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palli/onc Flashcards

1
Q

acanthosis palmaris

A

paraneoplastic
usually pulm or gastric origin

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2
Q

diagnosing AML

A

low Hb, neutrophils, platelets
raised WCC
blasts and Auer rods on film
> 20% blasts

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3
Q

AML treatment

A

cytarabine, idarubicin, daunorubucin
gemtuzumab ozogamicin (CD33)
midostaurin (FLT3)

supportive: hydroxycarbamide allopurinol rasburicase

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4
Q

diagnosing adrenal tumours

A

CT, MRI
MIBG scan- MIBG similar to adrenaline and taken up by neuroendocrine tumour
adrenal v sampling

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5
Q

adrenal tumour treament

A

alpha blockers then surgery for phaeochromocytoma

ketoconazole and metyrapone to reduce steroid
spironolactone to block aldosterone
mifepristone to block cortisol
tamoxifen to block oestrogen

mitotane for metastatic

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6
Q

pain ladder

A
  1. paracetamol
  2. ibuprofen or weak opioid
  3. 1 + 2
  4. paracetamol + alternative NSAID
  5. paracetamol + weak opioid
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7
Q

pain ladder for cancer pain

A
  1. non opioid +/- adjuvant
  2. opioid +/- 1.
  3. stronger opioid +/- 1
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8
Q

diagnosing aspergillosis

A

serum aspergillus galactomannan
serum 1-3 beta D glucan
halo sign (nodule), air crescent

ABPA- elevated IgE, aspergillus IgE and IgG

chronic- IgG

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9
Q

bladder ca treatment

A

non muscle invasive:
CIS, Ta, T1- resection TURBT and single shot mitomycin C intravesically
greater than 3cm- 6 shots
high risk G3T1 - 2x TURBT and intravesical BCG or radical cystectomy

muscle invasive:
radical cystectomy, ileal conduit
radical RTx
neoadjuvant cisplatin

metastatic: platinum chemo

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10
Q

CIN staging

A

CIN1- mild dyskaryosis
CIN3- high grade, full thickness, requires surgery

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11
Q

cervical cancer staging

A

1a, 1b confined to cervix
2 extends beyond uterus but not pelvic wall or lower 1/3 vagina
3 extends to pelvic sidewall or lower 1/3 vagina or hydronephrosis
4 beyond bladder/rectum

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12
Q

alkylating chemo

A

cyclophosphamide
inactivates enzymes involved in DNA production

s/e: haemorrhagic cystitis, pulm fibrosis

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13
Q

antimetabolite chemo

A

interferes with purine or pyramidine synthesis
MTX (hepatic failure, pulm fibrosis)
5FU (palmar plantar syndrome, cardiotoxic)

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14
Q

antibiotics as chemo

A

anthracycline- doxorubicin
s/e: CCF

bleomycin
s/e: pneumonitis, fibrosis, rash

mitomycin c
s/e: kidney failure, stomatitis, rash, alopecia

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15
Q

vincristine

A

inhibits spindle formation and mitosis
s/e: neuropathy, bronchospasm, blistering

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16
Q

paclitaxel

A

stabilises microtubules, inhibits mitosis
s/E: sudden total alopecia, myalgia, peripheral neuropathy

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17
Q

topoisomerase inhibitors

A

e.g. irinotecan
s/e: cholinergic syndrome, profuse diarrhoea

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18
Q

CLL cells

A

CD5, CD19, CD23 monoclonal B lymphocytes

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19
Q

diagnosing CLL

A

raised WCC
lymphocytosis > 5
smudge/smear cells on film
CD5, 19, 20, 23 on cytometry

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20
Q

CLL treatment

A

fludrabine + cyclophosphamide + rituximab 1st line

alkylating agents, purine analogues, ibrutinib second line

allogenic SCT for TP53 after remission

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21
Q

CML

A

BCR ABL chr 9, 22 philadelphia
mature myeloids, basophils and eosinophils on smear
granulocyte left shift

tx: tyrosine kinase inhib (imatinib)
allogenic SCT

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22
Q

MRI sequences for CNS tumours

A

T1: CSF low signal (dark)
T2: CSF high signal (white)
FLAIR: for periventricular
STIR

23
Q

indications for stereotactic brain RTX

A

AVM lesions not amenable to coiling or clipping
vestibular schwannoma
mets

24
Q

indications for brain metastectomy

A

patient is fit
symptomatic lesions is accessible
good prognosis of primary

25
indications for surgery for pituitary tumours
non functional with mass effects cushings acromegaly acute visual deterioration pituitary apoplexy
26
colorectal TNM
to- no evidence tis- in situ t1- submucosa t2- muscularis mucosa t3- subserosa or non peritonealised tissues t4- other organs or structures or perforates visceral peritoneum n1- 1-3 regional nodes n2- 4 regional nodes adjuvant chemo for stage 3 FUFA
27
colorectal cancer surgery abx prophylaxis
metro and cephalosporin at induction and 2 doses post op
28
indication for endometrial biopsy
> 4mm thickness
29
endometrial staging
FIGO 1: uterus body 2: uterus and cervix 3: beyond uterus within pelvis 4: bladder/bowel/beyond
30
endometrial ca treatment
internal/external RTX progesterone if still wanting to conceive CTx stage 3-4 hysterectomy: stage 1- hysterectomy and BSO stage 2-3- radical hysterectomy with nodes, cervix and top of vagina stage 4- debulking
31
driving and seizures
inform after 1st episode no driving for 6 months 1st seizure normal EEG no driving for 12 months if abnormal can drive if seizure free for 1y or nocturnal only for 3y vocational or group 2 license requires seizure and antiepileptic meds free for 10y
32
gastric ca Lauren classification
diffuse: poorly differentiated, aggressive intestinal type: well differentiated and slow growing, more common in men
33
first line antieplipetics
gen tonic clonic: valproate focal: carbamaz absence: ethosux
34
treating gastric ca
resection for T1/2 gastrectomy for > t2 or > N0 adjuvant chemo trastuzumab for HER2 metastatic adenocarcinoma triple therapy to eradicate h pylori
35
liver transplant criteria for liver ca
single tumour smaller than 5cm no vasc or metastatic spread AFP < 1000
36
treatment for cholangiocarcinoma
resection or transplant if unresectable at presentation capecitabine post resection CTx if inoperable: Gem/Cis FOLFOX second line palliative stenting to relieve jaundice
37
diagnosing and treating hodgkins lymphoma
raised neutrophils, platelets, eosinophils, ESR, LDH normocytic anaemia LDH guides volume of disease test for HIV biopsy: reed sternberg ABVD BEACOPP autologous SCT adjuvant RTX for stage I or II
38
lung cancer treatment
NSCLC: CTX for stage 2/3 or not suitable for surgery RX if surgery not suitable or can't tolerate CTX ablation for primary and secondary lung ca photodynamic therapy for localised inoperable endobronchial ca SCLC: surgery for early stage CTX +/- RTX for limited stage CTX for extensive stage repeat CTX for recurrence RTX for palliation
39
lung ca paraneoplastic syndromes
SCLC: lambert eaton, ACTH, SIADH squamous: PTH and bony mets, TSH large cell: gynaecomastia adenocarcinoma: gynaecomastia, HPOA- periostitis, clubbing, arthritis
40
BRCA1 and 2
BRCA1: chr 17 long arm, auto dom. assoc w/ female breast, ovarian, prostate, colon BRCA2: chr 13 long arm. assoc w/ breast, ovarian
41
indications for CTX for breast ca
premenopausal lymph node positive ER negative grade III large tumour lymphovascular invasion benefits of neoadjuvant: monitor response and optimise CTx regime reduce size to allow breast conserving surgery
42
indications for mastectomy
> 4cm or multifocal or central
43
NHL treatment
CHOP or FCR CTX MTX + dex for primary CNS lymphoma
44
pancreatic cancer treatment
neoadjuvant chemo if borderline resectable adjuvant gemcitabine + capecitabine folfirinox or gemcitabine or oxiplatin for metastatic
45
peutz jeghers
auto dom STK11 chr 19 perioral and mucosal pigmentation GI hamartomatous polyps GI, pancreas, lung, breast, thyroid, uterus, ovaries, testes malignancy 2 yearly colonoscopy > 25y
46
prostate ca diagnosis
transrectal ultrasound with 10-12 random biopsies MRI for staging
47
prostate ca staging
T1- clinically unapparent T1a- incidental finding at TURP T1b- incidental at TURP, > %5 tissue resected T1c- identified on biopsy due to PSA T2- palpable, confined to prostate T2a- half a lobe or less T2b- > half a lobe T2c- both lobes T3 extracapsular extension T4 adjacent structures beyond seminal vesicles Gleason grading 2 areas out of 5
48
prostate ca treatment
T1 and 2 potentially curable T3 and 4 considered advanced radical RTX or prostatectomy antiandrogens LHRH antagonists
49
types of testicular ca
seminomas: homogenous macroscopic appearance sheets of clear cells classic, anaplastic and spermatocytic non seminoma GCT: embryonal- glands or papules yolk sac- schiller duval (look like glomeruli) choriocarcinoma- look like cytotrophoblasts teratoma most have mixed pattern stromal tumours and lymphomas
50
testicular tumour markers
AFP (non seminomas) BHCG (mostly non seminomas) LDH (non specific) PLAP (seminomas)
51
testicular ca treatment
radical orchidectomy metastatic NSGCT: BEP CTX, resect residual masses seminoma: carboplatin single dose post op seminoma w/ mets: RTX +/- CTX
52
tumour lysis syndrome
raised urea, potassium, phosphate tx: IV fluids allopurinol (won't treat hyperuricaemia) urate oxidase (to treat hyperuricaemia) sodium bicarb calcium dialysis febuxostat
53
NSE tumour marker
SCLC neuroblastoma
54
ca 19-9 cancers
pancreas bowel lung gall bladder

MRCP 2 (12 decks)

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