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Z IPE > Cancer care > Flashcards

Cancer care Flashcards

1
Q

S&S of small cell lung

A

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

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2
Q

Tx of small cell

A

Tx:
• Usually metastatic by diagnosis
• If no mets consider surgery
• If mets, radio + chemo

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3
Q

S&S of spinal cord compression

A 
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

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4
Q

Tx and ix of spinal cord compression

A

Tx:
• High dose dexamethasone
• Urgent assessment for radiotherapy or surgery

ix - MRI spine

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5
Q

RFs of oesophageal cancer

A 
RFs:
	• Smoking
	• Alcohol
	• GORD
	• Barretts
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6
Q

ix of oesophageal cancer

A

Ix:
• Upper GI endoscopy
• CT staging

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7
Q

S&S of oesophageal cancer

A 
S&S:
	• Dermatological - acanthosis nigricans
	• Dysphagia progressive
weight loss
chest pain
hoarseness
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8
Q

Tx of oesophageal cancer

A 
Tx:
	• Surgical resection
	• Ivor-Lewis oeseophagectomy
	• Adjuvant chemo
palliative stenting
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9
Q

What is neoadjuvant and adjuvant chemo

A

neoadj - before tx

adj - post tx

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10
Q

How describe skin lesions?

A 
ABCDE Symptoms
A - Asymmetry
B - Border irregular
C - Colour
D - Diameter
E - Evolution
Symptoms - bleeding, oozing, itching, altered sensation
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11
Q

S&S of colorectal cancer

A 
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

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12
Q

Staging of colorectal ca

A

Staging - Dukes:

1. A - Within bowel wall
2. B - Through bowel wall
3. C - Lymph nodes involved
4. D - Distant mets
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13
Q

ix and tx of colorectal ca

A

Ix:
• Colonoscopy
• Staging CAP CT

Tx:
• Surgery +/- adjuvant chemo
○ Low rectal cancer - AP excision of rectum

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14
Q

S&S of stomach ca

A 
S&S:
	• Dyspepsia - >1 mth and >50
	• Weight loss
	• Vomiting
	• Dysphagia
	• Anaemia
	• Enlarged vircows node.
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15
Q

Ix and tx of stomach ca

A

Ix:
• Gastroscopy
• Staging CT

Tx:
• Gastrectomy

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16
Q

Define neutropenic sepsis

A

Neutrophil count <0.5*10^9 + :
• Temp >38C
• OR Sx consistent with sepsis
in pts taking anticancer tx

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17
Q

S&S of neutropenic sepsis

A 
S&amp;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
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18
Q

SVCO causes

A 
Causes:
	• Extrinsic compression:
		○ Right sided tumours
		○ Superior mediastinal lymphadenopathy
	• Intrinsic compression:
		○ Thrombosis
		○ Foreign body
Tumour
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19
Q

S&S of SVCO

A 
S&amp;S:
	• Swelling of face, neck, arms
	• Distended neck and chest wall veins
	• SOB
	• Headache
	• Lethargy
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20
Q

Tx of SVCO and IX

A

Ix:
• CXR
• CT chest with contrast

Tx:
	• Chemotherapy
	• Radiotherapy
	• Stent - palliative
	• Consider anticoag
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21
Q

Patho of malignancy induced hypercalcemia. S&S

A

Occurs in 5-30% of cancers
Caused by tumour secretion of PTHrP

S&amp;S:
	• Dehydration
	• Psychiatric manifestations + confusion
	• Anorexia
	• Constipation
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22
Q

Ix and tx of malig induced hypercal

A

Ix:
• Calcium
• U&E - dehydration
• PTH/PTHrP

Tx:
• IV access and bloods to check other electrolytes
• CXR and ECG
• IV fluids then IV bisphosphonates

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23
Q

S&S of tumour lysis and commonly caused by

A

Presentation:
• 3-7 days post chemo
• Cardiac arrhythmia
• Oligouria

Common cancers causing:
• Small cell lung
• Germ cell tumours
• Myeloma

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24
Q

Tx of tumour lysis and prevention

A

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)

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25
Q

ovarian tumour marker

A

ca 125

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26
Q

pancreatic tumour marker

A

ca19-9

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27
Q

breast tumour marker

A

ca15-3

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28
Q

prostate tumour marker

A

psa

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29
Q

hepatic tumour marker

A

alpha feto protein

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30
Q

colorectal tumour marker

A

CEA

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31
Q

test cancer tumour marker

A

beta HCG and alpha feto protein

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32
Q

Drugs for neuropathic pain

A

Drugs for neuropathic pain:
• Gabapentin/pregabalin (never at same time)
• TCA - amitryptiline
• Capsaicin

33
Q

give who step ladder. define adjuvant

A

Step 1 - non opioid +/- adjuvant
Step 2 - mild opioid + step 1
step 3 - strong opioid + step 1

adjuvant - non opioid analgesic

34
Q

give examples of mild opioid

A 
Mild Opioid:
	• Codeine
	• Dihydrocodeine
	• Tramadol
	• Oxycodone
35
Q

examples of strong opioids

A

Strong Opioid:
• Morphine
• Alfentanyl
• Methadone

36
Q

how do you reverse morphine od

A

naloxone

37
Q

how do you calculate how much morphine to give a pt

A
  1. Zomorph is given BD, once in day, once at night
    1. Give pt PRN 5-10mg dose of morphine until pain is controlled
    2. 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
38
Q

When is SC morphien used

A

SC used if pt vomiting or cant take drugs orally

39
Q

When is transdermal morphine used

A

Transdermal - Used if pt refuses SC route or is demented and keeps pulling line out etc

40
Q

How to calculte SC dosage of morphine

A

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

41
Q

ADRs of opioids

A 
ADRs of opioids:
	• Constipation
	• Nausea
	• Drowsiness
	• Pruritis
	• Resp depression
	• Dry mouth
42
Q

what co-prescribe with morphine?

A

Co-prescriptions:
• Constipation - Always co prescribe Osmotic laxative (laxido)
• Nausea - haloperidol

43
Q

antiemetic for dizziness and head movement nausea

A

Cyclizine, dexamethasone

44
Q

What antiemetic for slow gastric emptying

A

Metoclopromide or Demperidone

45
Q

What antiemetic for BO

A

Cyclizine, dexamethasone

46
Q

What antiemetic for fear/anxiety

A

haloperidol, BZD

47
Q

what antiemetic for drug induced

A

haloperidol

48
Q

what antiemetic for metabolic nausea

A

haloperidol

49
Q

What prescribe for excess resp secretions

A

hyoscine butylbromide

50
Q

Antidepressant for depression and anxiety in cancer?

A

1st choice - Citalopram

2nd choice - Sertraline

51
Q

S&S of non hodgkins lymphoma

A

S&S:
• Enlarged painless lymph nodes (75%) - cervical, axillary, inguinal
• Systemic (25%) - Weight loss, Night sweats, Fever, Lethargy

52
Q

Ix of non hodgkins and staging system

A

Ix:
• Bloods - FBC, U&E, LDH, LFT
• Marrow and node biopsy

Ann arbor staging

53
Q

Tx of non hodgkins

A

Tx:
• Localised - radiotherapy
• Diffuse - chemo
• R-CHOP if high grade

54
Q

Explain ann arbor staging

A

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

55
Q

S&S of hodgkins lymphoma

A

S&S:
• Enlarged painless lymph nodes (75%) - cervical, axillary, inguinal
• Systemic (25%) - Weight loss, Night sweats, Fever, Lethargy

56
Q

Pathology of leukaemia

A

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

57
Q

S&S of AML. ix

A

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
58
Q

Tx of AML and cx of tx

A

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

59
Q

ALL S&S

A 
S&amp;S:
	• Cytopenia - fatigue, infection, bleeding
	• Hepatosplenomegaly
	• Lymphadenopathy
	• Pneumocystitis pneumonia common

same as AML but with lymphadenopathy

60
Q

Ix of ALL

A 
Ix:
	• Blood film 
	• Bone marrow
	• WCC high
	• CXR and CT to look for lymph involvement

Lymph involved in ALL

61
Q

Tx of ALL

A

Tx:
• Supportive - blood/platelet transfusions, IV fluids
• Infections - prophylactic abx and antivirals and antifungals
• Chemo
• Bone marrow transplants

62
Q

What is myelodysplastic syndrome?

A

Build up of blasts but <20% blasts so not quite AML

63
Q

Patho of chronic leukaemia

A
  • 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.
64
Q

CML S&S

A 
CML S&amp;S:
	• Hepatosplenomegaly - abdo fullness
	• Fatigue
	• Bleeding
	• Immunosuppresion
	• Weight loss
	• Fever
	• Night sweats
65
Q

CML Ix

A 
CML Ix:
	• WBC up (>100)
	• Urate Up
	• B12 up
	• Bone marrow
66
Q

CLL S&S

A 
CLL S&amp;S:
	• Lymphadenopathy - pain in lymph nodes
	• Autoimmune hemolytic anaemia
	• Fatigue
	• Bleeding
	• Immunosuppresion
	• Weight loss
	• Sweats
67
Q

CLL ix and Tx

A

CLL Ix:
• Raised lymphocytes
• Decrease Hb, neutrophils, platelets

CLL tx:
• Chemo
• Steroids if autoimmune hemolysis

68
Q

What is multiple myeloma

A

Bone marrow cancer - Expansion of a single clone of IG secreting terminally differentiated B cells

69
Q

S&S of multiple myeloma

A

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

70
Q

Tx of multiple myeloma

A

Tx:
• Supportive - bone pain analgesia, bisphosphonate, erythropoeitin and blood transfusion anaemia, IV fluids for renal failure, abx prophylaxis
• Chemo

71
Q

Ix of multiple myeloma

A 
Ix:
	• FBC - normocytic normochromic anaemia
	• Blood film - roleaux formation
	• Increase calcium
	• Increase urea and creatinine
	• Bence Jones protein in urine
72
Q

Patho of polycythemia rubra vera

A

Patho:

• Myeloproliferation resulting in increase RBC, and platelets and neutrophils.

73
Q

S&S of polycyth rubra vera

A

S&S:
• Hyperviscosity - strokes
• Pruritis post hot bath
• Splenomegaly

74
Q

Ix and tx of polycyth rubra vera. Epi

A

Epidemiology:
• 60 age peak

Ix:
• JAK2 mutation - Diagnostic
• FBC and blood film

Tx:
• Phlebotomy

75
Q

S&S of prostate carcinoma

A 
S&amp;S:
	• Hesitancy during micturition
	• Nocturia
	• Poor stream
	• Post void dribble
	• Bone pain if mets
76
Q

Ix of prostate carcinoma

A 
Ix:
	• DRE
	• Serum PSA:
		○ Different ages have differing levels of acceptable PSA
	• Trans rectal USS biopsy
	• CT and bone scan for staging
77
Q

Tx of prostate carcinoma

A 
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
78
Q

S&S of BPH

A

S&S:
• Voiding sx - weak flow, hesitancy, straining, incomplete emptying
• Storage sx - urgency, frequency, incontinence, nocturia
• Complications - UTI, retention, obstruction uropathy

79
Q

Tx of BPH

A

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

Z IPE (15 decks)

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