Cancer Flashcards
A patient with a high-grade aggressive cancer presents in the first few days after chemotherapy initiation, reporting feeling ill with nausea/ vomiting, muscle cramps, and reduced urine output (oliguria). This is also often accompanied by generalised weakness, paraesthesias, and palpitations.
What blood tests would confirm the likely diagnosis?
Tumour lysis syndrome: UnEs - uric acid, K+; Additionally, get calcium and phosphate.
↑ potassium, ↑ phosphate, ↓ calcium, and ↑ uric acid levels.
Tumour cell lysis → release of intracellular ions (potassium, phosphate) and nucleic acids into the bloodstream. Nucleic acids are metabolised to uric acid → crystallisation in renal tubules → acute kidney injury (AKI). Hyperphosphataemia from cellular phosphate release → phosphate binds calcium.
How does tumour lysis syndrome contribute to AKI?
- Nucleic acids are metabolised to uric acid → crystallisation in renal tubules → acute kidney injury (AKI).
- calcium-phosphate precipitation in kidneys.
Medication of choice to treat hyperuricaemia in tumour lysis syndrome.
Rasburicase. (In addition to aggressive IV fluids and treatments to correct electrolyte abnormalities.)
Rapidly reduces uric acid levels by breaking it down into a more soluble form.
Quicker than allopurinol – which prevents uric acid formation.
Immediate initial treatment of a suspected spinal cord compression.
PO high-dose dexamethasone 16mg/day
Prevent spinal oedema > causing more damage. Use upon suspicion.
List one complication that may follow high-dose steroids (e.g. with chemotherapy, or dexamethasone for spinal cord compression.)
Steroid-induced diabetes
Monitor glucose closely.
List 5 cancers that can cause bony metastases. (from head to toe)
What complications might this cause?
Give one complication that is an oncological emergency.
- Breast
- Lung
- Renal cell
- Prostate
- Multiple myeloma
Can cause osteolytic bone lesions: bone pain, hypercalcaemia, spinal cord compression (emergency).
RED FLAGS: back pain/radiculopathy, dermatomal changes in sensation, weakness (if limb), bowel/bladder dysfunction (if cauda equina)
A patient with cancer presents with severe back pain. What should you rule out when assessing the back pain?
Spinal cord compression.
First-line: MRI whole spine
Gold standard: Start dexamethasone immediately, then treat with radiotherapy. (within 24 hours)
Most common location of metastatic spinal compression.
Consider where they originate from.
Thoracic spine (60-70%), lumbar spine (20-30%), and cervical spine (10%).
May cause localised pain + dermatomal sensory changes/ pain.
First line antibiotic for neutropenic sepsis.
IV tazocin (tazopectam + piperacillin)
Allergic: IV meropenem
A-E assessment, Sepsis 6
First-line imaging for Superior vena cava obstruction.
Which 2 cancers increases the risk of SVCO?
Lung and lymphomas.
SVCO is characterized by ~ few weeks of progressive facial and neck swelling, accompanied by shortness of breath and a persistent cough. On examination, they have distended neck veins, facial cyanosis, and swelling of the upper limbs.Others symptoms can be present including hoarseness, swelling around the eyes, fatigue, chest pain, headaches, and dizziness.
Medication to improve symptoms of SVCO.
Dexamethasone, diuretics,
LMWH (if thrombosis)
Definitive treatment: endovascular stenting or other means e.g. radiotherapy
Management options for hypercalcaemia of malignancy.
Rehydration
IV Bisphosphonates
Denosumab
Why is performance status important in cancer?
E.g. grossly:
1: mild or minimal
2: mostly okay
3/4: doesn’t get out of bed etc.
Assess fitness for surgery and how aggressive treatment can be.
Also helps prognosis.
0: Fully active
1: No sternous exercise, can do e.g., light housework, office work.
2: Ambulatory and capable of all self-care but unable to carry out any work activities
3: Limited self-care bed/chair-bound > 50% of waking hours.
4: Completely disabled; totally bed-bound.
5: Dead
Why are patients on cancer treatment often immunocompromised?
Chemotherapy targets rapidly dividing cells.
> includes not only cancer cells but also healthy cells in the bone marrow that produce blood cells.
Results in myelosuppression (pancytopenia.)
Which part of cellular metabolism does chemotherapy generally affect?
Cell cycle (G1, S, G2, Mitosis phases)
Apart from alkalyting agents which destroy DNA directly in cells by causing them to cross-link.
What is the mechanism of action of Antimetabolites? Which phase in the cell cycle does it affect?
Mimic nucleotides, interfering with DNA and RNA synthesis.
Acts during ‘S phase’ - DNA replication.
Examples include Methotrexate, 5-Fluorouracil, Cytarabine
What chemotherapeutic drug class does doxorubicin and bleomycin belong to?
Anthracyclic antibiotics
Which two classes of chemotherapy agents act on the ‘mitosis’ phase?
Vinca alkaloids (inhibits microtubules)
Taxanes (stabilises microtubules - preventing division)
They tend to cause peripheral neuropathy.
List two examples of Platinum Compounds.
- Cisplatin
- Carboplatin
- Oxaliplatin
Alkayting agent
