- external beam radiotherapy - using photons/ x-rays - 3D conformal radiotherapy ( individual tumour mapping to target the tumour)
40
What are the units of radiotherapy?
- gray units (Gy) | - given in small fractions rather than a large single dose
41
What is the mechanism of action of radiotherapy? (4 steps)
1. high energy short wavelength X-rays by a linear accelerator 2. X-rays penetrate deep into body tissue (sparing overlying skin) 3. X-rays produce secondary electrons and free radicals (cause DNA damage) 4. cancer cells defective at repair--> mitotic or apoptotic cell death
42
What 3 things does the success vs toxicity of radiotherapy depend on?
1. treatment issues ( total dose, total volume, overall treatment time) 2. co-morbidities (diabetes, IBD, smoking) 3. radio-sensitivity of the cancer
43
What three measurements are taken during a planning CT for tumour mapping before radiotherapy?
1. Gross tumour volume (GTV) 2. Clinical target volume (CTV) 3. Planning target volume (PTV)
44
What is the gross tumour volume?
- The tumour is delineated on each CT slice it appears on | - so the tumour on each CT slice
45
What is clinical target volume?
- added margins to allow for microscopic disease spread
46
What is the planning target volume?
- a further margin is added to allow for daily variations in patient and tumour position
47
Is radiotherapy safe in pregnancy?
NO | it is teratogenic
48
When do the acute side effects of radiotherapy usually develop?
- during treatment | - usually after the first 5-10 fractions
49
Why do you get the acute side effects of radiotherapy?
- due to damage of normal tissue and the ability of normal cells to repair damage - therefore usually completely resolve once treatment has finished
50
3 examples of acute side effects of radiotherapy?
1. localised skin reaction 2. oral mucositis 3. diarrhoea
51
When do the late side effects of radiotherapy usually develop and are they reversible?
- usually develop at least 3 months after radiotherapy (can be longer) - often irreversible and may get worse over time
52
Why do the late side effects of radiotherapy occur?
- some of the damage to normal cells cannot be repaired | - partly due to development of fibrosis and blood vessel damage within the irradiated tissue
53
what are 4 examples of late side effects of radiotherapy?
1. lung fibrosis 2. skin atrophy 3. infertility 4. risk of second malignany - radiotherapy itself is carcinogenic - risk is significantly greater in younger patients
54
What is brachytherapy?
- radiation sources placed within or close to tumour - localised high dose (intercavity or interstitial) - prostate, gynae, oesophageal, head and neck - patient is radioactive (risk to others)
55
What is chemotherapy?
- systemic treatment of cancer using cytotoxic agents
56
What is the MOA of chemotherapy?
- most target DNA indirectly or directly - agents are preferentially toxic towards actively proliferating cells - thus rapidly dividing tumours respond best
57
7 indications/ settings of chemotherapy?
1. radical- curative intent 2. primary- alone for cure 3. neo-adjuvant 4. adjuvant 5. chemoradiation 6. palliative 7. high dose- with bone marrow transplant for stem cell support
58
What does the term 'cycle' mean in chemotherapy?
e.g. docetaxel IV day 1 every 21 days
59
What does the term 'course' mean in chemotherapy?
the planned number of cycles
60
How do you calculate the dose for chemotherapy?
- using body surface area most commonly - DuBois formula - also according to renal function
61
immediate side effects of chemotherapy?
- nausea and vomiting - myelosuppression - diarrhoea and constipation - alopecia - ototoxicity - neuropathy - nephrotoxicity - arrhythmia - transient rise in LFTs - skin changes (pigmentation) - lethargy - myalgia
62
long term complications of chemotherapy?
- second malignancies - reduced fertility - pulmonary fibrosis - cardiac fibrosis
63
What is the definition of neutropenic sepsis?
- absolute neutrophil count of <1 x10 9 /L AND - single temperature over 38.5 OR - sustained temperature over 38 OR - clinical signs
64
How many days post chemo is neutropenic sepsis more common?
7-14 days post chemo
65
Which examinations should you avoid in a person with suspected neutropenic sepsis?
- rectal | - vaginal
66
Investigations for a person with suspected neutropenic sepsis?
- BUFALO - FBC, U and Es, LFTs - paired blood cultures (x2 anaerobes and aerobes, culture all lines or if no lines --> 2 peripheral cultures) - swabs - sputum culture - urinalysis and MSU - stool analysis and culture - CXR if respiratory signs (? atypical pneumonia serology)
67
Which type of organism is more likely to cause neutropenic sepsis (70%)?
Gram positive
68
Give three examples of gram positive organisms that may cause neutropenic sepsis?
- staph aureus - coagulase negative staph - alpha and beta haemolytic strep
69
What is the management of neutropenic sepsis?
Broad spec antibiotics (trust guidelines) within 1 hr - e.g. tazocin (tazobactam and piperacillin) - continue until afebrile for 72 hours OR - 5 days course and neutrophils >0.5 x 10 9
70
What is the MASCC score?
a scoring system for identifying low-risk (of complications) cancer patients with febrile neutropenia
71
Which 5 cancers are more commonly associated with metastatic cord compression?
- prostate - breast - lung - myeloma - lymphoma
72
Which region of the spinal cord does metastatic cord compression most commonly affect?
2/3 in the thoracic spine
73
Presentation of MSCC?
- back pain (alone in 90%) - leg weakness - sensory loss - bowel/bladder dysfunction (incontinence or retention) - saddle anaesthesia - loss of anal tone
74
Management of metastatic spinal cord compression?
- lie flat - 16mg dexamethasone (PPI cover) - urgent MRI full spine within 24hrs - contact local spinal cord co-ordinator - consider neurological intervention - ? radiotherapy
75
3 broad causes of superior vena cava obstruction?
1. extrinsic compression 2. thrombosis 3. invasion
76
What is the most common cause of SVCO and by which two types of cancer?
- extensive lymphadenopathy in upper mediastinum | - lung and lymphoma
77
5 benign causes of SVCO?
- goitre - mediastinal fibrosis - infection (TB) - aortic aneurysm - thrombus
78
Presentation of SVCO?
- breathlessness - headache - worse on coughing, "fullness" - facial/ neck/ arm swelling - distended neck and chest veins - cyanosis - visual disturbance
79
Investigations for SVCO?
- CXR - contrast CT - consider: tumour markers, bronchoscopy, OGD (if oesophageal cancer suspected, biopsy)
80
Management of SVCO?
- 16mg dexamethasone (PPI cover) | - depending on the cause (stenting under radiological guidance, radiotherapy, chemotherapy, LMWH if thrombosis)
81
why do you get hypercalcaemia in cancer?
- cancer of bones or bone mets | - due to an imbalance between bone resorption and calcium excretion
82
What is the most common cause of hypercalcaemia (before cancer)?
primary hyperparathyroidism
83
Cancers that cause hypercalcaemia?
- NSCLC - breast - prostate - renal cell carcinoma - myeloma/ lymphoma
84
Key investigation for hypercalcaemia?
- serum calcium | - CORRECTED FOR SERUM ALBUMIN
85
Presentation of hypercalcaemia?
General - dehydration - weakness - fatigue - bone pain CNS - confusion - seizures - proximal neuropathy - hyporeflexia - coma GI - weight loss - N and V - abdo pain - constipation - ileus - dyspepsia

Year 4 CCC (1 decks)

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