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NMF: Oncology > Cancer complications > Flashcards

Cancer complications Flashcards

1
Q

What is neutropenic sepsis?

A

sepsis plus neutrophil count <0.5 or <1 if chemo in past 21 days

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2
Q

How long should you assume a patient is neutropenic for following chemotherapy?

A

3 weeks

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3
Q

How should a patient with neutropenic sepsis be managed??

A
  1. Commence sepsis 6 within 15mins
  2. Assign risk as standard or high
  3. Initiate antibiotic therapy
  4. Full infection screen
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4
Q

What makes a patient with neutropenic sepsis standard risk?

A

news <6

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5
Q

What makes a patient with neutropenic sepsis high risk?

A

septic shock or news >7

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6
Q

How is a patient with standard risk neutropenic sepsis managed?

A

piperacillin or tazobactam

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7
Q

How is a patient with high risk neutropenic sepsis managed?

A

Gentamicin + piperacilin/tazobactam

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8
Q

What makes up a full infection screen?

A 
Blood cultures
MSU
Stool culture
Sputum culture
CXR
Skin swabs
Throat swabs
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9
Q

How should a patient with known prostate cancer presenting with back pain worse at night be investigated?

A

? neoplastic spinal cord compression

arrange urgent MRI and give high-dose oral dexamethasone

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10
Q

How does neoplastic spinal cord compression present?

A
  • pain in the spine which is worse on coughing and straining and radicular pain (burning, band)
  • weakness
  • sensory change: loss of proprioception, light touch or pinprick
  • urinary retention
  • bowel constipation
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11
Q

How should neoplastic spinal cord compression be treated?

A
  1. radiotherapy

2. surgery if single level, radioresistant or unknown primary

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12
Q

What are some symptoms of superior vena cava obstruction?

A

Swelling of face, neck one or both arms.
(one arm suggests more distal)

Distended veins.

Shortness of breath.

Headache.

Lethargy

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13
Q

How should superior vena cava obstruction be investigated?

A

CXR for mass
Venogram for clots
CT chest

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14
Q

What can cause superior vena cava obstruction?

A

DVT
Foreign body (eg line)
tumour in vessel
extrinsic compression from a mass

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15
Q

How can superior vena cava obstruction be managed?

A

thrombolysis if clot

if extrinsic: steroids, chemo or radio depending on sensitivities, stenting

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16
Q

What can cause hypercalcaemia in malignancy?

A
  1. humoral - oversecretion of parathyroid hormone-related peptide (PTHrP) from malignant tumors
  2. local bone destruction esp if lung, breast or myeloma
  3. tumour produces vit D analogues esp if lymphoma
17
Q

How does hypercalcaemia present in malignancy?

A
  • nausea, anorexia
  • polydipsia + polyuria
  • constipation
  • confusion
  • poor conc, drowsy
18
Q

How should a pt with malignant hypercalcaemia be investigated?

A
  • calcium
  • albumin (to find out corrected calcium)
  • U+Es (for dehydration)
  • phosphate (low in hyperparathyroidism)
  • myeloma screen (if no known malignancy)
19
Q

How is malignant hypercalcaemia managed?

A
  1. rehydrate - several litres of normal saline

2. bisphosphonates

20
Q

In pericardial effusion what happens to

a) cardiac output?
b) venous back pressure?

A

a) decreases as ventricles are compressed

b) increases as right atrium collapses

21
Q

How does malignant pericardial effusion present?

A

SOB
Fatigue
Palpitations
Pericarditis (chest pain relieved by sitting pt forward)

22
Q

What signs of malignant pericardial effusion may be present on exam?

A

jugular venous distention

Pulsus paradoxus –venous return drops when intra-thoracic pressure raised.

Soft heart sounds or pericardial rub.

Poor cardiac output – tachycardia with low BP and poor peripheral perfusion.

23
Q

How should malignant pericardial effusion be investigated and what would be found?

A

CXR - enlargement of cardiac silhouette.

ECG - reduced complex size.

Echocardiogram – rim of pericardial fluid.

Cytology of pericardial fluid.

24
Q

How should malignant pericardial effusion be managed?

A

Pericardiocentesis – drain into pericardium.

Pericardial window – operation to allow pericardial fluid to drain into pleural cavity.

25
Q

If SVCO is caused by intrinsic clot, which treatment should not be used

  • dexamethasone
  • anticoagulation
  • oxygen
  • stent
A

dont use dexamethasone or stent

26
Q

Which form of treatment for spinal cord compression generally has better outcomes?

A

surgery

27
Q

When starting a patient on an opiate you should also prescribe?

A

anti-emetic and a laxative

28
Q

What symptoms would be of concern in a patient who is on high dose Dexamethasone?

A

malaena –> GI bleed

excessive thirst –> diabetes

29
Q

Manage N+V in a patient with intracranial mets

A

dexamethasone

NMF: Oncology (6 decks)

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