Cancer Flashcards
1
Q
Define neutropenic sepsis
A
- Sepsis is a syndrome defined as life-threatening organ dysfunction due to a dysregulated host response to infection
- Septic shock is a subset of sepsis, which describes circulatory, cellular, and metabolic abnormalities which are associated with a greater risk of mortality than sepsis alone.
- In a hospital setting, septic shock is defined as sepsis with persisting hypotension despite fluid correction and inotropes (requiring vasopressors to maintain a mean arterial pressure [MAP] of 65 mmHg or more), and hyperlactataemia with a serum lactate level of greater than 2 mmol/L, where MAP is the driving pressure of tissue perfusion
- Neutropenic sepsis is a complication of anti-cancer and other immunosuppressive drug treatment, with temp over 38 or any symptoms/signs of sepsis with a neutrophil count of 0.5x10^9 or lower.
- Febrile neutropenia is a fever in a person with neutropenia
2
Q
Describe aetiology of neutropenic sepsis
A
- Cytotoxic chemotherapy
- Haematopoietic stem cell transplant
- Immunosuppressive drugs (azathioprine, methotrexate, sulfasalaxine, infliximab)
- Penicillin, carbimazole, valproic acid, allopurinal, NSAIDs
- Infections (viral HIV, influenza, hep B, TB shigella)
- Autoimmune (crohns, RA, SLE)
- Bone marrow failure (eg. aplastic anaemia)
- B12 and folate deficiencies
3
Q
List risk factors for neutropenic sepsis
A
- Infants and people over 60 at higher risk following chemotherapy
- Corticosteroids
- Antibiotics
- Advanced malignancy
- History of previous febrile neutropenia
- Previous surgery
- Co morbidities (diabetes mellitus, liver disease, renal disease, poor nutritional status)
- Central venous access devide
- TPN
4
Q
Describe epidemiology of neutropenic sepsis
A
- Increasing
- 20 cases a month in specialist units, 3 in general hospital in UK
- 7-45% of people with neutropenia develop shock
- Febrile neutropenia 8 per 1000 people with chemo
5
Q
List symptoms and signs of neutropenic sepsis
A
- Symptoms hinting at infection (dysuria, diarrhoea, productive cough)
- Chills, shivers, rigors, temperature over 38
- General malaise, agitation, behavioural change, changes in mental state
- Concern from carers
6
Q
Describe investigations for neutropenic sepsis
A
- Neutrophil count under 0.5 x 10^9 per litre
- Higher temp then 38
- Other signs or symptoms consistent with sepsis
- Investigate underlying cause (blood culture, Xray, sputum, lactate, unrine output, urine dip.ect)
7
Q
Define cholangiocarcinoma
A
- Cancers arising from the bile duct epithelium
- Intrahepatic within the liver, extrahepatic outside. Alternatively names perihilar and distal.
- Perihilar involving bifurcation of the ducts are also known as Klatskin’s
8
Q
Describe epidemiology of cholangiocarcinoma
A
- 2/3 in patients between 50-70
- Slight male predominance
- Increased incidence
- Highest rate in north east Thailand (80 per 100000), and south american countries and northern japan
- Low rates in UK and US, lowest in canada (0.3 per 100000)
9
Q
Describe aetiology/risks of cholangiocarcinoma
A
Intrahepatic
- Chronic liver disease due to hepB or C leading to cirrhosis
- Alcoholic liver disease
- Bile duct diseases
- Choledocholithiasis
- Cholecystolithiasis
- UC
- HIV
- Primary sclerosing cholangitis (7-13%)
Both
- Chronic typhoud carriers
- Liver flukes
- Heavy drinking
- Exposure to certain toxins/medications (PCB, isoniazid, OCP)
- Radionuclides (thorium dioxide)
10
Q
List symptoms and signs of cholangiocarcinoma
A
- Painless jaundice
- Weight loss
- Abdominal pain
- Pruritis
- Acute cholangitis (fever, jaundice, RUQ pain)
- Palpable gallbladder
- Hepatomegaly
- Dark urine
- Pale stools
- Fever
11
Q
List investigations of cholangiocarcinoma
A
- Serum bilirubin raised
- Alk phos, GGT, aminotransderases raised
- PT increased
- CA19-9 raised in 85%
- Serum carcinoembryonic antigen (CEA)
- CA19-9 + CEA calculate likelihood of tumour progression
- CA-125
- Abdo ultrasound - malignant VS benign (dilated intrahepatic ducts, mass lesion if intrahepatic)
- Consider abdo CT/MRI
- MR angiograpy for staging
- ERCP with staining for tissue diagnosis
- MRCP
- Percutaneous transhepatic catheterisation
12
Q
Define renal cell carcinoma
A
Renal malignancy arising from the renal parenchyma/cortex, accounts for around 85% of kidney cancers
13
Q
Describe epidemiology of renal cell carcinoma
A
- 80-90% of all kidney cancers
- Kidney cancer 4.2% of all new cancers, median age at diagnosis 64 years
- 6th and 7th most common diagnosed adult malignancy in men and women respectively
- 6.0 and 3.1 per 100000 incidence in males and females respectively
- More than 50% of renal massess diagnosed incidentally
- 2:1 male to female ratio
- 15% of dialysis patients
14
Q
Describe aetiology/risks of renal cell carcinoma
A
- Smoking most well established risk
- Obesity and hypertension (BMI over 35 results in 71% increased risk of RCC)
- Renal transplant, end-stage renal disease with dialysis
- Pelvic radiation
- Increased age
- Familial - von hippel lindau, folliculin, mesenchymal epithelial transition factor, fumarate hydratase, succinate dehydrogenase and BAP1
- VHL lifetime risk 70%
- Developed counties, black/American-indian ethnicity
15
Q
List signs and symptoms of renal cell carcinoma
A
- Often asymptomatic
- Haematuria, flank pain, palpable abdo mass (CLASSICAL TRIAD)
- Systemic - fever, weight loss, sweats, pallor, cachexia, myoneuropathy
- Hepatic - ascites, hepatomegaly, spider angiomata (paraneoplastic)
- Myoneuropathy
- Lower limb oedema
- Variocele (due to compression of renal vein)
- Birt Hogg Due papules, hereditary leimyomatous skin fibromas
- Vision loss and retinal angiomatosis in von Hippel Lindau
