Cancer care Flashcards
S&S of small cell lung
S&S:
• Central
• ADH secretion –> Hyponatremia
• ACTH secretion –> Cushings syndrome:
○ bilateral adrenal hyperplasia
○ Leading to high levels of cortisol and hypokalaemic alkalosis
• Lambert-Eaton syndrome - Abs to Na VGCs –> myasthenic like syndrome
Tx of small cell
Tx:
• Usually metastatic by diagnosis
• If no mets consider surgery
• If mets, radio + chemo
S&S of spinal cord compression
S&S: • Back pain - RED FLAGS: ○ New onset >55yrs ○ PMH of tumour ○ Thoracic pain ○ Systemically unwell ○ Etc • Lower limb weakness • Sensory changes Autonomic dysfunction
Earliest and most common is back pain worse when coughing or strainining
Tx and ix of spinal cord compression
Tx:
• High dose dexamethasone
• Urgent assessment for radiotherapy or surgery
ix - MRI spine
RFs of oesophageal cancer
RFs: • Smoking • Alcohol • GORD • Barretts
ix of oesophageal cancer
Ix:
• Upper GI endoscopy
• CT staging
S&S of oesophageal cancer
S&S: • Dermatological - acanthosis nigricans • Dysphagia progressive weight loss chest pain hoarseness
Tx of oesophageal cancer
Tx: • Surgical resection • Ivor-Lewis oeseophagectomy • Adjuvant chemo palliative stenting
What is neoadjuvant and adjuvant chemo
neoadj - before tx
adj - post tx
How describe skin lesions?
ABCDE Symptoms A - Asymmetry B - Border irregular C - Colour D - Diameter E - Evolution Symptoms - bleeding, oozing, itching, altered sensation
S&S of colorectal cancer
S&S: • Rectal bleeding • Change in bowel habit • Weight loss • Anaemia • Palpable mass
Right vs left sided:
• Right presents later as blood is not as fresh, and there are less symptoms
Staging of colorectal ca
Staging - Dukes:
1. A - Within bowel wall 2. B - Through bowel wall 3. C - Lymph nodes involved 4. D - Distant mets
ix and tx of colorectal ca
Ix:
• Colonoscopy
• Staging CAP CT
Tx:
• Surgery +/- adjuvant chemo
○ Low rectal cancer - AP excision of rectum
S&S of stomach ca
S&S: • Dyspepsia - >1 mth and >50 • Weight loss • Vomiting • Dysphagia • Anaemia • Enlarged vircows node.
Ix and tx of stomach ca
Ix:
• Gastroscopy
• Staging CT
Tx:
• Gastrectomy
Define neutropenic sepsis
Neutrophil count <0.5*10^9 + :
• Temp >38C
• OR Sx consistent with sepsis
in pts taking anticancer tx
S&S of neutropenic sepsis
S&S: • Can be perfectly well • Sx related to source of infection • Tx history of cancer (often 5-10 days post chemo) • Fever • Drowsy • Confused • Hypotension - V urgent referral needed
SVCO causes
Causes: • Extrinsic compression: ○ Right sided tumours ○ Superior mediastinal lymphadenopathy • Intrinsic compression: ○ Thrombosis ○ Foreign body Tumour
S&S of SVCO
S&S: • Swelling of face, neck, arms • Distended neck and chest wall veins • SOB • Headache • Lethargy
Tx of SVCO and IX
Ix:
• CXR
• CT chest with contrast
Tx: • Chemotherapy • Radiotherapy • Stent - palliative • Consider anticoag
Patho of malignancy induced hypercalcemia. S&S
Occurs in 5-30% of cancers
Caused by tumour secretion of PTHrP
S&S: • Dehydration • Psychiatric manifestations + confusion • Anorexia • Constipation
Ix and tx of malig induced hypercal
Ix:
• Calcium
• U&E - dehydration
• PTH/PTHrP
Tx:
• IV access and bloods to check other electrolytes
• CXR and ECG
• IV fluids then IV bisphosphonates
S&S of tumour lysis and commonly caused by
Presentation:
• 3-7 days post chemo
• Cardiac arrhythmia
• Oligouria
Common cancers causing:
• Small cell lung
• Germ cell tumours
• Myeloma
Tx of tumour lysis and prevention
Tx:
• Prevention:
○ Prehydration
○ Monitoring of electrolytes and fluid balance
○ Allopurinol
• Tx:
○ Hydration throughout
○ Correct electrolytes and fluid balance
§ Hyperkalaemia - K+ lowering regimens
§ Hyperphosphatemia - phosphate binders (Ca carbonate)
ovarian tumour marker
ca 125
pancreatic tumour marker
ca19-9
breast tumour marker
ca15-3
prostate tumour marker
psa
hepatic tumour marker
alpha feto protein
colorectal tumour marker
CEA
test cancer tumour marker
beta HCG and alpha feto protein
Drugs for neuropathic pain
Drugs for neuropathic pain:
• Gabapentin/pregabalin (never at same time)
• TCA - amitryptiline
• Capsaicin
give who step ladder. define adjuvant
Step 1 - non opioid +/- adjuvant
Step 2 - mild opioid + step 1
step 3 - strong opioid + step 1
adjuvant - non opioid analgesic
give examples of mild opioid
Mild Opioid: • Codeine • Dihydrocodeine • Tramadol • Oxycodone
examples of strong opioids
Strong Opioid:
• Morphine
• Alfentanyl
• Methadone
how do you reverse morphine od
naloxone
how do you calculate how much morphine to give a pt
- Zomorph is given BD, once in day, once at night
- Give pt PRN 5-10mg dose of morphine until pain is controlled
- Calculate total dose of morphine taken
a. Divide by 2 to get BD dose of Zomorph
Divide by 6 to get PRN dose of oramorph
When is SC morphien used
SC used if pt vomiting or cant take drugs orally
When is transdermal morphine used
Transdermal - Used if pt refuses SC route or is demented and keeps pulling line out etc
How to calculte SC dosage of morphine
To get SC dosage:
• For Daily dose - Divide by daily dose by 2 and put over 24 hrs
• For PRN dose - Divide PRN by 2
Morphine is metabolised 50% by first pass effect
ADRs of opioids
ADRs of opioids: • Constipation • Nausea • Drowsiness • Pruritis • Resp depression • Dry mouth
what co-prescribe with morphine?
Co-prescriptions:
• Constipation - Always co prescribe Osmotic laxative (laxido)
• Nausea - haloperidol
antiemetic for dizziness and head movement nausea
Cyclizine, dexamethasone
What antiemetic for slow gastric emptying
Metoclopromide or Demperidone
What antiemetic for BO
Cyclizine, dexamethasone
What antiemetic for fear/anxiety
haloperidol, BZD
what antiemetic for drug induced
haloperidol
what antiemetic for metabolic nausea
haloperidol
What prescribe for excess resp secretions
hyoscine butylbromide
Antidepressant for depression and anxiety in cancer?
1st choice - Citalopram
2nd choice - Sertraline
S&S of non hodgkins lymphoma
S&S:
• Enlarged painless lymph nodes (75%) - cervical, axillary, inguinal
• Systemic (25%) - Weight loss, Night sweats, Fever, Lethargy
Ix of non hodgkins and staging system
Ix:
• Bloods - FBC, U&E, LDH, LFT
• Marrow and node biopsy
Ann arbor staging
Tx of non hodgkins
Tx:
• Localised - radiotherapy
• Diffuse - chemo
• R-CHOP if high grade
Explain ann arbor staging
Ann arbor staging:
• Stage 1 - single lymph node region
• Stage 2 - 2+ lymph node regions on 1 side of diaphragm
• Stage 3 - Both sides of diaphragm
• Stage 4 - Spread to liver or bone marrow or spleen
At each stage can have ‘A’ symptoms (no systemic sx other than pruritis) or ‘B’ symptoms (weight loss, fever, night sweats). B indicates worse disease
S&S of hodgkins lymphoma
S&S:
• Enlarged painless lymph nodes (75%) - cervical, axillary, inguinal
• Systemic (25%) - Weight loss, Night sweats, Fever, Lethargy
Pathology of leukaemia
1) stem cell can divide into myeloids (RBCs) or lymphoids (B and T cell)
2) leukaemia is these blasts unable to differentiate and so build up in bone marrow and cause loss of other differentiated cells (pancytopenia)
3) if this occurs quickly - acute.
4) blasts spill out into blood and appear as larger than differntiated and low amounts of cytoplasm
S&S of AML. ix
S&S:
• Pancytopenia - fatigue, infection, bleeding, DIC
• Hepatosplenomegaly
Ix: • WCC raised, normal or low depending on if blast cells are in blood • Red cells and platelets lowered. • Blood film • Bone marrow biopsy is definitive
Tx of AML and cx of tx
Tx:
• Chemotherapy - cytarabine, daunorubicin
• Supportive care - walking exercises
• Bone marrow transplant - Destroy leukaemic cells with chemo and then repopulate marrow by transplant:
○ Complication of graft vs host disease, relapse, infertility
ALL S&S
S&S: • Cytopenia - fatigue, infection, bleeding • Hepatosplenomegaly • Lymphadenopathy • Pneumocystitis pneumonia common
same as AML but with lymphadenopathy
Ix of ALL
Ix: • Blood film • Bone marrow • WCC high • CXR and CT to look for lymph involvement
Lymph involved in ALL
Tx of ALL
Tx:
• Supportive - blood/platelet transfusions, IV fluids
• Infections - prophylactic abx and antivirals and antifungals
• Chemo
• Bone marrow transplants
What is myelodysplastic syndrome?
Build up of blasts but <20% blasts so not quite AML
Patho of chronic leukaemia
- Cells mature only partially (acute leukaemia cells don’t mature)
- Results in premature cells that don’t work effectively
- They take up space in bone marrow and result in cytopenias.
CML S&S
CML S&S: • Hepatosplenomegaly - abdo fullness • Fatigue • Bleeding • Immunosuppresion • Weight loss • Fever • Night sweats
CML Ix
CML Ix: • WBC up (>100) • Urate Up • B12 up • Bone marrow
CLL S&S
CLL S&S: • Lymphadenopathy - pain in lymph nodes • Autoimmune hemolytic anaemia • Fatigue • Bleeding • Immunosuppresion • Weight loss • Sweats
CLL ix and Tx
CLL Ix:
• Raised lymphocytes
• Decrease Hb, neutrophils, platelets
CLL tx:
• Chemo
• Steroids if autoimmune hemolysis
What is multiple myeloma
Bone marrow cancer - Expansion of a single clone of IG secreting terminally differentiated B cells
S&S of multiple myeloma
S&S:
• Osteolytic bone lesions - backache, path frac, hypercalcemia
○ Lesions due to increased osteoclast activation from myeloma cell signalling
• Anaemia, neutropenia, thrombocytopenia due to infiltration
• Recurrent bacterial infections - immunoparesis
• Renal failure
• Hyperviscosity - clotting
Tx of multiple myeloma
Tx:
• Supportive - bone pain analgesia, bisphosphonate, erythropoeitin and blood transfusion anaemia, IV fluids for renal failure, abx prophylaxis
• Chemo
Ix of multiple myeloma
Ix: • FBC - normocytic normochromic anaemia • Blood film - roleaux formation • Increase calcium • Increase urea and creatinine • Bence Jones protein in urine
Patho of polycythemia rubra vera
Patho:
• Myeloproliferation resulting in increase RBC, and platelets and neutrophils.
S&S of polycyth rubra vera
S&S:
• Hyperviscosity - strokes
• Pruritis post hot bath
• Splenomegaly
Ix and tx of polycyth rubra vera. Epi
Epidemiology:
• 60 age peak
Ix:
• JAK2 mutation - Diagnostic
• FBC and blood film
Tx:
• Phlebotomy
S&S of prostate carcinoma
S&S: • Hesitancy during micturition • Nocturia • Poor stream • Post void dribble • Bone pain if mets
Ix of prostate carcinoma
Ix: • DRE • Serum PSA: ○ Different ages have differing levels of acceptable PSA • Trans rectal USS biopsy • CT and bone scan for staging
Tx of prostate carcinoma
Tx: • Watch and wait - elderly with multiple comorbs and low gleason score • Radiotherapy • Bracytherapy • Radical prostatectomy - ED and urine incontinence is common ADR • Hormonal therapy: ○ LHRH analogues eg Goserelin ○ Anti-androgen • Orchidectomy
S&S of BPH
S&S:
• Voiding sx - weak flow, hesitancy, straining, incomplete emptying
• Storage sx - urgency, frequency, incontinence, nocturia
• Complications - UTI, retention, obstruction uropathy
Tx of BPH
Tx:
• Watchful waiting
• Medical - alpha 1 antagonist (tamsulosin), 5 alpha-reductase inhibitors (finasteride - blocks conversion of test to DHT, therefore decreasing prostate size)
• Surgery - transurethral resection of prostate
