Cancer and Oncology Flashcards
Systemic Side Effects of Chemotherapy
Lung Fibrosis Nephrotoxicity Hypomagnesaemia Coronary Artery Spasm Cardiomyopathy Haemorrhagic cystitis Ototoxicity Peripheral Neuropathy Reduced fertility
What is the single most common, but treatable, side effect of chemotherapy?
Nausea and vomiting
Use Ondansetron/ Haloperidol palliatively
Other important patient-reported side effects of chemotherapy to discuss
Alopecia Mucositis Candida infection Photosensitivity Extravasation Palmar- Plantar Erythema
Fractions vs Grays in radiotherapy
Fractions: number of times radiotherapy is delivered
Grays: total dose of radiation
Important side effects of Radiotherapy to tell patients about
Fatigue/ somnolence Mucositis (plus thrush, dysphagia, xerostomia) Nausea and vomiting Diarrhoea Cystitis (± urinary frequency) Brachial Plexopathy Spinal Cord Myelopathy Lung Fibrosis
Breast cancer: most common type
Invasive Ductal Carcinoma
Stage 1 Breast Cancer
Mobile lump confined to breast
Stage 2 Breast Cancer
Mobile lump confined to breast
Axillary node involvement
Stage 3 Breast Cancer
Fixed to muscle
Axillary nodes matted and fixed
Skin involvement (larger than the tumour)
Stage 4 Breast Cancer
Completely fixed to chest wall
Distant metastases
Indications for 2 week urgent referral for breast cancer
30+ with unexplained breast/ axillary lump
50+ with unilateral nipple changes of concern
Skin changes
Cancers most commonly associated with bone metastases
1: Prostate
2: Breast
3: Lung
Most common sites of bone metastases
- Spine
- Pelvis
- Ribs
- Skull
- Long bones
Indications for neoadjuvant chemotherapy in breast cancer
Post-menopausal ER+ women
HER2+ / ER- women
Triple negative women
Who receives biological therapy for breast cancer
Women who are HER2+
Trastuzumab (Herceptin)
Who receives Tamoxifen as an endocrine treatment for breast cancer?
Pre-Menopausal women who are ER/PR +
Who receives Aromatase Inhibitors as a treatment for breast cancer?
Post-menopausal women who are ER/PR+
Tamoxifen side effects
Blocks oestrogen receptors, so SEs similar to menopause:
- Hot flushes/ sweating
- Vaginal atrophy
- Tiredness
- Period changes
- Nausea
- Oedema
- Increased Endometrial cancer risk
Trastuzumab side effects
Effects cardiac function (chest pain, SOB, syncope, palpitations) Neutropenia- infection risk Feeling sick Loss of appetite Bitter taste
Aromatase inhibitors sside effects
Menopausal symptoms
Myalgia/ joint pains
Hair and skin changes
Carpal tunnel syndrome
Genetic mutations associated with prostate cancer
BRCA2
pTEN
Ethnicity most at risk of prostate cancer
Afro-Caribbean
T1 staging of prostate cancer
Clinically inapparent tumour
- Not palpable/ visible
T2 Staging of prostate cancer
Confined within the prostate
T3 staging of prostate cancer
Extends through capsule ± into bladder
T4 staging of prostate cancer
Fixed tumour OR
invades rectum/ levator muscles/ pelvic wall
Most common type of prostate cancer
Adenocarcinoma
Criteria for 2 week referral for prostate cancer
Malignant feeling prostate on examination
PSA levels above age-specific reference range
Indications for radiotherapy in prostate cancer
T1/T2 cancers with a low PSA (low risk)
Use Volumetric Modulated Arc Therapy
Hormonal therapies for prostate cancer
Used as an adjunct for RT or in advanced disease
- LHRH agonists e.g. Leuprorelin, Goserelin
- GRH agonists e.g. Degarelix
- Anti-androgens
- Bilateral orchidectomy
Which IBD is more strongly associated with colorectal cancer development
Ulcerative colitis
Distribution of CRC in the colon
1/3 rectal
1/3 left side
1/3 rest of colon
Who is elligble for the NHS bowel screening programme
Men and women 60-75
2 Week referral criteria for colorectal cancer
40+ with unexplained weight loss and abdo pain
50+ with unexplained rectal bleeding
60+ with anaemia or change in bowel habit
Unexplained FOBT result
Unexplained anal mass/ ulceration
Which NSCLC type is associated with Parathyroid Hormone related peptide secretion and subsequent hypercalcaemia?
Squamous cell carcinoma
Cell origin of SCLC
Kulchitsky cells
Pulmonary Hypertrophic Osteoarthropathy
Squamous cell lung cancers
Clubbing, periostitis of small joints, bone deposition of long bones
Syndrome of Inappropriate ADH
Small cell lung cancers
Hypo-osmolar, hyponatraemic state
Nausea and vomiting, reduced oral intake, fatigue
Lambert-eaton syndrome
Small cell lung cancers
Antibodies against calcium channels
Muscle weakness
Troussea’s Syndrome
VTE- clots/ thrombophlebitis palpable under the skin in lung cancer
Ectopic ACTH syndrome
Small cell lung cancers
Get Cushing’s Syndrome
NICE red flags for lung cancer
Unexplained Cough ± haemoptysis SOB Weight loss Fatigue Reduced appetite
NICE CXR indications in lung cancer
2 unexplained red flags
1 red flag + patient is a smoker
Key indications for surgery in lung cancer
T1-2 NSCLC
No mediastinal involvement
Indications for G-CSF in neutropenic sepsis
Neutrophils <0.1 x 10 ^9
Lasts longer than 10 days
Severe sepsis or multi-organ failure
Co-morbidities
WHO Performance Status 0
Fully active, able to carry on all pre-disease performance without restriction
WHO Performance Status 1
Restricted in physically strenuous activity but ambulatory and able to carry out work of a light/ sedentary nature e.g. light house work, office work
WHO Performance Status 2
Ambulatory and able of all self-care but unable to carry out any work activities. Up and about more than 50% of waking hours
WHO Performance Status 3
Capable of only limited self-care and confined to bed or chair for more than 50% of waking hours.
WHO Performance Status 4
Completely disabled and unable to carry out any self care. Totally confined to bed or chair.
WHO Performance Status 5
Dead
