901. Oncology tutorials part 2

Question 1

What cancers are likely to spread to the bone?

What is a common site of collapse?

Answer 1

Breast, bronchus, prostate, myeloma, renal cancer.

Thoracic spine

Question 2

What is usually found when taking a history/exam of these patients?

Answer 2

Back pain
Radicular in distribution (radiating along dermatome)
Worsening. worse with cough/sneeze/move
Progressive weakness and sensory loss (leg)
Urinary incontinence/retention

upper motor neuron finding, sensory issues, bladder issues

Question 3

What investigations are done in this instance?

Answer 3

MRI of whole spine (gold standard)
CT if patient is not known to have cancer
Check serum calcium

Question 4

How are spinal cord compressions manged?

Answer 4

Supportive- lie flat, monitor output, physio
Steroids-dexamethasone 8mg 2x day
Surgery- decompression and stabilisation if patient fit
Chemo- only if tumour is chemo sensitive
Radiotherapy- targeted at level of compression

Question 5

What causes superior vena cava obstruction?

Answer 5

Bronchogenic carcinoma
Lymphoma
Metastatic tumours- renal cancer, germ cell

Question 6

What signs of svc obstruction would you see on examination?

Answer 6

distention of neck and chest wall veins
Fixed elevated JVP
Facial oedema/puffiness
Oedema of the arms
Plethora of the face
Peripheral cyanosis

Question 7

What investigations are done for suspected SVC obstruction?

Answer 7

Staging for new malignancies
CXR
CT 
Superior venacavogram
Bronchoscopy in lung primary

Question 8

How is SVC obstruction managed?

Answer 8

Steroids and supportive measures
Radiotherapy
Chemotherapy
Stenting of SVC
Thrombolysis and anticoagulation

Question 9

What are the normal ranges for calcium?

What if the difference between bound and unbound calcium?

Answer 9

Normal range 2.2-2.6 mmol/l

Corrected calcium= excluding the calcium bound to albumin so only look at free calcium.

Question 10

What causes hypercaclemia in oncology patients?

Answer 10

Bone metastases

Para- neoplastic syndrome production of PTH-rp

Question 11

What are the signs and complications of hypercalcemia

Answer 11

Osmotic features
Cognitive impairment (fatigue,lethargy,psychosis)
Constipation, N+Renal failure
Cardiac arrhythmias

Question 12

How do you manage hypercalcemia?

Answer 12

Check PTH if cause unclear
rehydration 4-6 litres 0.9% saline
Loop diuretic if required
Bisphosphonates (zoledronate 4mg)
Calcitonin
Steroids