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Y4 medicine > Cancer care > Flashcards

Cancer care Flashcards

1
Q

symptoms for lung cancer

A

unexplained cough >3wks
heamoptysis
weight loss
SOB
lethargy
weakness
hoarsness
dysphagia
chest pain
wheeze
fever

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2
Q

common sites of lung cancer mets?

A

lung
brain
adrenal
bone
liver

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3
Q

what is the gold standard Ix is lung cancer is suspected?

A

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

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4
Q

what cancer is CA 125 associated with?

A

ovarian cancer

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5
Q

what cancer is CA 19-9 associated with?

A

pancreatic cancer

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6
Q

what cancer is CA 15-3 associated with?

A

breast cancer

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7
Q

what cancer is PSA associated ewith?

A

prostate specific antigen

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8
Q

what cancer is AFP associated with?

A

hepatocellular carcinoma, teratoma

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9
Q

what cancer is CEA (carcinoembryonic antigen) associated with.

A

colorectal cancer

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10
Q

what is combination chemotherapy?

A

combo of drugs with different mechanisms and side effect profiles reduced risk of resistance and toxicity

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11
Q

what is adjuvant and neoadjuvant chemo?

A

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

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12
Q

why is chemotherapy given in cycles?

A

to allow time for recovery of healthy cells

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13
Q

name the types of chemotherapy drugs? and some examples?

A

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

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14
Q

name some immediate SEs of chemotherapy?

A

extravasion occurs (leakage of chemo to adjacent tissue)
facial and body flushing
cardiac arrythmias
hypotension
hypersensitivity
anaphylaxis
haemorrhagic cystitis

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15
Q

name some short term SE of chemotherapy

A

discolouration of urine
TLS
n+v
mucositis
constipation
diarrhoea
fatigue

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16
Q

name some medium/long term SE of chemotherapy?

A
  • marrow suppression
  • alopecia
  • nail changes - beau’s lines
  • liver dysfunction
  • renal toxicity
  • cardiac toxicity
  • peripheral neuropathy
  • pulmonary fibrosis
  • changes in fertility
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17
Q

risk factors for n+v in chemotherapy?

A
  • anxiety
  • <50yo
  • concurrent opioid use
  • female gender
  • past hx of n+v
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18
Q

how to managed chemotherapy n+v?

A

low risk: metoclopramide
high risk: 5HT3 antagonists antagonists e.g. ondansetron with dexamethasone

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19
Q

what is extravasation?

A

when anticancer drug gets into the subcutaneous/subdermal space

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20
Q

clinical features in extravasation?

A

burning, tingling with pain, redness and swelling

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21
Q

what to do if extravasation has occured?

A
  1. stop and disconnect the infusion
  2. aspirate any residual drug before cannula is removed
  3. follow local policies
  4. use dry cold compress to vasoconstrict, or apply warmth to allow vasodilation depending on agent being used
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22
Q

name specific SE of asparagine?

A

neurotoxicity

23
Q

name specific SE of cisplatin?

A

ototoxic, nephrotoxic

24
Q

name specific SE of vincristine/vinblastine?

A

vincristine: peripheral neuropathy
vinblastine: myelopsuppression

25
Q

name specific SE of bleomycin?

A

pulmonary fibrosis

26
Q

name specific SE of doxorubicin?

A

cardiotoxic

27
Q

name specific SE of cyclophosphamide?

A

nephro/bladder toxic

28
Q

name specific SE of methotrexate?

A

nephrotoxic, myelosupression

29
Q

what is radiotherapy?

A

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)

30
Q

early SE of radiotherapy?

A
  • fatigue
  • skin reactions: erythema, desquamation, ulcers
  • mucositis
  • n+v
  • diarrhoea
  • dysphagia
  • cystitis (in pelvic radiation)
  • lymphoedema
31
Q

late SE of radiotherapy?

A
  • solemness 4-6 wks post brain
  • spinal myelopathy
  • brachial plexusopathy
  • pneumonitis
  • xerostomia
  • urinary frequency, ED, infertility, vaginal stenosis
  • panhypopituitarism
32
Q

what is immunotherapy?

A

cancer treatment that boosts natural immune defences to eliminate malignant cells

33
Q

what are the SE of immunotherapy?

A

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

34
Q

what are the different types of pain?

A

nociceptive (Normal): normal nervous system, lesion from tissue damage

neuropathic: malfunctioning nervous system, nerve structure damage

mixed (40%)

35
Q

characteristics of nociceptive and neuropathic pain?

A

nociceptive:
(somatic) sharp, throbbing, well localised
(visceral) dull ache, difficult to localise

neuropathic: stabbing, shooting, burning, stinging, allodynia, numbness, hypersensitivity

36
Q

name some examples of adjuvants used for pain relief

A

antidepressants -> amitriptylline, duloxetine
anti-convulsants -> gabapentin, pregabalin
benzodiazepines -> diazapam, clonazepam
steroids -> dexamethasone
bisphosphonates (for bone pain)

37
Q

drugs for neuropathic pain?

A

amitriptyline
gabapentin
pregabalin

38
Q

which analgesia drugs come under each step of the WHO ladder?

A

1: paracetamol and NSAIDs
2: dihydrocodeine, codeine phosphate, tramadol, co-codamol
3: oxycodone, morphine, fentanyl, diamorphine

39
Q

what is the WHO ladder?

A

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

40
Q

key principles on opioid prescribing:

A
  • 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

41
Q

SE of opioids

A

drowsiness / confusion
n+v
constipation
dry mouth
urinary retention
rash / pruritus
resp depression

42
Q

clinical features of opioid toxicity?

A

pinpoint pupils
hallucinations
drowsiness
vomiting
confusion
myoclonic jerks
resp depression

43
Q

causes of breathlessness in cancer?

A
  • infection
  • effusion
  • anaemia
  • PE
  • SVCO
44
Q

Mx of breathlessness in patients with cancer?

A
  • 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

45
Q

causes of n+v in cancer?

A
  • chemo
  • constipation
  • hypercalcaemia
  • oral candidiasis
  • obstruction
  • drugs
  • severe pain
  • infection
  • renal failure
46
Q

which antiemetic is good in intracranial disorders?

A

cyclizine (antihistamine, anticholinergic)

47
Q

what antiemetic is good in gastroparesis?

A

metocloperamide - blocks central chemoreceptor trigger zone and peripheral gastric effects

48
Q

what antiemetic is good in drug or metabolically induced n+v?

A

haloperidol

49
Q

what antiemetic is good in chemo and radio induced n+v?

A

ondansetron - serotonin agonist
aprepitant - NK1 antagonist

50
Q

causes of constipation in cancer?

A

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

51
Q

tx for constipation in cancer?

A

stimulant - senna
osmotic - movicol/laxido

52
Q

tx options for malignant bowel obstruction?

A

surgical intervention for single level
endoscopic stenting
venting gastrostomy to decompress

53
Q

tx options for inoperable malignant obstruction?

A
  • IV fluids
  • NG tube
  • correction of electrolyte imbalances
  • analgesics
  • trial of dexamethasone

Y4 medicine (18 decks)

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