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Oncology Flashcards

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1
Q

What is multiple myeloma?

A

A neoplasm of the bone marrow plasma cells

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2
Q

Peak incidence for multiple myeloma?

A

60-70 years old

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3
Q

What are the clinical features of multiple myeloma?

A 
Bone disease - osteoporosis, osteolytic lesions (rain-drop skull x-ray with black drops in the skull)
Lethargy
Hypercalcaemia
Renal failure
Amyloidosis
Infection
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4
Q

Investigations for multiple myeloma?

A

Monoclonal proteins (IgG or IgA) in the serum and urine (Bence Jones proteins)
Increased plasma cells in the bone marrow
Skeletal survey for bone lesions (however we now use full body MRI)
X-ray - rain drop skull

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5
Q

Why is hypercalcaemia a feature in myeloma?

A

Due to increased osteoclastic bone resorption caused by local cytokines (Il-1, TNF) released by myeloma cells
Impaired renal function

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6
Q

Unexplained petechiae and hepatomegaly indicate?

A

Could indicate leukaemia

Refer for immediate assessment

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7
Q

What is Burkitt’s lymphoma associated with?

A

Epstein-Barr virus

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8
Q

What condition are thymoma’s commonly seen in?

A

Myasthenia gravis

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9
Q

What genes can predispose women to breast cancer?

A

BRCA1
BRCA2
These account for 10% of breast cancers

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10
Q

Risk factors for breast cancer

A

Prolonged oestrogen exposure (early menarche, late menopause, nulliparity)
HRT

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11
Q

Histology in breast cancer

A

Invasive ductal carcinoma (70%)

Invasive lobular carcinoma (30%)

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12
Q

Clinical presentation of breast cancer

A

Mass that is present throughout menstrual cycle
Nipple discharge (10%)
Pain (7%)

40% have axillary node disease

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13
Q

Common metastases sites breast cancer

A

Bone (70%)
Lung (60%)
Liver (55%)
Pleura (40%)

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14
Q

What is Paget’s disease of the nipple?

A

A rare form of breast cancer usually affecting the ducts of the nipple
Eczematous skin changes to the nipple/areola

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15
Q

Staging for breast cancer

A

TMN

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16
Q

Treatment of breast cancer

A

Spans from observation to prophylactic bilateral mastectomy

Axillary nodal excision as well

Adjuvant radiotherapy

Adjuvant hormonal therapy (if ER+ receptor expressed) - tamoxifen

Adjuvant chemotherapy (trastuzumab for HER2)

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17
Q

Prevention of breast cancer in high risk patients

A

Tamoxifen

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18
Q

Breast cancer screening

A

Mammographic screening (age 50-70, 2-3 yearly)

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19
Q

Types of lung cancer

A

Small cell lung cancer (20%)

Non-small cell lung cancer (80%)

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20
Q

Types of non-small cell lung cancer

A

Squamous (35%)
Adenocarcinoma (30%)
Large cell (10%)

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21
Q

Features of small cell lung cancer

A

Usually central
Arise from APUD cells (amine, precurosr uptake and decarboxylase cells)
Association with ectopic ADH and ACTH
Labert-Eaton syndrome - antibodies to calcium channels causing myasthenia gravis like syndrome

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22
Q

What features are caused by ectopic hormone production in small cell cancer?

A

ADH > hyponatraemia
ACTH > Cushing’s syndrome
ACTH > bilateral adrenal hyperplasia and thus high cortisol/hypokalaemic alkalosis

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23
Q

How do we manage small cell lung cancer

A 
Chemotherapy generally (due to likelihood of metastatic disease)
Etoposide or cisplatin

Median survival is 14 months

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24
Q

Squamous cell lung cancer

A

Normally central
Associated with PTH related protein secretion - causing hypercalcaemia
Finger clubbing
HPOA

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25
Adenocarcinoma lung cancer
Typically peripheral - most common type in non-smokers Gynaecomastia HPOA
26
Large cell lung cancer
Peripheral Anaplastic (poorly differentiated) May secrete beta hCG
27
Non-small cell lung cancers
Develop from the epithelial cells anywhere from the central bronchi to the terminal alveoli
28
Non-small cell cancer treatment
Stages IIIa and less - complete surgical excision | Stages IIIb and IV - carboplatin or cisplatin
29
Investigating lung cancers
X-ray CT - Ix of choice Bronchoscopy - can allow biopsy PET scanning - non-small cell cancers to determine viability of surgery
30
Surgery contraindications in lung cancer
``` Stage IIIb or IV (metastases) FEV1 <1.5L Malignant pleural effusion Tumour near hilum Vocal cord paralysis SVC obstruction ```
31
Superior vena cava obstruction
Oncological emergency commonly associated with lung cancer
32
SVC obstruction symptoms
``` Dyspnoea Swelling of face, neck, arms Headache Visual disturbance Pulseless jugular venous distension ```
33
Causes of SVC obstruction
Non-small cell cancers, lymphoma, breast cancer Aortic aneurysm Goitre
34
Management of SVC obstruction
Dexamethasone Balloon venoplasty Stenting
35
Lambert-Eaton syndrome
Associated with small cell lung cancer - an antibody against calcium channels Repeated muscle contractions lead to increased muscle strength Hyporeflexia Autonomic symptoms: dry mouth, impotence, difficulty micturating Ophthalmoplegia and ptosis not commonly seen
36
Mesothelioma
Aggressive tumour of the surface serosal cells of the pleura, peritoneal and pericardial cavities
37
Risk factors associated with mesothelioma
Asbestos (20-50 years before) | Smoking
38
Symptoms associated with mesothelioma
Cough Dyspnoea Non-pleuritic chest wall pain
39
Signs in mesothelioma
Usually there is dullness on one lung base + a pleural effusion seen on x-ray
40
Mesothelioma x-ray findings
Thickened, nodular, irregular mass Pleural plaques Tumour often encompasses the whole lung, but rarely seen bilaterally Moderate-large pleural effusion unilaterally also
41
Colorectal cancer risk factors
``` Strong relation to age (>60) Diet: high calorie intake, red meat and alcohol intake Smoking Obesity Inflammatory bowel disease ```
42
What is HNPCC/lynch syndrome? | Hereditary non-polyposis colorectal cancer
Genetic syndrome of autosomal dominant pattern | Patients generally develop colorectal cancer in their 40s
43
What is FAP? | Familial adenomatous polyposis
An inherited autosomal dominant pattern genetic condition. | Patients develop benign polyps which can progress into cancerous lesions
44
Treatment for FAP
Prophylactic colectomy
45
Pathophysiology of colorectal cancer
70% are adenocarcinomas arising in the mucosa from benign adenomatous polyps
46
How do we stage colorectal cancer?
Duke's staging: A: tumour confined to mucosa B: tumour has breached serosa C: regional lymph nodes involved D: Distant metastases present
47
Treatment of colorectal cancer
Surgical - usually hemicolectomy Radiotherapy (sometimes before the surgery to reduce its size) 5-fluorouracil/irinotecan regimens
48
Prognosis of colorectal cancer
50% relapse within 2 years
49
Colorectal cancer locations
Rectal - 40% Sigmoid - 30% Transverse/ascending - 15% ea.
50
Colorectal cancer screening
60-74 year olds offer faecal immunochemical tests (FIT) every 2 years If +ve result, colonoscopy
51
Two categories of lymphoma
Hodgkin's | Non-hodgkin's
52
Hodgkin's lymphoma
Malignant proliferation of lymphocytes which accumulate in lymph nodes/other organs M more affected than F Peak incidence in 30s and 70s Can be following EBV infection
53
Clinical features of Hodgkin's lymphoma
``` Asymptomatic lymphadenopathy (usually above diaghram) Fever Night sweats Weight loss Alcohol pain Chronic pruritus ```
54
Pathophysiology of Hodgkin's lymphoma
``` Nodular sclerosing (60%) Mixed cellularity (30%) Lymphocyte predominant (5%) Lymphocyte depleted (5%) ```
55
In what condition do you see Reed-Sternberg cells
Hodgkin's lymphoma These are giant cells found with light microscopy, usually derived from B lymphocytes
56
What might you find raised in Hodgkin's lymphoma?
``` Eosinophils Lactate dehydrogenase (LDH) ```
57
Which form of Hodgkin's lymphoma has the worst prognosis?
Lymphocyte depleted
58
How do we diagnose Hodgkin's lymphoma
Biopsy of an enlarged lymph node (usually seeing Reed-Sternberg cells)
59
Treatment of Hodgkin's lymphoma
Radiotherapy if stage I-IIa Stages IIb-IV - chemotherapy Stem cell transplantation sometimes
60
Chemo drugs for Hodgkin's lymphoma
``` ABVD Adriamycin Bleomycin Vinblastine Dacarbazine ```
61
Non-Hodgkin's lymphoma
Malignant proliferation of lymphocytes | Does NOT contain Reed-Sternberg cells
62
Risk factors for non-Hodgkin's lymphoma
Elderly Caucasian History of viral infection (EBV) FHx
63
Clinical features of non-Hodgkin's lymphoma
Painless lymphadenopathy | Fever, weight loss, night sweats, lethargy
64
How can we differentiate between Hodgkin's and non-Hodgkin's lymphoma clinically?
Alcohol induced lymph node pain in Hodgkin's lymphoma B symptoms occur earlier in Hodgkin's than in non-Hodgkin's Extra-nodal disease more common in non-Hodgkin's
65
What are 'B' symptoms?
Constitutional symptoms, e.g. | Weight loss, night sweats, fevers
66
Investigations in non-Hodgkin's lymphoma?
Excisional node biopsy
67
Staging system for non-Hodgkin's lymphoma
Ann Arbor system
68
Ann Arbor system stages
Stage I - One node affected Stage II - More than one node but same side of diaghram Stage III - one node affected on either side of diaghram Stage IV - extra-nodal involvement (e.g. spleen, bone marrow, CNS)
69
Management of non-Hodgkin's lymphoma?
Radiotherapy for stage I Stages II-IV: Oral chlorambucil, IV cyclophosphamide, vincristine + prednisolone
70
Neutropenic sepsis
Commonly 7-14 days following chemotherapy | Defined as neutrophils <0.5 with temp >38 or other clinical symptoms of sepsis
71
How can we prevent neutropenic sepsis
We give fluoroquinolones if we are anticipating patient to get a <0.5 neutrophil count
72
Management of neutropenic sepsis
Give abx immediately (tazocin, piperacillin) | Vancomycin sometimes
73
What is Burkitt's lymphoma?
A high grade B cell neoplasm
74
Two forms of Burkitt's lymphoma?
Endemic (African) form: maxilla or mandible involvement | Sporadic: abdominal tumours (more common in patients with HIV)
75
Microscopy appearance in Burkitt's lymphoma
Starry sky appearance - lymphocyte sheets interspersed with macrophages and dead apoptic tumour cells
76
Management of Burkitt's lymphoma
Chemotherapy
77
Tumour lysis syndrome
A condition related to treatment of lymphomas and leukaemias, usually following chemotherapy Breakdown of tumour cells releases chemical into the body
78
Electrolyte abnormalities with tumour lysis syndrome
Potassium high Phosphate high Calcium high Uric acid high
79
How do we treat tumour lysis syndrome?
IV allopurinol given before chemotherapy Fluids Dialysis if kidney failure is bad and other therapy has not worked
80
Malignant spinal cord compression symptoms
Usually due to vertebral metastases, symptoms include: Vertebral pain - esp. lying flat/coughing Sensory changes two dermatomes below level Motor weakness Sphincter disturbance
81
Treatment of malignant spinal cord compression
High dose dexamethasone | Surgical decompression/radiotherapy

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