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Finals!!! > Cancer > Flashcards

Cancer Flashcards

1
Q

CUP- characteristics, common primaries, presentation

A
  • Character:
    • Met early –> multiple sites
    • Absence of primary cancer
    • Unpredictable
    • Aggressive
    • Common primaries
  • Common primaries- liver, bone, lung, LN
  • Presentation- depends on primary!
    • Anaemia
    • SOB
    • Fatigue
    • Lymphadenopathy
    • Ascites
    • Pain
    • Skin tumours
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2
Q

Approach to CUP + Ix + Tx

A
  1. Early referral to oncology. Search for primary.
  2. Rule out potentially treatable/ curable.
  3. Treat! ?Curative/ palliative?
  • Ix:
    • Bedside- urinalysis, FOB
    • Bloods- FBC, U+Es, LFTs, CRP, tumour markers
    • Imaging- CT thorax/abdo/pelvis, PET. ?endoscopy ?MRI
    • ?Biopsy
  • Tx- chemo, hormonal, radio, surgery. ?Palliation
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3
Q

What are paraneoplastic syndromes and their broad categories?

A
  • = Set of Sx that come as a consequence of cancer.
  • Endocrine- SIADH, Cushing’s syndrome, hypercalcaemia
  • Growth factor related- Acanthosis nigricans, hypertrophic pulmonary arthropathy (clubbing + peristitis)
  • Immune system mediated- cerebellar syndrome, Lambert-eaton syndrome
  • Vascular- Trousseau’s
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4
Q

What is SIADH and what might cause it?

A
  • = Syndrome of Inappropriate Anti-Diuretic Hormone
  • ++ ADH –> more reabsorption of water in kidneys –> dilutional hyponatraemia. Osmosis into cells –> cerebral oedema.
  • Causes:
    • Cancer- SCLC, mesothelioma, GI, bladder, urethral, prostate, endometrial, lymphoma
    • Drugs- carbamazepine, sodium valproate, SSRIs, TCAs, morphine
    • Diseases affecting the CNS- meningitis, encephalitis, trauma, SAH, MS
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5
Q

SIADH - Presentation and diagnostic criteria

A
  • Presentation:
    • Euvolaemic hyponatraemia
    • N+V
    • Cramps
    • Cerebral oedema –> confusion, low GCS, seizures, coma
  • Diagnostic criteria= strict!
    1. Urine osmolality >500mosm/kg
    2. No recent diuretics
    3. Clinical euvolaemia
    4. Urine Na+ >20mmol/L
    5. Normal adrenal and thyroid function
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6
Q

Ix and Tx of SIADH

A

Ix:

  • Bedside- urine osmolality + Na+
  • Bloods- FBC, U+Es, LFTs, CRP, TFTs, plasma osmolality
  • Imaging - ?Ca
  • Special - Short synacthen test

Tx:

  • Cons- remove cause, restrict fluids (1200mL/d)
  • ?Hypertonic saline
  • Mannitol (osmotic diuretic), demeclocycline
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7
Q

How does cancer cause Cushing’s syndrome and what cancers might cause it? Ix + Tx

A
  • Tumour –> ectopic release of ACTH –> raised cortisol –> Cushing’s
  • Causes: SCLC, pancreatic, thoma, (cervix/prostate)
  • Ix:
    • High blood cortisol
    • Dexamethasone suppression - dosen’t suppress at 1mg or 8mg
    • Serum ACTH detectable
    • Imaging - ?? where is the cancer?
  • Tx: Tx underlying Ca. Reduce cortisol- ketonazole, metyrapone
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8
Q

How does cancer cause hypercalcaemia and what cancers might do this?

A
  • Ectopic release of PTHrP –> stimulates osteoclasts –> release calcium from bone. Also calcitriol production.
  • Causes: Lung SCC, breast, renal, bladder, ovaria, myeloma (40% of those with myeloma)
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9
Q

Bloods that make cancer more likely cause of hypercalcaemia

A
  • Low albumin, low chloride, alkalosis, hypokalaemia, high phosphate, high alk phos
  • More likely hyperparathyroidism- high PTH
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10
Q

Paraneoplastic cerebellar degeneration - cause, presentation and Tx

A
  • Cause: Cancer produces proteins similar to those in cerebellum –> AI attack of cancer and native proteins
  • Presentation= DANISH
    • Dysdiadochokinesia
    • Ataxia
    • Nystagmus
    • Intention tremor
    • Slurred/staccato speech
    • Hypotonia/ Heel-shin test
  • Tx- Tx cause. Immunosuppression- cyclophosphamide, methylprednisolone
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11
Q

What is Lambert Eaton Syndrome? How is it caused?

A
  • Antibodies bind to cancer cells –> change shape –> attack calcium channels in muscle –> reduced muscular action potentials.
  • Cause= Cancer (SCLC, GI, breast, thymus) or AI
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12
Q

Presentation of Lambert-Eaton Syndrome. Ix and Tx

A
  • Muscle weakness legs>arms
  • Hyporeflexia
  • Weakness and hyporeflexia improve after exercise!
  • Resp issues
  • Gait
  • Eye - eye muscle weakness, drooping, diplopia, reduced pupillary reflex
  • ANS- dry mouth, constipation, impotence
  • Ix: nerve conduction studies, anti-VGCC Abs
  • Tx: Plasmapheresis, IV immunoglobulin
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13
Q

What is acanthosis nigricans? Causes, presentation, Tx

A
  • Insulin mediated growth factors –> AN.
  • Causes: DM, malignancy (type 4) - GI adenocarcinomas, lung, endometrial, prostate, breast, ovary, lymphoma
  • Presentation- velvety, hyperpigmented skin. Flexural. Armpits/ neck.
  • Tx- topical fade creams
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14
Q

What is Trousseau’s sign of malignancy? Causes, presentation, Tx

A
  • = Thrombophlebitis migrans
  • Cause= cancer. Hypercoaguable state –> more blood clots –> vessel inflammation.
  • Causes- Cancer- pancreatic, gastric, lung
  • Presentation- inflammation around clot. Red, painful, oedema. Recurrent in diff locations over time.
  • Tx- anticoagulation, TED stockings
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15
Q

What is hypertrophic pulmonary osteoartropathy? +causes, Tx

A
  • Growth factor release from tumour. Lung cancer.
  • Clubbing, periostitis of MCPs + DIPs
  • Tx= NSAIDs
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16
Q

Neutropoenic Sepsis - Presentation, Ix and Tx

A
  • = Pyrexia >38C and neutrophils <0.5x109/L
  • Presentation:
    • Always suspect if unwell and chemo <6w
    • NB examine indewelling cannulas/ catheters
    • Fever + rigors
    • Tachycardia
    • Hypotension
    • ??Localising signs
  • Ix:
    • INFECTION SCREEN inc swabs, catheter + lines
    • Bloods inc culture
  • Tx: ASAP! High dose empirical Tazocin IV
17
Q

What cancers are more likely to cause spinal cord compression?

A
  • Lung
  • Prostate
  • Breast
  • Myeloma
  • Melanoma
18
Q

What is superior vena cava obstruction and what might cause it?

A
  • = Extrinsic compression (most common) or venous thrombosis (current/past central venous access) –> less venous return from head, neck and upper limbs.
  • Causes: >90% due to malignancy- lung, lymphoma, breast, thmoma, germ cell, mets
19
Q

Presentation of SVC obstruction

A
  • SOB + orthopnoea
  • Oedema - face, arm
  • Cough
  • Headache
  • Engorged neck/ chest wall veins
  • Plethora/ cyanosis
  • Stridor
  • Pemberton’s test- elevation of arms –> facial plethora/ cyanosis
20
Q

Ix and Tx of SVC obstruction

A
  • Dx= clinical.
  • Ix= CT
  • Tx:
    • ABCDE. Sit up.
    • Medical- dexamethasone 16mg/24h
    • Surgical- balloon venoplasty and SVC stenting
    • Refer to oncology –> Tx underlying cause. Chemo/ radio.
21
Q

Causes and presentation of brain metastases

A
  • Causes= mets from: lung, breast, colorectal, melanoma.
  • Presentation:
    • Raised ICP headache
    • Ataxia
    • N+V
    • Papilloedema
    • Fits
    • Focal neurology
22
Q

Ix and Tx of brain mets

A
  • Ix= urgent CT/MRI
  • Performance status?
  • Tx:
    • Cons- Sx control
    • Med- dexamethasone 16mg/24h, stereotactic radiotherapy
    • Surg- neurosurgery
23
Q

What is tumour lysis syndrome and how might it present?

A
  • High tumour burden –> death of large no. of cells over short time (eg chemo/ steroids)
  • More common in rapidly proliferating tumours- leukaemia, lymphoma, myeloma.
  • Presentation:
    • Chest pain
    • SOB
    • Arrhythmias
    • Diarrhoea
    • Muscle weakness
    • Anorexia
    • N+V
    • Seizures
    • Syncope
  • Precipitants- chemo, radio, steroids, immune modifiers, surgery, spontaneous
24
Q

Diagnosis of tumour lysis syndrome

A
  • Ix- bloods, ECG, imaging for underlying Ca
  • Bloods:
    • Uraemia
    • Hyperkalaemia
    • Hyperphosphataemia
    • Hypocalcaemia
    • Raised LDH
    • Raised serum creatinine
25
Q

Complications of tumour lysis syndrome

A
  • Metabolic disturbance (K+) –> cardiac arrest, arrhythmias
  • High urate –> AKI
  • High LDH –> DIC
26
Q

Tx and prevention of tumour lysis syndrome

A
  • Prevention- ++ hydration, allopurinol, avoid drug interactions (ACEi, spironolactone, NSAIDs)
  • Twice daily bloods in those at risk!
  • Correct electrolytes- calcium gluconate, insulin, hydration, IV bicarbonate?
  • Haemodialysis
  • Reduce urate- Allopurionol, urate oxidase inhibitor
27
Q

Causes/ RF, presentation and Tx of lymphoedema

A
  • = Accumulation of interstitial fluid due to abnormal lymphatic drainage.
  • Causes- congenital, surgery, radio, malig
  • RF: female, obesity, FHx, obesity, breast Ca esp axillary node clearance.
  • Presentation:
    • Limb swelling - pitting acute, woody in chronic
    • Reduced mobility
    • Recurrent infection
  • Tx:
    • Cons- elevation, compression bandage, massage
    • Med- ABx for secondary inf
    • Surg- ?Excisional techniques
28
Q

Presentation and RF for testicular cancer

A
  • Presentation:
    • Usually young adults/ teens
    • Mass/ swelling
    • Hydrocoele
    • Gynaecomastia
    • Pain / back ache
    • ?SVC obstruction
    • Fatigue, weight loss
  • RF: Genetics, Down’s, Maldescended testicles, Klinefelter’s, infertility
29
Q

Ix and Tx of testicular cancer

A
  • Ix: TUMOUR MARKERS V USEFUL!
    • AFP
    • Beta-hCG
    • LDH
    • CXR- mediastinal lymphadenopathy. ?Canon ball mets
    • CT- staging
  • Tx:
    • Surgery- radical orchidectomy
    • Surveillance- CXR monthly 1 y –> 6 monthly 5y
    • Chemo/radio
  • Complications of Tx- Tumour lysis, infertility, malignancy, CVS, psychosocial
30
Q

What anticipatory meds might you prescribe in palliative care?

A
  • Pain/ SOB: Morphine, eGFR <30 –> alfentanil
  • Secretions: Hyoscine hydrobromide, eGFR <30 –> hyoscine butlbromide
  • Nausea and vomiting: Cyclizine, eGFR <30 –> haloperidol
  • Agitation: Midazolam
  • Capillary bleeding - tranexamic acid

Finals!!! (19 decks)

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