22- Oncology & Transplant Explains Flashcards
What is the breakthrough dose of morphine in relation to the daily dose?
The breakthrough dose of morphine is one-sixth of the daily dose of morphine.
What should be prescribed to all patients receiving opioids?
All patients receiving opioids should be prescribed a laxative.
Should opioids be used with caution in patients with chronic kidney disease?
Yes, opioids should be used with caution in patients with chronic kidney disease.
Which opioids are preferred in palliative care prescribing for pain?
Alfentanil, buprenorphine, and fentanyl are preferred opioids in palliative care prescribing for pain.
What are the possible treatment options for metastatic bone pain?
Metastatic bone pain may respond to NSAIDs, bisphosphonates, or radiotherapy.
By how much should the next dose of opioids be increased when increasing the dose?
The next dose of opioids should be increased by 30-50% when increasing the dose.
How do you convert from oral codeine to oral morphine?
To convert from oral codeine to oral morphine, divide the dose by 10.
How do you convert from oral tramadol to oral morphine?
To convert from oral tramadol to oral morphine, divide the dose by 5.
How do you convert from oral morphine to oral oxycodone?
To convert from oral morphine to oral oxycodone, divide the dose by 2.
What is the approximate equivalent dose of oral morphine sulphate (80-90mg over 24 hours) to one ‘25 mcg/hour’ fentanyl patch?
The approximate equivalent dose of oral morphine sulfate (80-90mg over 24 hours) to one ‘25 mcg/hour’ fentanyl patch can be found in the product literature and should be consulted.
How do you convert from oral morphine to subcutaneous diamorphine?
To convert from oral morphine to subcutaneous diamorphine, divide the dose by 3.
How do you convert from oral oxycodone to subcutaneous diamorphine?
To convert from oral oxycodone to subcutaneous diamorphine, divide the dose by 1.5.
What is the main screening test for colorectal cancer in the NHS?
The main screening test for colorectal cancer in the NHS is the faecal occult blood (FOB) test, which is being replaced by FIT testing.
What happens if a patient has abnormal results from the FOB or FIT test?
Patients with abnormal results are offered a colonoscopy.
Who is eligible for colorectal cancer screening through the NHS national screening programme?
All men and women aged 60 to 69 years are offered screening every 2 years. Patients aged over 70 years may request screening.
What are the findings at colonoscopy for most patients?
Approximately 5 out of 10 patients will have a normal exam, 4 out of 10 patients will have polyps that may be removed due to their premalignant potential, and 1 out of 10 patients will have cancer.
What is the purpose of the NHS BOSS flexible sigmoidoscopy screening?
The NHS BOSS flexible sigmoidoscopy screening comprises a single flexible sigmoidoscopy for patients aged 55 years.
What are the symptoms that indicate the need for referral for further evaluation of colorectal cancer?
Patients with altered bowel habit for more than six weeks, new onset of rectal bleeding, or symptoms of tenesmus should be referred for further evaluation.
What are the options for diagnosing colorectal cancer aside from colonoscopy?
Other options for diagnosing colorectal cancer include double contrast barium enema and CT colonography.
How are patients with colonic cancer staged?
Patients with colonic cancer are staged using chest/abdomen and pelvic CT.
How are patients with rectal cancer evaluated for staging?
Patients with rectal cancer undergo evaluation of the mesorectum with pelvic MRI scanning.
What is the preferred system for staging colorectal cancer for examination purposes?
The preferred systems for staging colorectal cancer for examination purposes are the Dukes and TNM systems.
What is the main tumour marker in colorectal cancer?
The main tumour marker in colorectal cancer is carcinoembryonic antigen (CEA).
Are all colorectal tumors secrete carcinoembryonic antigen (CEA)?
No, not all colorectal tumors secrete carcinoembryonic antigen (CEA). It may also be raised in conditions such as inflammatory bowel disease (IBD).
How is carcinoembryonic antigen (CEA) used in follow-up for colorectal cancer?
Carcinoembryonic antigen (CEA) levels, although not specific, roughly correlate with disease burden and are once again being used routinely in follow-up.
Are metastatic lesions affecting bone more common than primary bone tumors?
Yes, metastatic lesions affecting bone are more common than primary bone tumors.
Which are the typical tumors that spread to bone?
The typical tumors that spread to bone include breast, bronchus, renal, thyroid, and prostate tumors.
What is the age group most commonly affected by bone metastases?
Around 75% of cases of bone metastases affect individuals over the age of 50.
Which are the most common bone sites affected by metastatic lesions?
The most common bone sites affected by metastatic lesions are the vertebrae (usually thoracic), proximal femur, ribs, sternum, pelvis, and skull.
What type of bone lesions pose the greatest risk for pathological fracture?
Osteolytic lesions pose the greatest risk for pathological fracture.
How does the risk of fracture vary according to the extent of bone lesion involvement?
The risk of fracture varies according to the extent of bone lesion involvement. Bones with lesions occupying 50% or less of the bone are prone to fracture under loading, while when 75% of the bone is affected, torsion about a bony fulcrum may produce a fracture.
Which scoring system can be used to determine the risk of fracture in bone metastases?
The Mirel scoring system can be used to help determine the risk of fracture in bone metastases, and it is more systematic than the Harrington system.
What is the Mirel Scoring system used for?
The Mirel Scoring system is used to determine the risk of fracture in bone metastases.
What are the factors considered in the Mirel Scoring system?
The Mirel Scoring system considers points, site of the lesion, radiographic appearance, width of bone involved, and pain.
Can you provide an example of the Mirel Scoring system?
Score points , Site , Radiographic appearance, Width of bone involved , Pain
1 Upper extremity Blastic Less than ⅓ Mild
2 Lower extremity Mixed 1/3 to ⅔ Moderate
3 Peritrochanteric Lytic More than ⅔ Aggravated by functio
How is the treatment determined based on the Mirel Score?
Depending upon the score the treatment should be as follows:
Score Risk of fracture Treatment
9 or greater Impending (33%) Prophylactic fixation
8 Borderline Consider fixation
7 or less Not impending (4%) Non operative management
What treatment should be considered for isolated metastatic deposits?
For isolated metastatic deposits, consideration should be given to excision and reconstruction as the outcome is better.
What are the non-operative treatments for bone metastases?
Non-operative treatments for bone metastases include rehydration and bisphosphonates for hypercalcemia, opiate analgesics and radiotherapy for pain, and chemotherapy and/or hormonal agents for certain tumors like breast and prostate cancer.
What is the indication for endocrine therapy in breast cancer treatment?
Endocrine therapy is indicated for oestrogen receptor-positive tumors, downstaging primary lesions, and definitive treatment in old or infirm patients.
When is irradiation used in breast cancer treatment?
Irradiation is used after wide local excision and in cases of large lesions, high grade tumors, or marked vascular invasion following mastectomy.
Which endocrine agents are commonly used in breast cancer treatment?
Tamoxifen is commonly used as a partial oestrogen receptor agonist in breast cancer treatment. Aromatase inhibitors are preferred in postmenopausal women, while tamoxifen is initially used in perimenopausal women before switching at 3 years. Exemestane is increasingly preferred over tamoxifen in premenopausal women.
When is chemotherapy used in breast cancer treatment?
Chemotherapy is used to downstage advanced lesions to facilitate breast conserving surgery and in patients with grade 3 lesions or axillary nodal disease.
What is the most commonly used chemotherapy regime in breast cancer treatment?
The FEC regime (Fluorouracil, epirubicin, and cyclophosphamide) is most commonly used in breast cancer treatment. In high-risk patients, a regime of docetaxal, doxorubicin, and cyclophosphamide may be used.
What percentage of chemotherapy cases may be complicated by extravasation reactions?
Up to 6% of chemotherapy cases may be complicated by extravasation reactions.
What should be considered when using anthracycline class drugs in breast cancer treatment?
Anthracycline class drugs, which include trastuzumab, have marked cardiotoxicity, which can limit their use in some cases.
What percentage of extravasation reactions may be complicated by ulceration?
Up to 30% of extravasation reactions may be complicated by the development of ulceration.
Which chemotherapy agents are recognized causes of extravasation reactions?
Doxorubicin, vincristine, vinblastine, cisplatin, mitomycin, and mithramycin are recognized causes of extravasation reactions.
What is the recommended approach for extravasation of vinca alkaloids?
Warm compresses have been found to be beneficial in extravasation of vinca alkaloids.
What should be done when an extravasation reaction is suspected?
When an extravasation reaction is suspected, the infusion should be stopped, and the infusing device should be aspirated. The extremity should be elevated.
What is the recommended approach for reducing the incidence of subsequent ulceration with doxorubicin extravasation?
Cold compresses have been shown to reduce the incidence of subsequent ulceration with doxorubicin extravasation.
What can be infused in some cases of extravasation, ideally within 5 hours of the event occurring?
Dimethylsulfoxide may be infused in some cases of extravasation, ideally within 5 hours of the event occurring.
Are corticosteroids or sodium bicarbonate recommended for extravasation injuries?
No conclusive evidence exists to support the use of corticosteroids or sodium bicarbonate for extravasation injuries.
How is extravasation of total parenteral nutrition solutions usually managed?
Extravasation of total parenteral nutrition solutions is usually managed by the local administration of hyaluronidase to the infusion site.
How are lung cancers classified according to histological subtypes?
Lung cancers are classified into small cell and non-small cell lung cancer based on histological subtypes.
Which is the most common variant of lung cancer?
Non-small cell lung cancer is the most common variant, accounting for 80% of all lung cancers.
What are the common subtypes of non-small cell lung cancer?
The common subtypes of non-small cell lung cancer are squamous cell carcinoma (25% cases), adenocarcinoma (40% cases), and large cell carcinoma (10% cases).
How do non-small cell lung cancers differ from small cell lung carcinoma in terms of prognosis and features?
Non-small cell lung cancers have a lower likelihood of paraneoplastic features and early disease dissemination compared to small cell lung carcinoma.
Which type of lung cancer is most commonly encountered in never smokers?
Adenocarcinoma is the most common type of lung cancer encountered in never smokers.
What are the characteristics of small cell lung carcinoma?
Small cell lung carcinomas are comprised of cells with a neuroendocrine differentiation. They are strongly associated with smoking and typically arise in the larger airways. They disseminate early in the course of the disease and, although chemosensitive, long-lasting remissions are rare.
What percentage of lung cancer cases are suitable for surgery?
Only 20% of lung cancer cases are suitable for surgery.
Why is mediastinoscopy performed prior to surgery in non-small cell lung cancer?
Mediastinoscopy is performed prior to surgery because CT scans do not always show mediastinal lymph node involvement.
How do non-small cell lung cancers typically respond to chemotherapy?
Non-small cell lung cancers generally have a poor response to chemotherapy.
What are the treatment options for non-small cell lung cancer?
The treatment options for non-small cell lung cancer include curative or palliative radiotherapy and chemotherapy.
What lung function tests may be recommended if FEV1 is below the cut-off point for lobectomy or pneumonectomy?
If FEV1 is below the cut-off point for lobectomy (< 1.5) or pneumonectomy (< 2.0), some authorities may recommend further lung function tests to determine if the operations can still proceed based on the results.
What is the general cut-off point for FEV1 in determining surgery eligibility?
FEV1 < 1.5 liters is considered a general cut-off point for determining surgery eligibility.
What are the different modalities of tissue sampling?
The different modalities of tissue sampling include fine needle aspiration cytology, core biopsy, excision biopsy, Tru cut biopsy, punch biopsy, cytological smears, and endoscopic or laparoscopic biopsy.
What are the contraindications for surgery in non-small cell lung cancer?
The contraindications for surgery in non-small cell lung cancer include poor general health, stage IIIb or IV disease (i.e., presence of metastases), malignant pleural effusion, tumor near the hilum, vocal cord paralysis, and SVC obstruction.
What are the limitations of fine needle aspiration cytology (FNAC)?
Fine needle aspiration cytology can be limited by operator inexperience and the lack of histological architectural information.
How is fine needle aspiration cytology (FNAC) performed?
Fine needle aspiration cytology is performed by passing a needle through a lesion while applying suction to a syringe. The obtained material is expressed onto a slide and sent for cytological assessment.
What are core biopsy and tru cut biopsy?
Core biopsy and tru cut biopsy are methods of obtaining tissue samples. Core biopsy uses a spring-loaded gun with a needle passing quickly through the lesion, while tru cut biopsy involves manually moving the needle.
When is image guidance desirable for core biopsy and tru cut biopsy?
Image guidance, such as in breast lesions, may be desirable when performing core biopsy and tru cut biopsy.
