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)
What is an important blood test to do in acute leukaemia?
- Clotting profile - may be coagulopathy
- Urate
- LDH
What is seen on blood film with ALL and AML and how do you differentiate between the two?
IMPORTANT
- Blasts
- Need bone marrow aspirates to do flow cytometry and immunophenotyping
What tests are done on bone marrow biopsy?
- Flow cytometry
- Immunohistochemistry
- Cytogenetics e.g karyotyping, FISH for things like BCR-ABL
Hydroxycarbamide is used for cytoreduction if the WCC are really high in leukaemia. What do you need to think about when giving this?
- Prophylaxis for TLS
- Monitor FBC as will lower WCC but also RBC and platelets so may need transfusion of these
How can you monitor the response of treatment for CML?
Monitor BCR-ABL load by PCR
What staging investigation is needed and what is NOT needed for Hodgkin’s lymphoma?
- PET-CT: can upstage normal CT
- ESR: prognostic marker
DO NOT NEED BONE MARROW BIOPSY
How is Hodgkin’s lymphoma treated?
Radiotherapy PLUS chemotherapy
High cure rate with no stem cell transplant
What is the long term sequelae after treatment for HL?
- Secondary leukaemia, lymphoma, sarcoma, breast cancer
- Cardio and respiratory issues from chemo drugs
What lymphoma is Rituximab used for?
NHL
What is the characteristic cytogenetics for AML?
T(8:21)
What is done to determine clonality of plasma cells?
Flow cytometry
What examination do you need to do on a patient with suspected MSCC?
- Neuro exam: UMN signs and sensory level
- PR Exam
What cancers are associated with MEN syndromes?
MEN1
Pituitary
Paraythroid
Pancreatic
MEN2a
Thyroid
Parathyroid
Phaeochromocytoma
MEN2b
Thyroid
Phaeochromocytoma
Mucosal neuromas
Associated with GI symptoms and craniosyntosis
