Oncology

Question 1

Name three ER positive cancers

Answer 1

Luminal A
Luminal B
Luminal C

Question 2

Name two ER negative cancers

Answer 2

HER Overexpression

Basal like - triple negative

Question 3

How is luminal A type of cancer treated?

Answer 3

Endocrine therapy

Question 4

How is luminal B type of cancer treated?

Answer 4

Chemo followed by endocrine

Question 5

How is HER2 positive cancer treated?

Answer 5

Chemo
Anti-HER2
Endocrine if ER positive

Question 6

How is triple negative cancer treated?

Answer 6

Chemo

Immunotherapy

Question 7

State the indications for neoadjuvant chemotherapy

Answer 7

• downsizing tumour
• enroll patients in clinical trials
• locally advanced breast cancer (inflammatory, ulcerative)
• large primary tumour compared to breast

Question 8

State the indications for adjuvant chemotherapy

Answer 8

• risk of relapse
• tumour extent
• grade
• proliferation
• vascular invasion
• patient preference

Question 9

What is the key online prognostic tools?

Answer 9

NHS PREDICT

Question 10

What tool can be used to predict recurrence?

Answer 10

Oncotype Dx type genomic testing

Question 11

Name the acute side effects of chemotherapy

Answer 11

Fatigue 
Myelosuppression
Nausea/vomiting 
Alopecia 
Mucositis 
Diarrhoea 
Constipation
Renal 
Neurotoxicity 
Infertility

Question 12

Name the late side effects of chemotherapy

Answer 12

Cardiac 
Infertility - premature menopause
Neuropathy 
Renal impairment 
Osteoporosis 
Carcinogenesis

Question 13

Name three anti-HER2 treatments

Answer 13

1. Monoclonal antibodies
2. Antibody drug conjugate
3. Kinase inhibitor

Question 14

Name two monoclonal antibodies

Answer 14

Transtuzumab

Pertuzumab

Question 15

Describe antibody drug conjugates

Answer 15

Monoclonal antibody linked to chemo - antiHER2 attaches to HER2 protein signalling for the chemo drug to directly come to it

Question 16

Name an antibody drug conjugate

Answer 16

TDM1

Question 17

Describe kinase inhibitor

Answer 17

HER2 is a kinase protein that tells the cell to grow

Question 18

Name the side effects of HER2 targeted drugs

Answer 18

Heart disease 
Diarrhoea 
Hand-foot syndrome 
Transaminitis 
Pneumonitis/IDL

Question 19

What neoadjuvant endocrine therapy can be given?

Answer 19

Pre-menopausal - unlikely

Post-menopausal - letrozole

Question 20

What kind of drug is tamoxifen?

Answer 20

Partial ER antagonist

Question 21

What kind of drug is letrozole?

Answer 21

Aromastase inhibitor (enzyme converts hormones to oestrogen)

Question 22

Name the side effects of endocrine therapy

Answer 22

Bone/joint pain
Hot flushes 
Fatigue 
Weight gain
Mood swings 
Hair thinning 
Loss of libido

Question 23

In post menopausal women with an ER positive tumour what endocrine treatment is given?

Answer 23

Low risk - tamoxifen for 5 years or AI

High risk - aromatase inhibitor for 10 years

Question 24

In pre menopausal women with an ER positive tumour what endocrine treatment is given?

Answer 24

Low risk - tamoxifen for 5 years

High risk - ovarian suppression, tamoxifen, exmestane

Question 25

How is triple negative cancer treated?

Answer 25

Neoadjuvant chemotherapy High risk of brain/CNS mets or visceral mets Clinical trials

Question 26

When is bisphosphonate recommended?

Answer 26

Post-menopausal high risk for hormone therapy | Pre-menopausal treated with ovarian suppression

Question 27

What is needed in addition to bisphosphonate?

Answer 27

Vitamin D daily

Question 28

What is the assessment guideline for metastatic disease?

Answer 28

``` Minimal staging No routine brain imaging Evaluate treatment response every 2-4 months biopsy metastatic lesion reassess biological markers ```

Question 29

What new drug can be used in metastatic disease?

Answer 29

CDK4/6 Inhibitors

Question 30

Describe CDK4/6 Inhibitors

Answer 30

Block phosphorylation of retinoblastoma - 3 different types

Question 31

What the side effects of CDK4/6 Inhibitors?

Answer 31

Neutropenia, diarrhoea, increased LFT, QTc prolongation, thromboembolic events

Question 32

What type of drugs can be used in triple negative disease?

Answer 32

Immunotherapy

Question 33

What is the aim of radiotherapy?

Answer 33

Reduce recurrence rate - 12 weeks post surgery

Question 34

State the early toxicity of radiotherapy

Answer 34

Fatigue, skin reaction, hair loss

Question 35

State the late toxicity of radiotherapy

Answer 35

Breast changes, discomfort, telangiectasia, lymphedema, heart/lung disease