Cancer care Flashcards
symptoms for lung cancer
unexplained cough >3wks
heamoptysis
weight loss
SOB
lethargy
weakness
hoarsness
dysphagia
chest pain
wheeze
fever
common sites of lung cancer mets?
lung
brain
adrenal
bone
liver
what is the gold standard Ix is lung cancer is suspected?
FBC, U+E, Calcium, LFTs, INR
CXR
staging CT (CT thorax, abdo and pelvis)
US guided neck node core biopsy
bronchoscopy
CT biopsy
thoracoscopy is pleural effusion present
what cancer is CA 125 associated with?
ovarian cancer
what cancer is CA 19-9 associated with?
pancreatic cancer
what cancer is CA 15-3 associated with?
breast cancer
what cancer is PSA associated ewith?
prostate specific antigen
what cancer is AFP associated with?
hepatocellular carcinoma, teratoma
what cancer is CEA (carcinoembryonic antigen) associated with.
colorectal cancer
what is combination chemotherapy?
combo of drugs with different mechanisms and side effect profiles reduced risk of resistance and toxicity
what is adjuvant and neoadjuvant chemo?
adjuvant: chemo given after other initial treatment to reduce risk of relapse e.g. following surgery
neoadjuvant: used to shrink tumours prior to surgical or radiological treatments
why is chemotherapy given in cycles?
to allow time for recovery of healthy cells
name the types of chemotherapy drugs? and some examples?
alkylating agents: cyclophosphamide, chlorambucil, busulfan
platinum agents: cisplatin, carpoplatin, oxaliplatin
anti-metabolites: methotrexate, 5-fluorouricil
topoisomerase inhibitors: etoposide, topotecan
vinka-alkaloid’s: vincristine and vinblastine
taxanes: docetaxel, paclitaxel
other:
- antioestrogens: anastrazole (breast cancer)
- monoclonal antibodies
- anti tumour abx: bleomycin, mitomycin, doxorubicin
name some immediate SEs of chemotherapy?
extravasion occurs (leakage of chemo to adjacent tissue)
facial and body flushing
cardiac arrythmias
hypotension
hypersensitivity
anaphylaxis
haemorrhagic cystitis
name some short term SE of chemotherapy
discolouration of urine
TLS
n+v
mucositis
constipation
diarrhoea
fatigue
name some medium/long term SE of chemotherapy?
- marrow suppression
- alopecia
- nail changes - beau’s lines
- liver dysfunction
- renal toxicity
- cardiac toxicity
- peripheral neuropathy
- pulmonary fibrosis
- changes in fertility
risk factors for n+v in chemotherapy?
- anxiety
- <50yo
- concurrent opioid use
- female gender
- past hx of n+v
how to managed chemotherapy n+v?
low risk: metoclopramide
high risk: 5HT3 antagonists antagonists e.g. ondansetron with dexamethasone
what is extravasation?
when anticancer drug gets into the subcutaneous/subdermal space
clinical features in extravasation?
burning, tingling with pain, redness and swelling
what to do if extravasation has occured?
- stop and disconnect the infusion
- aspirate any residual drug before cannula is removed
- follow local policies
- use dry cold compress to vasoconstrict, or apply warmth to allow vasodilation depending on agent being used
name specific SE of asparagine?
neurotoxicity
name specific SE of cisplatin?
ototoxic, nephrotoxic
name specific SE of vincristine/vinblastine?
vincristine: peripheral neuropathy
vinblastine: myelopsuppression
name specific SE of bleomycin?
pulmonary fibrosis
name specific SE of doxorubicin?
cardiotoxic
name specific SE of cyclophosphamide?
nephro/bladder toxic
name specific SE of methotrexate?
nephrotoxic, myelosupression
what is radiotherapy?
cancer treatment that uses ionising radiation to cause damage to DNA preventing cell division + eventually leading to cell apoptosis (aim is to target cancer cells and cause minimal damage to normal tissue)
early SE of radiotherapy?
- fatigue
- skin reactions: erythema, desquamation, ulcers
- mucositis
- n+v
- diarrhoea
- dysphagia
- cystitis (in pelvic radiation)
- lymphoedema
late SE of radiotherapy?
- solemness 4-6 wks post brain
- spinal myelopathy
- brachial plexusopathy
- pneumonitis
- xerostomia
- urinary frequency, ED, infertility, vaginal stenosis
- panhypopituitarism
what is immunotherapy?
cancer treatment that boosts natural immune defences to eliminate malignant cells
what are the SE of immunotherapy?
GI: diarrhoea, abdo pain, peritonitis, bowel perforation
derm: pruritus, dry skin, rash
hepatic: hepatitis
neuro: weakness, sensory alterations, parasthesia, MG, GBS
endocrine: hypopituitarism, adrenal insufficiency, hypothyroidism, hypophysitis
other: pneumonitis, vasculitis, nephritis
what are the different types of pain?
nociceptive (Normal): normal nervous system, lesion from tissue damage
neuropathic: malfunctioning nervous system, nerve structure damage
mixed (40%)
characteristics of nociceptive and neuropathic pain?
nociceptive:
(somatic) sharp, throbbing, well localised
(visceral) dull ache, difficult to localise
neuropathic: stabbing, shooting, burning, stinging, allodynia, numbness, hypersensitivity
name some examples of adjuvants used for pain relief
antidepressants -> amitriptylline, duloxetine
anti-convulsants -> gabapentin, pregabalin
benzodiazepines -> diazapam, clonazepam
steroids -> dexamethasone
bisphosphonates (for bone pain)
drugs for neuropathic pain?
amitriptyline
gabapentin
pregabalin
which analgesia drugs come under each step of the WHO ladder?
1: paracetamol and NSAIDs
2: dihydrocodeine, codeine phosphate, tramadol, co-codamol
3: oxycodone, morphine, fentanyl, diamorphine
what is the WHO ladder?
step 1: non opioid +/- adjuvant
step 2: opioid for mild to moderate pain +/- adjuvant +/- non opioid
step 3: opioid fro moderate to severe pain +/- adjuvant +/- non opioid
key principles on opioid prescribing:
- GO LOW AND SLOW
- give laxative and anti-emetic
e.g. pt with moderate to severe pain consider oral morphine 5mg every 4hr plus 5mg PRN, if not controlled up 30-50% every 24hrs
when pain controlled convert to modified release:
- TTD/2 (every 12 hrs) = morphine SR dose
- TDD/6 = morphine IR ‘breakthrough’ PRN dose
TTD = total daily dose
SE of opioids
drowsiness / confusion
n+v
constipation
dry mouth
urinary retention
rash / pruritus
resp depression
clinical features of opioid toxicity?
pinpoint pupils
hallucinations
drowsiness
vomiting
confusion
myoclonic jerks
resp depression
causes of breathlessness in cancer?
- infection
- effusion
- anaemia
- PE
- SVCO
Mx of breathlessness in patients with cancer?
- positioning: use gravity to aid and not hinder weak chest wall muscles
- air flow across face: fan/open window
- trial of O2 if hypoxic
consideR: morphine 1-2mg orally PRN or 1-2mg SC PRN
or lorazepam -.5-1mg SL PRN
causes of n+v in cancer?
- chemo
- constipation
- hypercalcaemia
- oral candidiasis
- obstruction
- drugs
- severe pain
- infection
- renal failure
which antiemetic is good in intracranial disorders?
cyclizine (antihistamine, anticholinergic)
what antiemetic is good in gastroparesis?
metocloperamide - blocks central chemoreceptor trigger zone and peripheral gastric effects
what antiemetic is good in drug or metabolically induced n+v?
haloperidol
what antiemetic is good in chemo and radio induced n+v?
ondansetron - serotonin agonist
aprepitant - NK1 antagonist
causes of constipation in cancer?
disease related: immobility, reduced food intake, intra abdo, pelvic disease
fluid depletion: poor fluid intake, increased fluid loss (vomiting, sweating)
weakness: inability to raise intra-abdo pressure (paraplegia)
intestinal obstruction: disease, adhesions, recent surgery
medication: opioids, diuretics, phenothiazines
biochemical: hypercalcaemia, hypokalaemi
tx for constipation in cancer?
stimulant - senna
osmotic - movicol/laxido
tx options for malignant bowel obstruction?
surgical intervention for single level
endoscopic stenting
venting gastrostomy to decompress
tx options for inoperable malignant obstruction?
- IV fluids
- NG tube
- correction of electrolyte imbalances
- analgesics
- trial of dexamethasone
