Blue book - cancer Flashcards
What current screening programmes for cancer are there? Give brief details for each
- Breast cancer
50-70yo women
mammography every 3 years - Cervical cancer
25-65yo women
cervical smear every 3 years (when 49 every 5 years) - Colorectal cancer
60-69 (stretched to 74)
Faecal occult blood every 2 years
What cancer does is tumour marker CEA used in?
Coloectal cancer
What cancer is CA125 raised in?
Ovarian cancer
What cancer is alpha fetoprotien rasied in?
Hepatocellular carcinoma
What cancer/s is hCG raised in?
- Hydatiform moles/trophobastic disease
- Testicular cancer
- Some seminomas
What cancer is Bence Jones protein found in urine?
Myeloma
What is the definition of neutropenic sepsis?
Neutrophil count less than 1x10^9 per litre and a temperature of >38 or other signs/symptoms of infection
What investigations shoud you do in neutropenic sesis
SEPTIC SCREEN
- FBC, U&E, LFT, CRP, Lactate
- Blood cultures - 2x anerobes and anaerobes (and any line central or peripheral)
- Swabs as indicated
- Urinary MCS
If symptoms suggest
a. CXR
b stool test
What score can you calculate for patients with neutropenic sepsis?
MASCC - looks at risk of complications during neurtopenic febrile episode and burden of infection, co morbidities etc
When should you give G-CSF (colony stimulating factors)? (3)
- if neutrophils <0.1
- predict >10 days
- severe sepis/multi organ failure/co - morbidities
They promote stem cell proliferation and shorten duration of neutropenia
What is the usual management of neutropenic sepsis?
Broad spectrum abx (Tazocin) within 1hr
Describe the body’s response to low calcium in the blood?
Parathyroid releases PTH
In bone - promotes osteocasts to release calcium from bone
In kidney: stimulates kidney to absorb calcium and activates vit D
In bowel: activated vit D leads to increased absorption of calcium
= increases calcium
Describe the body’s response to high calcium levels?
Thyroid releases calcitonin
In bone - promototes osteobasts to deposit calcium in bones
In Kidneys - reduces absorption of calcium
What are the 2 ways tumours lead to hypercalcaemia?
- Produce PTH related peptide
- Transforming growth factor alpha (TGFa) - which is a powerful stimulator of bone resorption (promotes osteoclast activity)
What are the most common cancer causes of hypercalcaemia? (6)
- Squamous cell carcinoma of the lung
- Head and neck cancer
- Renal carcinoma
- Blood cancers - Myleoma and lymphoma
- Breast cancer
- Prostate cancer
What are the symptoms of hypercalcaemia (work head to toe)
- CNS - confusion, seizures, proximal neuropathy, HYPOreflexia, coma
- Cardiac - arrythmia and arrest (short QT, bradycardia, wide T wave, prolonged bundle branch block)
- GI - constipation, abdo pain, n+v
- Urinary - polyuria and polydipsia
- General - dehydration, weakness, fatgiue, bone pain
Bones (bone pain) , moans (weird mental state), stones (kidney) and groans (constipation)
Investigation for suspected hypercalcium?
Serum calcium
What is the management for hypercalcaemia?
FLUIDS 1L saline 4 hourly over 24h 1L saline 6 hourly over next 48-72h With adequate K+ Consider Furosemide if at risk of fluid overload
BISPHOSPHONATES- IV pamidronate or Zoledronic acid
CALITONIN + CORTICOSTEROIDS - if arrythmias/seizures
Define MSCC
Tumour or mets in vertebral body or paraspinal region pressing on the spinal cord
(2/3 in thoracic region)
What are the red flags for MSCC? (6)
- Leg weakness
- Sensory loss
- Thoracic back pain
- Constant pain at night and rest
- Urinary retention/faecal incontinence
- Saddle anaaesthesia - loss of anal tone
Management for suspected MSCC
- 16mg dexamethasone + PPI cover
- MRI scan within 24h
- Radiotherapy within 24h of diagnosis
What is the prognosis of MSCC?
Bad. Only 57% regain motor function
What cancers most commonly cause MSCC? (4)
- Breast
- Prostate
- Lung
- myeloma and lymphona
Define SVCO
Extrinsic comperession, thrombosis or invasion or the invasion of the wall of SVC
In terms of cancer what is the most common mechanism of SVCO?
Extensive lymphadeonpthy in the upper mediatistnum caused by lung cancer of lymphoma
What are the sympmtoms and signs of SVCO?
- breathlessness
- headache worse on coughing
- Swelling - face/neck/arm
- Distended neck and chest veins
- Visual disturbances
- Hoarse voice
- Cyanosis
What is the management for SVCO?
- 16mg Dexamethasone (+PPI)
- Vascular stent = normal choice followed by radiotherapy or
chemotherapy depending on cancer type
LMWH if thrombus confirmed
How would you investigate the cause of SVCO if this was the initial presentation?
- Biopsy is important
2. If germ cell tumour possible then tumour markers (AFP, βhCG, LDH) may be useful.
What is the management of a major hemorrhage? (in context of palliative care)
Symptom control mus be fast and effective
- Green towels to absorb and reduce visual impact of blood loss
- Midazolam IV/SC
What are the malignant causes of SVCO? (7)
- Lung cancer
- Lymphoma
- Mediastinal lymphadenopathy
- Germ cell tumours
- Thymoma
- Oesophageal cancer
- Tumour associated thrombus
What are the benign causes of SVCO? (5)
- Non malignant tumours eg goitre
- Mediastinal fibrosis (idiopathic or post radiation)
- Infection - TB
- Aoritc anuerysm
- Thrombus associated within indwelling catheters
What is von-Hippel Lindau syndrome?
Hereditray condition leading to tumours arising in multiple organs
What is Li-fraumeni syndrome?
Inherited familial predisposition to a wide range of certain, often rare, cancers. This is due to a change (mutation) in a tumor suppressor gene known as TP53.
Which chemicals are associated with cancer? (5)
- Cigarette smoke - cause specific mutations in the p53 tumour supressor gene
- Aromatic amines -bladder cancer
- Benzene - Leukaemia
- Wood dust - nasal adenocarcinoma
- Vinyl chloride - angiosarcomas
Characteristic translocations may be induced by the topoisomerase inhibitors (type of drug) and cause what cancer?
Acute leukaemia
