Cancer lecture

Question 1

What are the oncological emergencies?

Answer 1

• Neutropenic sepsis-as chemo depletes bone marrow of white blood cells
• Superior vena cava obstruction
• Tumour lysis syndrome-give cytotoxics and sometimes all tumours can respond and release

Question 2

Most cancer is managed as an outpatient:

Answer 2

E-cog performance status 0-5 (0 is us-normal, 4-bedbound and relient on people, 5-dead)

GRADE ECOG PERFORMANCE STATUS

0. Fully active, able to carry on all pre-disease performance without restriction
1. Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2. Ambulatory and capable of all selfcare but unable to carry out any work activities; up and about more than 50% of waking hours
3. Capable of only limited selfcare; confined to bed or chair more than 50% of waking hours
4. Completely disabled; cannot carry on any selfcare; totally confined to bed or chair
5. Dead

Probs not surgery or chemotoxic therapy if score is 3 or 4

Typically use frailty score in other hospital departments but oncology uses e-cog score.

Question 3

Emergency presentation of new cancer:

Answer 3

Question 4

Investigations

Answer 4

Radiological-mammography, CT

Endoscopic-

Surgical-biopsy eg for melanoma

Biochemical-blood tests

Question 5

Radiological investigations

Answer 5

Question 6

Biochemical investigations

Answer 6

Tumour marker

• CEA-associated but not specific to lower GI tumours
• Ca 19-9-poor specificity but associated with pancreatic cancer, not diagnostic but good for monitorig treatment
• Ca 51-3-poor specificity but associated with breast cancer, not diagnostic but good for monitorig treatment
• PSA-protease that is almost exclusive to prostate cancer but can be rised after catheterisation or prostatitis or in BPH
• Ca125-associated with ovarian cancer, not diagnotic biomarker but prognostic and useful to monitor treatment

Question 7

Endoscopic investigations

Answer 7

Question 8

Advantages of endoscopy

Answer 8

Question 9

Surgical investigations

Answer 9

Question 10

Tissue diagnosis is very important and necessary as this determines diagnosis and treatment

Answer 10

Key67-tells us proliferative rate, if high poor prognosis

Question 11

Limitations of MDT

Answer 11

-For each tumour type the mdt is only once a week and so if picked up on thursday and meeting was on wednesday then they have to wait a week.

Question 12

Information needed by MDT

Answer 12