Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

RACP Written Exam 2021 > Oncology > Flashcards

Oncology Flashcards

(75 cards)

Start Studying
1
Q

What is the role of P53 in the prevention of cancer

A

P53 = tumor supressor gene
Activation of P53 leads to arrest in the G1 phase of the cell cycle allowing for cells to repair DNA before proceeding to S phase (where DNA is replicated).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which familial cancer syndrome is associated with a germ line mutation of P53

A

Li-Fraumeni Syndrome (SBLA)

  • Sarcoma
  • Breast
  • Leukemia
  • Adrenal Gland
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of renal clear cell carcinoma?

A

Von Hippel Lindau Gene mutation.
In the absence of VHL hypoxia inducible factor accumulates leading to production of several growth factors and enhance glycolosysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Von Hippel Lindau Syndrome

A

Inherited, autosomal dominant syndrome manifested by a variety of benign and malignant tumors.
●Hemangioblastomas of the brain (cerebellum) and spine
●Retinal capillary hemangioblastomas (retinal angiomas)
●Clear cell renal cell carcinomas (RCCs)
●Pheochromocytomas
●Endolymphatic sac tumors of the middle ear
●Serous cystadenomas and neuroendocrine tumors of the pancreas
●Papillary cystadenomas of the epididymis and broad ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the function of mismatch repair?

Example of familial cancer syndrome caused by failure of MMR

A

Mismatch Repair corrects replication errors that cause incorporation of the wrong nucleotide (mismatch) and nucleotide deletions/insertions.
Lynch Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the function of Nucleotide excision repair?

A

Removes helix distorting adducts on DNA e.g those caused by UV light or tobacco smoke and contributes to the repair of intrastrand and inter strand crosslinks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the mechanism of PARP inhibition

A

Impair DNA repair pathway leading to accumulation of defects that in healthy cells are repaired by alternative Homogolous repair pathways but in HR mutated cells (i.e. BRCA1/2) the accumulated damage is not repaired and therefore are apoptosed - tutor selective cell death “synthetic lethality”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When is Parp inhibitor ‘Oliparib’ indicated in ovarian cancer

A

monotherapy for maintenance treatment of patients with platinum-sensitive relapsed BRCA-mutated high grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer who arein partial or complete response followingat leasttwo courses of platinum-containing regimens.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk factors for Type 1 Endometrial Cancers

A

Unopposed oestrogen states

  • Obesity
  • Nulliparity
  • Early menarche/late menopause
  • Chronic anovulatory state
  • Tamoxifen

Protective = OCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors for Cervical Cancer

A

HPV 16/18
Smoking
Immunosupression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Bevacizumab (anti VEGF) in gynaecological cancers

A

Metastatic cervical cancer

Stage 4 Breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

TKI used in metastatic NSCLC with EGFR mutation first line

A

Erlotinib
A/E = acneaform rash.
- Treat with topical or oral tetracyclines, topical steroids, skin care and sun protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

TKI used in metastatic NSCLC with EGFR mutation when resistance to erlotinib occurs and which mutation must they have?

A

Osimertinib (must have mutation of T790)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

TKI used in metastatic NSCLC with ALK mutation first line

A

Alectanib is now listed as first line on the PBS

Brigatinib (particularly in patients with intracranial metastases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

TKI used in metastatic NSCLC with Ros-1 mutation first line

A

Crizitonib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In which patients with metastatic NSCLC is pembrolizumab/nivolumab indicated first line?

A

PDL-1 >50% (keynote trial)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Regardless of PDL-1 status which immune checkpoint inhibitors can non-small cell lung cancer patients be commenced on as second line therapy?

A

Nivolumab or Atezolizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Classification of small cell lung cancer

A 
Limited (within one radiation field) 
or Extensive (extends over one radiation field)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Small Cell Lung Cancer Limited disease treatment

A

Chemoradiotherapy
Chemotherapy 2 cycles: Platinum based + etoposide
Radiotherapy
Prophylactic brain radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Common metastatic site of small cell lung cancer

A

Brain. Therefore brain MRI important in the work up (CT if MRI not available)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What predicts for lack of response to Cetuximab in bowel cancer

A 
KRAS mutated
(Only benefit shown in KRAS wild type)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Use of CEA in cancer monitoring?

A

Used to monitor for early recurrence

Note can also be elevated in smoking and other malignancies ie lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ca125 elevation

A

Ovarian Cancer

Non malignant fluid third spacing - i.e ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How to treat hypercalcaemia of malignancy

A
  1. IVF
  2. Zoledronic acid
  3. Furosemide if/when euvolaemic.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Malignant spinal cord compression
``` Back pain + Neuro symptoms Upgoing planters (differentiates from cauda equine syndrome) MRI Rx > Surgery > Radiotherapy > Steroids > Chemo if sensitive (lymphoma/germ cell tutor/SCLC) ```
26
BRCA mutation associated with prostate cancer
BRCA2 Note both BRCA mutations (autosomal dominant) are associated with increased risk of pancreatic cancer.
27
Initial investigation on identification of either palpable breast mass/positive breast screening
Triple testing - Clinical exam - Imaging with MMG or US (US if younger) - Biopsy: Core or FNA
28
Trastuzumab adverse effects
Reversible cardiomyopathy | > Monitor with regular echo
29
Mutations in NSCLC
EgFR: Elotonib ``` ALK/ROS: Crizotinib Alecitinib PDL1>50%: Pembroluzimab PDL 1-49%: PDL-1 inhibitor + Chemotherapy PDL<1%: Chemoimmunotherapy ```
30
Two most important factors for melanoma prognosis
Breslow depth | Mitotic rate
31
Most common mutation in Melanoma
BRAF 35-45% | > 80-90% V600E
32
BRAF inhibitors
BRAF Vemarufanib + Dabrafenib BRAF+MEK Inhibitors Note current first line treatment is BRAF+MEK inhibitor Adverse effects > Pyrexia > Photosensitivity > Rash and pruritus
33
Mutation negative
Ipilimumab + Nivolumab If CNS disease or LDH high Either if no CNS disease or LDH normal
34
Where do monoclonal antiodies exert their effect
Extracellular
35
Where do TKI's exert their effect?
Intracellular
36
Side effect of Sunitinib
Hypertension (anti-angiogenesis)
37
What is the treatment for acquired EGFR T790M mutation in NSCLC
Osimertinib. | A/E: QTC prolongation
38
Mechanism of action of Trastuzumab Emtansine (T-DM1)
Antibody-drug conjugate Trastuzumab linked with emtansine. Targeted lethality. A/E: Thrombocytopenia
39
Mechanism of action of CKK4/6 inhibitors (i.e. Palbociclib)
CDK4/6 functions to inhibit retinoblastoma which allows the progression of the cell cycle. Inhibiting the CDK4/6 lead to reactivation of retinoblastoma --> arrest of cell cycle in G1. Adverse Effects: Neutropenia, LFT Abnormalities
40
Treatment for metastatic renal cell carcinoma
Good prognosis: TKI (sunitinib/pazopanib) Note previously routine cytoreductive nephrectomy but questioned by the Carmena trial Poor prognosis: Ipilimumab & Nivolumab Second line therapy includesL - Nivolumab or sonitinib/pazopanib - Carbozatinib - Axitnib - Everolimus - Sorafenib
41
Sunitinib side effects
``` Hypertension (predicts response) Hand and foot syndrome Neutropenia and thrombocytopenia LV dysfunction Hypothyroidism Skin and hair discolouration ```
42
Mechanism of action of sunitinib/pazopanib/axitinib/sorafenib
TKIs that targets the VEGF pathway
43
Definition of castrate resistant prostate cancer
Progression of disease despite castrate testosterone (<1.7nmol/L)
44
Treatment of castrate sensitive prostate cancer
Androgen deprivation therapy - GnrH agonist (goserelin/leuprolide) - GnrH antagonists (degarelix) - Bilateral orchidectomy - Adjuvant: Docetaxel/Abiraterone
45
Complication of GnRH agonists
Clinical flare phenomenon (spinal cord compression if spinal mets). Surge in LH --> increased testosterone - Ensure you give with testosterone antagonists
46
Treatment of metastatic castrate resistant prostate cancer
Chemotherapy: Docetaxel/Cabazitaxel Androgen receptor targeted therapies: Abiraterone/Enzalutamide Radiopharmaceuticals Immunotherapy: Sipuleucl
47
Side effects of taxanes therapies
MOA: Stabilises microtubules leading to death during mitosis Docetaxel: Polyneuropathy/cytopenias/hypersensitivity Cabazitaxel: Diarrhoea/neutropenia
48
Mechanism of action of abiraterone
Inhibits adrenal and autocrine production of androgens (inhibits 17-alpha hydroxyls and c-17 20 lyase) This leads to shunting to increased production of mineralocorticoids
49
Adverse effects of abiraterone
Hypertension Hypokalaemia Peripheral oedema Transaminitis Need to administer with corticosteroids
50
Adverse effects of enzalutamide
Cognitive side effects | Seizures
51
Most common germline DNA mutation in patients with prostate cancer
BRCA2
52
Most common type of renal cell cancer?
Clear cell renal cell cancer | - Commonly associated with aberration in VHL gene
53
Mechanism of VHL driven Renal cell carcinoma
Increase hypoxia inducible factor --> angiogenesis
54
Risk factors for bladder cancer
Urothelial: Smoking | Non-urotherlial: Schistosomiasis
55
Treatment of metastatic bladder cancer
Platinum based/Gemcitabine
56
Cisplatin adverse effects
Nephrotoxicity (have to have a CrCl or >60) | Ototoxicity
57
Which testicular cancer produces AFP?
Non seminomas Nb: Beta HCG may be produced by both seminomas and non-seminomas.
57
Which testicular cancer produces AFP?
Non seminomas Nb: Beta HCG may be produced by both seminomas and non-seminomas.
58
Testicular cancer
Orchidectomy | Exquisitely sensitive to chemotherapy: Carboplatin
58
Treatment for seminoma
Orchidectomy | Exquisitely sensitive to chemotherapy: Carboplatin
59
High risk seminoma
Tumor >4cm | Rete testis invasion
60
Treatment for Non seminoma
Orchidectomy + Sruveillans | High risk: Add in BEP regimen
61
Treatment for Metastatic melanoma with Braf mutation
``` Immunotherapy: Nivolumab + Braf Inhibitor: Dabrafenib + MEK inhibitor: Trametinib ```
62
Adverse effects of Dabrafenib
Fever - usually within in the first month of treatment Cutaenous Squamous Cell Carcinoma and Keratoacanthoma - Can be excised while dabrafenib continues Rash
63
Bowel Cancer Screening
FOBT for those between 50-74 every second year
64
Risk factors for Colon Cancer
Non-Modifiable: Previous abdominal radiotherapy and genetic risk predisposition (Lynch, Modifiable: Obesity, Inflammatory Bowel disease, Diabetes and Insulin resistance, meat constipation.
65
Colorectal cancer screening for moderate risk patients
``` Moderate risk - 1st degree relative diagnosed <55 - 2 1st/2nd degree diagnosed at any age Screening - Colonoscopy every 5 years from age 50 or 10 years younger than ages of 1st diagnosis. ```
66
Screening requirements for patient with FAP
Sigmoidoscopy from age 12-15 Total colectomy and ileorectal anastomosis Duodenal screening from age 25 or time of colectomy
67
Screening and management of Lynch Syndrome in relation to Colorectal cancer
Colonoscopy 1-2 yearly from age 25 or 5 years younger than familial case Nb: MLH1 genetic subtype highest risk
68
Treatment of stage 3 colorectal cancer (nodal spread)
Neoadjuvant chemotherapy with fluoropyrimidine as a radio sensitiser Surgical resection Adjuvant chemotherapy with fluoropyrimide and doublet with oxaliplatin
69
Surveillance for colorectal cancer
6-12 monthly CT CAP for 3 years | CEA
70
Adverse effects of 5-FU/Capcetibine
Coronary vasospasm | Planta Palmar Erythema
71
Adverse effects of oxaliplatin
Peripheral Neuropathy Pseudolaryngopharyngeal dysasthesia Hypersensitivity reaction
72
Targeted treatment of patients with KRAS wild type left sided colorectal cancer
Cetuximab/Panitumumab
73
Targeted treatment of patients with right sided LRAS mutant colorectal cancer
VEGF inhibitor such as bevacizumab

RACP Written Exam 2021 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions