Oncology and Palliative Care

Question 1

Alkylating Agents
Example (1)
Mechanism of action
Adverse effects

Answer 1

cyclophosphamide
causes cross-linking in DNA
Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

Question 2

Cytotoxic Antibiotics

Examples (2) plus MOA and Side effects

Answer 2

Bleomycin

• Degrades preformed DNA
• Lung fibrosis

Doxorubicin
- Stabilizes DNA-topoisomerase II complex inhibits DNA &
RNA synthesis
- Cardiomyopathy

Question 3

Methotrexate
Class
MOA
Side effects

Answer 3

Antimetabolite

Inhibits dihydrofolate reductase and thymidylate synthesis Myelosuppression, mucositis, liver fibrosis, lung fibrosis

Question 4

Fluorouracil (5-FU)
Class
MOA
Side effects

Answer 4

Antimetabolite
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
Myelosuppression, mucositis, dermatitis

Question 5

6-mercaptopurine
Class
MOA
Side effects

Answer 5

Antimetabolite
Purine analogue that is activated by HGPRTase, decreasing purine synthesis
Myelosuppression

Question 6

Cytarabine
Class
MOA
Side effects

Answer 6

Antimetabolite
Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase Myelosuppression, ataxia

Question 7

Vincristine, vinblastine
Class
MOA
Side effects

Answer 7

‘spindle poisons’
Inhibits formation of microtubules
Vincristine: Peripheral neuropathy (reversible), paralytic ileus
Vinblastine: myelosuppression

Question 8

Docetaxel
Class
MOA
Side effects

Answer 8

‘Spindle Poisons’
Prevents microtubule depolymerisation & disassembly, decreasing free tubulin
Neutropaenia

Question 9

Irinotecan
Class
MOA
Side effects

Answer 9

Topoisomerase inhibitors
Inhibits topoisomerase I which prevents relaxation of supercoiled DNA
Myelosuppression

Question 10

Cisplatin
MOA
Side effects

Answer 10

Causes cross-linking in DNA

Ototoxicity, peripheral neuropathy, hypomagnesaemia

Question 11

Hydroxyurea (hydroxycarbamide)
MOA
Side effects

Answer 11

Inhibits ribonucleotide reductase, decreasing DNA synthesis

Myelosuppression

Question 12

Name the associated cancer

CA 125

Answer 12

Ovarian cancer

Question 13

Name the associated cancer

CA 19-9

Answer 13

Pancreatic cancer

Question 14

Name the associated cancer

CA 15-3

Answer 14

Breast cancer

Question 15

Name the associated cancers

Alpha-feto protein (AFP)

Answer 15

Hepatocellular carcinoma, teratoma

Question 16

Name the associated cancer
Carcinoembryonic antigen (CEA)

Answer 16

Colorectal cancer

Question 17

Name the associated cancers

S-100

Answer 17

Melanoma, schwannomas

Question 18

Name the associated cancers

Bombesin

Answer 18

Small cell lung carcinoma, gastric cancer, neuroblastoma

Question 19

Mx for nausea and vomiting with intracranial tumours

Answer 19

Dexamethasone

Question 20

conversion of oral to subcut morphine

Answer 20

divide dose by 2

Question 21

Mx of nausea and vomiting associated with chemotherapy

Answer 21

metoclopramide is first-line
Second-line is 5HT3 receptor antagonists e.g. ondansetron
can add dexamethasone

Question 22

Risk factors for N&V with chemo

Answer 22

anxiety
age less than 50 years old
concurrent use of opioids
the type of chemotherapy used

Question 23

convert from oral morphine to diamorphine s/c

Answer 23

divide by 3

Question 24

SVCO Features

Answer 24

dyspnoea - most common
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension

Question 25

SVCO Causes (9)

Answer 25

common malignancies: non-small cell lung cancer, lymphoma other malignancies: metastatic seminoma, Kaposi's sarcoma, breast cancer aortic aneurysm mediastinal fibrosis goitre SVC thrombosis

Question 26

SVCO Management

Answer 26

general: O2 if required, dexamethasone, balloon venoplasty, stenting small cell: chemotherapy + radiotherapy non-small cell: radiotherapy

Question 27

Lynch Syndrome

Answer 27

Autosomal dominant Develop colonic cancer and endometrial cancer at young age 80% of affected individuals will get colonic and/ or endometrial cancer High risk individuals may be identified using the Amsterdam criteria

Question 28

How to work out the breakthrough dose of morphine

Answer 28

= 1/6th of daily morphine dose

Question 29

Palliative care Mx of hiccups

Answer 29

chlorpromazine or haloperidol | gabapentin and dexamethasone also used

Question 30

Mx of excessive respiratory secretions

Answer 30

hyoscine hydrobromide

Question 31

Mx of bowel colic

Answer 31

hyoscine butylbromide

Question 32

HPV subtypes

Answer 32

Subtypes 16,18 & 33 are particularly carcinogenic. | 6 & 11 are non-carcinogenic and associated with genital warts.

Question 33

preferred opiates in CKD

Answer 33

Alfentanil, buprenorphine and fentanyl

Question 34

raised calcitonin suggests what type of cancer?

Answer 34

medullary thyroid cancer

Question 35

Most common tumour causing bone metastases (in descending order)

Answer 35

prostate breast lung

Question 36

Mx of metastatic bone pain

Answer 36

analgesia, bisphosphonates or radiotherapy