Oncology

Question 1

What cancers have screening programmes ?

Answer 1

Breast
Cervix
Bowel

Question 2

What are the 6systemic red flags symptoms of cancer ?

Answer 2

• Unexplained weight loss
• Loss of appetite
• Fatigue
• Back pain
• Night sweats
• Unexplained anaemia

Question 3

what is the WHO performance status ?

Answer 3

• 0 = fully active
• 1 = Restricted in physical strenuous activity but ambulatory and able to carry out light work.
• 2 = Ambulatory and capable of all self care. No work activities. Awake for >50% of waking hours.
• 3 = Confined to bed / chair >50% of working hours
• 4 = bed bound.

Question 4

What are the 4 types of treatment in regards to non surgical oncology

Answer 4

• Curative / radical = aims to cure
• Neoadjuvant = therapy before surgery / radiotherapy with aim to shrink cancer
• Adjuvant = aims to reduce risk of local or distant recurrence by treating metastatic disease. After surgery.
• Palliative = not curative but aimed at improving quality of life and survival

Question 5

What is neutropenic sepsis ?

Answer 5

• Complication of cancer therapy, usually occurring 7-14 days after treatment

Question 6

How is neutropenic sepsis defined ?

Answer 6

• Neutrophil count of <1*10^9 + either :
• Temp of higher than 38
• Other signs / symptoms consistent with clinically significant sepsis

Question 7

what is the most common cause of neutropenic sepsis ?

Answer 7

• Staphylococcus epidermidis

Question 8

What can be given as prophylaxis to neutropenic sepsis ?

Answer 8

• Fluoroquinolone
• Antifungals
• Granulocyte colony-stimulating factor (G-CSF)

Question 9

How is neutropenic sepsis managed ?

Answer 9

• Immediate empirical therapy ( IVTazocin = piperacillin + tazobactam)
• DO NOT wait for FBC, aim to give within an hr of presentation.

Question 10

What 5 cancers most commonly spread to bone ?

Answer 10

1. Prostate
2. Breast
3. Lung

• Kidney
• Thyroid

BLT ketchup please

Question 11

How is malignancy spinal cord compression managed ?

Answer 11

• Same day whole spine MRI.
• High dose steroids = dexamethasone 8mg BD with PPI and monitor BMs)
• Urgent discussion with oncology and spinal surgeons.
• Surgical decompression / stabilisation vs radiotherapy

Question 12

How can malignant spinal cord compression present ?

Answer 12

• WORSENING back pain -> worse on lying / coughing
• Lower limb weakness
• Sensory loss / changes
• Bowel or bladder dysfunction
• Radicular pain
• Abnormal neurological examination

Question 13

Where are the neurological signs seen dependent on the level of spinal cord compression ?

Answer 13

• Lesion above L1 = UMN signs in legs and a sensory level
• Lesion below L1 = LMN signs in the legs and perianal numbness.

Question 14

Other than bone pain, what features are seen in bone metastases ?

Answer 14

• Pathological fractures
• Hypercalcaemia
• Raised ALP

Question 15

What can cause malignant hypercalcaemia ?

Answer 15

• Bone metastases = osteolysis
• Humoral = PTHrP in squamous cell lung cancer
• Dehydration

Question 16

How does hypercalcaemia present ?

Answer 16

• Kidney stones
• Bone pain
• GI : abdo pain, vomiting, constipation
• Psych : depression

Question 17

How is malignant hypercalcaemia managed ?

Answer 17

• Correct dehydration : 0.9% saline 3-4L
• Following rehydration : IV bisphosphonates (Zolendronic acid)

Question 18

Why are IV bisphosphonates used in hypercalcaemia and what are their SE ?

Answer 18

• They inhibit osteoclasts.
• Se : flu like symptoms, bone pain, myalgia, reduced phosphate levels, N&V, headache

Question 19

what cancer most commonly causes SVC obstruction

Answer 19

• Lung cancer
• Lymphoma

Question 20

6 Features of SVC obstruction

Answer 20

• Dyspnoea = most common symptom
• Swelling of the face, neck and arms
• Conjunctival and periorbital oedema
• Headache: often worse in the mornings
• Visual disturbance
• Pulseless jugular venous distension

Question 21

How is SVC obstruction diagnosed ?

Answer 21

• CXR + widened mediastinum
• CT scan

Question 22

How is SVC obstruction managed ?

Answer 22

• Elevation of head and O2 for symptomatic relief
• High dose steroids
• Endovascular stenting
• Further radio/chemotherapy depends on the type of cancer

Question 23

what carcinogens are associated with what cancers ?

Answer 23

1. Aflatoxin = hepatocellular carcinoma
2. Aniline dyes = bladder (transitional cell carcinoma)
3. Asbestos = mesothelioma and bronchial carcinoma
4. Nitrosamines = oesophageal and gastric
5. Vinyl chloride = hepatic angiosarcoma

Question 24

Common SE of chemotherapy

Answer 24

• N&V
• Fatigue
• Sepsis
• Myelosuppression
• Impact on renal liver function
• Alopecia
• Blood clots
• Infertility
• Allergic reactions

Question 25

what kind of chemotherapy is cyclophosphamide ?

Answer 25

- Alkylating agent = causes cross-linking of DNA

Question 26

Give 3 adverse effects of cyclophosphamide

Answer 26

-> Haemorrhagic cystitis (mesna used to prevent) -> Myelosupression -> Transitional cell; carcinoma

Question 27

CA 125

Answer 27

- CA 125 = ovarian

Question 28

What tumour antigens are associated with what cancers ?

Answer 28

- PSA = prostatic carcinoma - AFT = hepatocellular carcinoma, teratoma - Carcinoembryonic (CEA) = colorectal - S-100 = melanoma, schwannomas - Bombesin = SCLC, gastric and neuroblastoma

Question 29

Give an example of an anthracycline cytotoxic agent, how it works and an adverse effect

Answer 29

- Doxorubicin - Inhibits DNA & RNA synthesis - Cardiomyopathy

Question 30

Give an example of an antimetabolite cytotoxic agent and its advertse effcets

Answer 30

- Methotrexate - Myelosuppression, mucositis, liver fibrosis and lung fibrosis

Question 31

How does Docetaxel work and what is an adverse effect ?

Answer 31

- Prevents microtubule depolymerisation - Neutropenia

Question 32

Tumour markers for recurrence of testicular teratoma

Answer 32

Alpha-fetoprotein Beta-HCG

Question 33

Tumour marker for breast cancers

Answer 33

CA 15-3

Question 34

Tumour marker for pancreatic cancer

Answer 34

CA 19-9

Question 35

Tumour marker for hepatocellular carcinoma

Answer 35

Alpha-fetoprotein

Question 36

what does a PET scan demonstrate

Answer 36

Glucose uptake

Question 37

what is the BRCA2 mutation associated with in men

Answer 37

Prostate cancer

Question 38

Medication to help with N&V caused by intracranial masses

Answer 38

Dexamethasone

Question 39

Action of cyclophophamide and 3 adverse effects

Answer 39

- Alkylating agent - Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

Question 40

Adverse effect of bleomycin

Answer 40

Lung fibrosis

Question 41

Adverse effect of anthracyclines (e.g. doxorubicin)

Answer 41

Cardiomyopathy

Question 42

4 SE of methotrexate

Answer 42

Myelosuppression Mucositis Liver fibrosis Lung fibrosis

Question 43

3 SE of fluorouracil

Answer 43

Myelosupression Mucositis Dermatitis

Question 44

most common lung cancer in non smockers

Answer 44

Adenocarcinoma

Question 45

Lung cancer most strongly associated with smoking

Answer 45

squamous cell cancer

Question 46

SE of 6-mercaptopurine

Answer 46

Myelosuppresion

Question 47

2 SE of cytarabine

Answer 47

Myelosuprresion, ataxia

Question 48

2 Adverse effect of vincristine

Answer 48

Peripheral neuropathy Paralytic ileus

Question 49

se of docetaxel

Answer 49

Neutropenia

Question 50

3 SE of Cisplatin

Answer 50

Hypomagnesaemia Ototoxicity Peripheral neuropathy

Question 51

SE of hydroxycarbamide

Answer 51

Myelosupression

Question 52

CA 19-9

Answer 52

pancreatic cancer

Question 53

CA 15-3

Answer 53

breast cancer

Question 54

Alpha-feto protein

Answer 54

Hepatocellular carcinoma Teratome

Question 55

Carcinoembryonic antigen

Answer 55

Colorectal cancer

Question 56

S-100

Answer 56

Melanoma Schwannomas

Question 57

Bombesin

Answer 57

SSLC Gastric cancer Neuroblastoma

Question 58

Calcitonin

Answer 58

Medullary thyroid cancer

Question 59

HPV strains associated with cervical cancer

Answer 59

16,18 and 33