Back pain Flashcards
common sites of the spine for degenerative spinal disease
cervical and lumbar area
medication that requires DEXA scan monitoring, and why
indication for medication
aromatase inhibitors; lower oestrogen levels which can accelerate bone loss
indicated in previous history of breast cancer
management by GP for suspected metastatic spinal cord compression
urgent (24-48 hours) MRI whole spine
7 symptoms suggestive of metastatic spinal cord compression
- progressive pain in spine
- severe unremitting spinal pain
- spinal pain aggravated by straining e.g. cough, sneeze, moving
- band like pain
- local spinal tenderness
- nocturnal spinal pain preventing sleep
- neuro symptoms: radicular pain, limb weakness, walking difficulty, sensory loss, bowel/bladder dysfunction
when should the MSCC coordinator be contacted
within 24 hours
2 curative treatments
- surgery
- radical radiotherapy
aim of palliative care?
- increase life expectancy
- improve symptoms now + in the future
adjuvant therapy
- occurs following surgery that has been curative
- systemic treatment aimed at reducing the chance of relapse
systemic treatment options for MSCC
- endocrine therapy
- chemotherapy
- HER2 targeted therapy
- bone targeted therapy
further blood tests following MSCC
FBC: bone marrow infiltration can lead to bone marrow suppression: anaemia + thrombocytopenia
Bone profile: hypercalcaemia
U + E: if hypercalcaemia found
LFTs: marker for liver mets
management of hypercalcemia from bone mets
1st line saline
2nd line IV bisphosphonate infusion
what is vertebroplasty?
injecting cement into a collapsed vertebral body, to help with pain control
Tamoxifen
selective oestrogen receptor modulator; which blocks receptors; preventing oestrogen from reaching them
aromatase inhibitors
prevent conversion of androgens to oestrogens; therefore reducing the level of oestrogen in the blood to undetectable levels
only effective in post menopausal women
hormonal treatments for ER positive cancer (3)
- Tamoxifen
- Aromatase inhibitors
- Fluvestrant
drug to lower oestrogen levels in post menopausal women
Aromatase inhibitors
Fluvestrant
% breast cancers that are Her2 positive
15
combination 1st line trx for Her2 positive breast cancer
- Pertuzumab
- Trastuzumab
- Docetaxel (chemotherapy)
mechanism of Trastuzumab
interacting with HER2 receptor and preventing it being stimulated by growth factors
what can be affected by both Pertuzumab + Trastuzumab
and consequently what must be assessed
cardiac function
LVEF prior to starting and at regular intervals while they continue to receive them
2 ways of measuring LVEF
- echo
- MUGA scan (multi gated acquisition scan… nuclear medicine scan)
What is denosumab
monoclonal antibody, RANK ligand inhibitor
denosumab can treat (2)
- metastatic cancers
- osteoporosis
what is denosumab effective at reducing
skeletal related events e.g. fractures, spinal cord compression, need for interventional surgery or radiotherapy
long term trx of bone mets
denosumab
2 important side effects of denosumab
- hypocalcaemia
- jaw osteonecrosis
Red flags in back pain
- previous hx malignancy
- age < 16 or > 50 years with new onset pain
- previous long standing steroid use
- recent serious illness
- recent significant infection
red flag signs
- saddle anaesthesia
- reduced anal tone
- hip/knee weakness
- generalise spinal deformity
- urinary retention
