Cancer care

Question 1

What percentage of patients with advanced cancer experience pain

Answer 1

30-40 percent with early disease
75-90 percent with late disease
65% dying from non-malignant disease experience significant pain
1/3 of patients have 2 or more different pains
Pain can be controlled in 80%

Question 2

What are the causes of pain in a person with SCC

Answer 2

Cancer related:
- chest wall invasion of cancer
Bone mets
MSCC

Treatment related
- oseophagitis
- local reaction to radiotherapy

Other
- PE
- PNEUMOTHORAX
- CAP
- MI
- Anxiety
- MSK pain

Question 3

Immune related Colitis guidelines

Answer 3

Question 4

Radiation mucositis guidelines

Answer 4

Question 5

Abdominal ascites guidelines

Answer 5

Question 6

Malignant pleural effusion guidelines

Answer 6

Features
dyspnoea, non-productive cough or chest pain
classic examination findings include dullness to percussion, reduced breath sounds and reduced chest expansion

Imaging
- (PA) chest x-rays
- ultrasound
contrast CT is now increasingly performed to investigate the underlying cause, particularly for exudative effusions

Pleural aspiration
as above, ultrasound is recommended to reduce the complication rate
a 21G needle and 50ml syringe should be used
fluid should be sent for pH, protein, lactate dehydrogenase (LDH), cytology and microbiology

Options for managing patients with recurrent pleural effusions include:
recurrent aspiration
pleurodesis
indwelling pleural catheter
drug management to alleviate symptoms e.g. opioids to relieve dyspnoea

Question 7

Lights criteria for pleural effusion

Answer 7

Light’s criteria was developed in 1972 to help distinguish between a transudate and an exudate. The BTS recommend using the criteria for borderline cases:
exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
pleural fluid protein divided by serum protein >0.5
pleural fluid LDH divided by serum LDH >0.6
pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Other characteristic pleural fluid findings:
low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis