2 - Investigation and Diagnosis Flashcards
What are causes of raised AFP?
- Hepatocellular carcinoma
- Liver metastasis
- Neural tube defects
- Germ cell tumours
What are some differentials for a mass in the liver?
- Hepatocellular carcinoma
- Lymphoma
- Cholangiocarcinoma
- Haemangioma
- Hepatic abscess
- Metastatic lesions.
What are some differentials for SOB in oncology patients?
- Ascites
- Hepatomegaly
- PE
What are some differentials for confusion in oncology patients?
- Metabolic disturbance (hypoglycaemia, hypercalcaemia)
- Infection (pneumonia, UTI)
- Metastatic spread to the brain
- Anaemia
- Intense pain
- Side effects of pain medication
What PRN medications are written up for anticipatory medications?
- Morphine
- Midazolam
- Levomepromazine
- Glycopyrronium bromide
If you are referring someone from GP for a 2 week wait what information do you need give them?
- Explain to people they are being referred to a cancer service. Reassure them, as appropriate, that most people referred will not have a diagnosis of cancer, and discuss potential alternative diagnoses with them
- Assess if they need support in the interim
- Advise people who may not meet the referral criteria to contact you again if their symptoms persist or progress.
- Give people information on their possible diagnosis (both benign and malignant), in accordance with their wishes for information
- What type of tests may be carried out and what will happen during these procedures.
What are the principles of a good screening programme?
Disease
1. Known aetiology and risk factors
2. Known natural history
3. High incidence and/or prevalence
4. High morbidity and/or mortality
Testing
1. Simple
2. Acceptable
3. Valid
4. Reliable
Treatment
1. Available
2. Acceptable
3. Effective
4. Benefits from early detection
Programme
1. Cost-effective
2. Agreed protocol
3. Quality assurance
4. Does “more good than harm”
How should you treat immunotherapy side effects?
Steroids
Immunotherapy works by stimulating immune system so need to suppress immune system
What size do you consider lymphadenopathy to be pathological and what investigation should you do?
>3cm
Do a lymphoreticular exam then excision lymph node biopsy
Which department from GP should you refer a patient to for cervical lymphadenopathy?
ENT as will need excision lymph node biopsy even if lymphoma
FNA cannot be done as may miss cancer
Why is doing an FBC important in the work up for lymphoma?
Hb and platelet involvement suggests that there is a bone marrow infiltration
So bone marrow biopsy will be needed
How should you treat low grade lymphomas?
Watch and wait until they get symptomatic as can live normal life without the chemo making them sick
What do you think has happened and what should you investigate?
Either progression or transformation to higher grade
What do you think has happened and what should you investigate?
Why may this patient have pancytopenia?
Either progression or transformation to higher grade
Do a CT CAP and then CT guided core biopsy of biggest mass. No point biopsying old lymph nodes as these may not have transformed yet
Pancytopenia from bone marrow infiltration
If someone has a high LDH what should we be thinking about?
Risk of tumour lysis syndrome
What are the causes of the following splenomegaly:
- Massive
- Moderate
- Mild
Massive
- Myelo and Lymphoproliferative disorders
- Myelofibrosis
- CML
- Malaria
- EBV
- Gaucher’s
Moderate
- Portal hypertension e.g. secondary to cirrhosis
- Haemolytic anaemia
- Infective endocarditis
- Sickle-cell, thalassaemia
- Rheumatoid arthritis (Felty’s syndrome)
