Oncology Flashcards by Rivka Lebrett

Welcome to oncology

“Big pharma has the cure for cancer”

How well did you know this?

Not at all

Perfectly

How does radiotherapy treat cancer?

Breaks the double stranded DNA leading to cell death in all cells. Normall cells recover faster than cancerous cells.

How well did you know this?

Not at all

Perfectly

What is a fraction when referring to radiotherapy?

A dose of radiothearpy

How well did you know this?

Not at all

Perfectly

What the difference between palliative and radical radiotherapy?

Radical aims for cure and takes longer to plan.

Palliative aims to control symptoms and is quicker to plan (next day)

How well did you know this?

Not at all

Perfectly

How can radiotherapy cause side effects?

Inflammation - acute

Fibrosis and scaring - chronic

How well did you know this?

Not at all

Perfectly

What side effects of radiothearpy can be atributed to inflammation?

Fratigue

Pain flare from bones

Site dependent inflamation

D&V

raised ICP

skin irritation

How well did you know this?

Not at all

Perfectly

What side effects of radiothearpy can be atributed to fibrosis?

Stricutres

Oesteonecrosis

Rib fractures

2nd malignancies

How well did you know this?

Not at all

Perfectly

What is the main type of chemo thearpy?

Cytotoxic chemotherapy

How well did you know this?

Not at all

Perfectly

What is the aim of adjuvant chemotherapy?

Stop relapse (via micro metastesis) after curative treatment

How well did you know this?

Not at all

Perfectly

What is Neo-adjuvant therapy?

Treatment of tumour in order to reduce size or “buy time” for curative treatment

How well did you know this?

Not at all

Perfectly

How can chemotharpy attenuate radiotherapy?

Chemothaerpy agenst like gemcitabine can increase radiotherapy effectiveness

How well did you know this?

Not at all

Perfectly

What would chemotherapy side effects would be dose limiting (e.g: pause or reduce chemotherapy dose)?

Neutropenia

Thrombocytopenia

mucositis (GI tract)

D&V

alopecia

Peripheral neuropathy

How well did you know this?

Not at all

Perfectly

What oncological emergencies are there?

Neutropenic sepsis

Tumour lysis syndrome

Spinal chord compression
Hypersensitivity

Superior vena cava obstruction

Malignancy associated hypercalcaemia

Brain mets

How well did you know this?

Not at all

Perfectly

What is brachytherapy?

High dose radioactive source placed locally to the tumour. Often used uterus prostate

How well did you know this?

Not at all

Perfectly

What is stereotactic radiotheraoy?

Highly acurate conventional external beam radiotherpy (ERBT) to target small tumours with precision (e.g: Gamma knife). Treatment of intacranial tumours

How well did you know this?

Not at all

Perfectly

What is defined as neutropenic sepsis?

Temp > 38ºC

Neut count <0.5x10^9/L

How well did you know this?

Not at all

Perfectly

What is the treatment neutropenic sepsis?

Sepsis within 1 hour

How well did you know this?

Not at all

Perfectly

What is the Sepsis 6?

3 in:

IV fliuds

IV antibiotics

O2 (if < 94%)

3 out:

ABG for lactate

Cultures

Urine output

How well did you know this?

Not at all

Perfectly

What is hypersensitivity

Anaphlyaxis after 2 or mre doses

Treat by stopping the offending drug then:

fliuds

Immunosupression -steroids and anti-histamines

How well did you know this?

Not at all

Perfectly

What is tumour lysis syndrome?

Hyperureaemia

hyperkalaeima

hyperphsophateamia

potentially occompanying renal failure

How well did you know this?

Not at all

Perfectly

What is the pathophysiology of tumour lysis syndrome?

Rapid tumour cell destruction releasing itracellular contents. Often lymphoma, leukaemias or germ cell cancers

Phosphate and uric crystals form in kidneys leading to renal failure

How well did you know this?

Not at all

Perfectly

How is Tumour lysis syndrome treated?

Prevention is better:

Allupurinol or Rusburicase

fluids

monitoring and ID at risk pt.

How well did you know this?

Not at all

Perfectly

What is superior vena cava (SVC) syndrome?

Reduced venus return from head and neck due to tumour compression partially occluding the SVC

How well did you know this?

Not at all

Perfectly

How is SVC syndrome treated?

Avoid hypoxia

Dexamethasone

Organise - SVC stenting or radiotherapy

How well did you know this?

Not at all

Perfectly

What are the symptoms of spinal chord compression?

Pain which radiates from back to front - nocturnal worse on straining UMN signs - neuro defecit, sesory loss, ataxia Bladder or bowel symptoms

How is spinal chord compression treated?

Dexamethasone - PPI MRI spine Radiolotherapy within 24 hours

What is ECOG?

A performance score form 0 to 5

What is ECOG score 3?

\> 50% of day in bed or chair

What is ECOG 2?

\< 50% of day in chair or bed

What cancer can HPV cause?

Cervical Head and neck

What is Li-Fraumeni syndrome?

TP53 mutation leading to muiltiple early cancers

What is would be shown in the blood test for malignancy associated hypercalcaemia?

Raised calcium (inc. corrected), ALT and urea

How is oncologically related hypercalcaemia treated?

Dilution and dieresus via IV fluids Zolendronic acid

What is Zolendronic acid?

SC biphosphate quicker acting than alendronic acid

How can skeletal related events be avoided?

Denusumab

What is the mechanism of action of Denosumab?

A monoclonal antibody for RANKL. This leads to the inhibition of osteoclast activity SE - hypocalcaemia and osteonecrosis of the jaw?

What drugs can cause osteonecrosis of the jaw?

Denosumab Zenodronic acid

What are Breslow and clark scales?

Staging systems to describe how deap melonama is from the epidermis

What conditions may be exacerbated by immunothearpy?

Autoimmune conditions

What is Gardasil?

HPV vaccine

Who is eligable for a HPV vaccine?

12-13 year old females

Who is screened for cervical cancer?

Ages 25-49 every 3 years every 5 years until 64 years old

Where in the lungs is small cell lung cancer located?

Centrally

Where in the lungs is squamous cell lung cancer located?

centrally

Where in the lungs is adenocarcinoma located?

Peripherally

Which lung cancer is most common in non smokers?

adenocarcinoma

Which type of lung cancer grows slowly?

adenocarcinoma

Which type of lung cancer tends to metastesis early?

Adenocarcioma

Which lung cancer has the best survival?

Squamous cell carcinoma as it is potentially operable

Which type of lung cancer are tyrosine kinase inhibitors used for?

adencarcinoma

Cancer patient present with new onset confusion, what investigation should be used?

MRI - brain mets Blood test - Ca2+

What medication should be given for brain mets?

8mg dexamethasone BD PO

What Symptoms are there for SVC obstruction?

dilated veins on upper chest red eyes SOB worse when lying down Arm swelling

A patient with lung cancer has a hoarse voice, what does this indicate?

Laryngeal nerve involvement and therefore mediastinal involvement by the lung cancer

What type of biopsy is used for hodgkins lymphoma?

Excisional biopsy

What is good clinical practise in relation to clinical trials?

nternationally-recognised ethical and scientific quality requirements that must be followed when designing, conducting, recording and reporting clinical trials that involve people.

What type of hodgkins lymphoma can have a asymptomatic relapse?

Nodular lymphoid predominant

Doxorubicin is a cytotoxic chemotherapy agent used in hodgkins lymphoma. What is its common side effect?

cardiotaxic

What is the fitzpatrick scale?

A scale from 1 to 5 which classifies responce to UV

What side effects does cisplatin have?

Bone marrow supression Peripheral neuropathy Hearing impairment Renal impairment Not hair loss

How is chemotherapy usually dosed?

By body area due to GFR

What genetic mutation is tested for in melanoma?

BRAF v600

What is the treatment for BRAF v600 positive melanoma?

Combination of BRAF and MEK inhibitor immunotherapy

What do MEK and BRAF have in common?

They are both part of the same signalling pathway. Also both immunotherapies can used with no increase in toxicities to stop metastesis of the melanoma.

What biochemical indicators are there for testical cancer?

Teratomas can secret HCG and AFP Human chorionic gonadotropin Alpha fetal protien

top three cancers in men

1. prostate2. lung3. colorectal

top three cancers in women

breastlungcolorectal

common sites for mets

lung, bone, brain, liver

Most common type of paraneoplastic syndrome in lung cancer

SCC- hypercalcaemia due to PTrH, HPOA

things need to know before performing CT with contrast

previosu contrast reactionrenal functiondiabetes- metformin might need to be stopped

small cell cancers lung

smoking relatedrapid growthnot curable

sqamous cell carcinomas lung

smoking relatedusually operable

adenocarcinoma- lung

mets earlynon smokerperipheral location

Ct scan reveals brain mets- immediate treatment

dexamethasone

signs of superior vena cava obstruction

ref suffsed eyesSOB on lying downdilated veins in upper chestswelling of arm

treatment for metastatic spinal cord compression

high dose dexamethasoneneurosurgical stabilisation, opioid analgesiamaybe radiotherapy

Red flags in back pain

pain in thoracic spinepain at rest and on movementweight losship weaknessurinary retention

Treat hypercalcaemia

bisphosphonates, denosumab, fluids and diuretics, prednisone

HPV strains in vaccine

16 and 18- cancer related6 and 11- warts

cervical screening

starts age 25, invited every 3 years until 4950-64- 5 yearly

cisplatin toxicity

hearing impairmentperipheral neuropathyrenal impairmentbone marrow suppression

chemotherapy typically dosed according to what

body surface area

reed sternburg cells

hodgkins lymphoma

smudge cells

CLL

Oncology Flashcards

(86 cards)