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Phase 3B > Oncology > Flashcards

Oncology Flashcards

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1
Q

What are cancer cells?

A

Cells which undergo uncontrolled and unregulated cell proliferation with the ability to metastasise to other places in the body.

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2
Q

What are the twelve characteristics of cancer cells that underline their behaviour?

A
  • Self sufficiency in growth signals
  • Insensitivity to anti-growth signals
  • Evading apoptosis
  • Limitless replicative potential
  • Sustained angiography
  • Tissue invasion and metastasis
  • Dysregulating metabolism
  • Evading the immune system
  • Genome instability
  • Inflammation
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3
Q

Where in the cell cycle do cytotoxic chemotherapy agents target?

A

Depends on how the agent works.
More rapidly growing tumours have more cycles and therefore more G1, S, and G2 phases.
So a drug specific for DNA synthesis (S) stage is most effective against rapidly growing tumours.

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4
Q

Define pharmacokinetics.

A

What the body does to the drug.

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5
Q

Define pharmacodynamics.

A

What the drug does to the body.

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6
Q

What are the main principles of cancer drug treatment?

A

The drug must reach the cancer cells
Cell must be sensitive to the cytotoxic of drug
Toxic effect must be minimal to the benefit of the drug

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7
Q

What is screening?

A

A process of identifying apparently health people who may be at increased risk of a disease or conditions.

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8
Q

How is the grade of a tumour determined?

A

The extent to which the neoplasm resembles its cell or tissue of origin.

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9
Q

How are malignant tumours graded?

A

Well, moderately, or poorly differentiated.

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10
Q

How are benign tumours graded?

A

They are not, as they closely resemble their parent tissue.

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11
Q

Which tumours grow slowly?

A

Well differentiated

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12
Q

What does the stage of a cancer describe?

A

The size of the tumour and the extent to which it has spread

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13
Q

What are the components of the TNM staging classification?

A

Tumour
Nodes
Metastases

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14
Q

What does TNM stage IV generally represent?

A

Metastases to distant organs

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15
Q

For which tumours is systemic anticancer treatment given alone, with radical intent?

A

Germ cell tumours

Haematological cancers

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16
Q

What do “neoadjuvant” and “adjuvant” mean?

A

Neoadjuvant - perioperative period, pre surgery

Adjuvant - perioperative, post surgery

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17
Q

Why does surgical resection of early tumours not cure some patients?

A

Presence of micrometastases which can cause recurrence.

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18
Q

How does neoadjuvant chemotherapy offer survival benefit?

A

Eradicated micrometastatic disease

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19
Q

What are the risks of neoadjuvant chemotherapy?

A

Risks a potentially fatal chemotherapy related complication.

Decreases the patients performance prior to curative surgery

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20
Q

Why is adjuvant chemotherapy given?

A

Ensures any margins or micrometastatic sites are free from disease

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21
Q

What is radiotherapy?

A

The administration of ionizing radiation with the intent of killing the cancer cell or prevent it from replicating.

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22
Q

How does radiotherapy work?

A

Ionizing - ionizes cells causing apoptosis
Non-ionizing (X-Rays) - formation of free radicals and reactive oxygen species. These interact with the covalent bonds of DNA and can result in apoptosis.

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23
Q

How is radiotherapy delivered?

A

External to the body
Internal to the body (brachytherapy)
Systemically (iodine-131)

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24
Q

What is the radiation dose measured in?

A

Grays - Gy

The amount of radiation absorbed by each kilogram of tissue

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25
What are the acute side effects of radiotherapy?
``` Nausea, vomiting, anorexia Acute radiation dermatitis Mucositis Oesophagitis Diarrhoea ```
26
Name three types of systemic anti-cancer treatment.
Cytotoxic chemotherapy Hormone therapy Molecularly targeted therapy
27
How are cytotoxic chemotherapies classified?
Alkylating agents Antimetabolites Natural products
28
How do alkylating agents work?
Add an alkyl group to the guanine base of DNA, preventing DNA replication and RNA transcription. Not phase specific i.e. can occur at any point in the cell cycle
29
How do antimetabolites work?
Inhibit enzymes or metabolites involved in DNA or RNA synthesis
30
Name two alkylating agents
Cisplatin | Cyclophosphamide
31
Name two antimetabolites
Methotrexate | Fluorouracil
32
Name two natural products
Bleomycin | Doxorubicin
33
What are some problems with chemotherapy?
Variable efficacy secondary to tumour biology/intrinsic resistance Acquired resistance Toxic side effects
34
What are general side effects of chemotherapy related to?
Rapidly dividing cells
35
Name some general side effects of chemotherapy.
Nausea and vomiting Alopecia Skin rashes Constipation
36
Name some other specific side effects of chemotherapy?
Cardiomyopathy Renal impairment Infertility
37
Define hypercalcaemia.
Corrected calcium >2.6mmol/L
38
40% of circulating calcium is bound to what?
Albumin
39
How do you correct calcium levels?
Add 0.1mmol/L to calcium, for every 4g/L that albumin levels are below 40g/L This allows for changes in serum albumin levels
40
What are the main causes of hypercalcaemia?
Hyperparathyroidism Malignancy - bone mets or parathyroid hormone related peptide secretion Thyrotoxicosis
41
How does hypercalcaemia present?
Bones, stones, groans, and psychic moans Abdo pain, constipation, vomiting Polyuria and polydipsia Confusion and fatigue Depression
42
What are the important investigations for hypercalcaemia?
PTH ECG Imaging for bone mets if appropriate
43
What is seen on ECG in hypercalcaemia?
Shortened QT interval
44
What is the initial acute management of hypercalcaemia?
Diagnose underlying cause | Correct dehydration with 0.9% saline
45
What is the further management of hypercalcaemia following rehydration?
IV bisphosphonates e.g. pamidronate Inhibits osteoclasts and reduces bone turnover, reduces calcium over several days
46
What is the treatment of persistent or relapsed hypercalcaemia of malignancy?
Denosumab (inhibits RANK ligand)
47
What does the SVC drain?
The head, neck, upper limbs, and upper thorax
48
What are the causes of SVC obstruction?
Thrombus | Direct tumour invasion inside and outside the vessel wall
49
Which tumours can invade the SVC?
Lung cancer Lymphoma Germ cell tumours ALL
50
What are the symptoms of SVC obstruction?
``` May be sudden or gradual Dyspnoea Chest pain at rest Cough Neck, face, and arm swelling Nasal stuffiness Visual disturbance ```
51
What are the signs of SVC obstruction?
Dilated veins and oedema over arms, neck, and anterior chest wall Severe respiratory distress Cyanosis Engorged conjunctiva
52
How is SVC obstruction diagnosed?
Clinical CXR - widened mediastinum/mass CT
53
How is SVC obstruction managed?
Elevation of the head, oxygen High dose dexamethasone Endovascular stenting
54
What is the name of the condition caused by abrupt release of large quantities of cellular components into the blood following rapid lysis of the malignant cell?
Tumour lysis syndrome
55
What are the risk factors for tumour lysis syndrome?
Volume depletion Renal impairment Treatment sensitive tumours High pre-treatment urate, lactate, and LDH
56
What are the most common malignancies for tumour lysis syndrome?
Haematological
57
How does tumour lysis syndrome present?
Weakness Paralytic ileus - constipation, vomiting, abdo pain Cardiac arrhythmias - palpitations, chest pain Seizures AKI
58
What are the metabolic abnormalities of tumour lysis syndrome?
``` Hyperuricaemia Hyperphosphataemia Hyperkalaemia Hypocalcaemia AKI ```
59
How does tumour lysis syndrome cause renal impairment?
Deposition of uric acid and calcium phosphate crystals in renal tubules can cause acute renal failure
60
How is tumour lysis syndrome prevented?
IV fluids Allopurinol Rasburicase
61
How does allopurinol work?
Xanthine oxidase inhibitor | Blocks conversion of xanthines to uric acid
62
How does rasburicase work?
Recombinant urate oxidase | Catalyses the oxidation of uric acid to allantoin which is much more soluble
63
How is tumour lysis syndrome treated?
``` Vigorous hydration Correct high potassium Rasburicase (stop allopurinol) Acetazolamide Phosphate binders Dialysis ```
64
How is potassium corrected in tumour lysis syndrome?
10mls 10% calcium gluconate IV if potassium >7mmol/L or ECH changes IV insulin and dextrose Salbutamol 2.5mg nebulizer
65
Which patients are at risk of neutropenic sepsis?
Neutrophil count below 1x10^9/L
66
When should patients be treated for neutropenic sepsis?
Oral temperature >38 degrees OR Two consecutive readings of >37.5 degrees for two hours AND an absolute neutrophil count <1x10^9/L
67
How is neutropenic sepsis diagnosed?
Septic screen | Clinically relevant swabs or cultures
68
What are the antibiotic guidelines for neutropenic sepsis?
Piperacillin with tazobactam - tazocin
69
How is neutropenic sepsis prevented against?
Fluoroquinolone or granulocyte colony stimulating factor in some cases
70
Where does the spinal cord run to and from?
The base of the skull to L1
71
What does the cauda equina contain?
Extends below L1 and contains the lumbar, sacral, and coccygeal spinal nerves
72
What is the most common cause of spinal cord compression?
Secondary malignancy
73
What are the other causes of spinal cord compression?
Trauma Disc prolapse RA Spinal infection
74
How does spinal cord compression present?
Radicular pain Limb weakness below the level of compression Sensory loss below level of compression (sensory level present) Bladder or bowel dysfunction
75
How is spinal cord compression diagnosed?
MRI whole spine
76
How is spinal cord compression treated?
Analgesia High dose steroids Spinal decompression Radiotherapy

Phase 3B (20 decks)

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