Cancer Presentations and Initial Management Flashcards
What is the surgical sieve?
VITAMIN C DEF Vascular Infection/Inflammatry Trauma Autoimmune Metabolic Iatrogenic Neoplastic
Congenital
Degenerartive
Endocrine/Environment
Functional
What is a clinical oncologist?
Treat disease with radiotherapy, using drugs to support their therapy
What is a medical oncologist?
Treat disease with drugs alone
How can you break the news of Cancer well?
Language and Communication skills
How to handle uncertainty
Remember no one likes to be the bearer of bad news
Refer them to support networks early
Remember they probably won’t remember everything
What are the most common presentations of cancer in secondary care?
unintentional weight loss (major red flag) confusion/fitting shortness of breath generalised pain liver/renal failure off legs lumps and bumps paraneoplastic less common
What are the differentials of confusion/fitting?
infection biochemical abnormality drugs brain metastasis primary brain cancer
What are your primary investigations for confusion/fitting?
Bloods (FBC, U&E, LFTs, Mg, Ca, CRP, toxic screen if indicated)
CT Brain
What is midline shift?
A CT scan of the brain that shows the midline shifting to the side, indicating brain metastasis
What is the first basic step you would initiate following suspicious CT head?
Start Dexamethasone
It reduces oedema around the metastasis and reduce midline shift - can have drastic improvement on patient’s QoL
Organise an MRI head and CT CAP
What are the most common cancers in the UK?
Lung, Bowel, Breast, Prostate
What is a CT CAP?
CT chest, abdomen, pelvis
What happens if it’s a solitary lesion in the brain?
Surgery
What are some of the differentials of Shortness of Breath?
COPD Heart Failure Infections e.g. pneumonia, TB MI Sarcoidosis "Wet" disease - pleural effusion, ascites, pericardial effusion, bronchiectasis Pneumothorax Primary Lung Cancer Metastatic Disease
Investigations of SOB patient
CXR Bloods Arterial Blood Gases Act accordingly CTPA ECG
What is a CTPA?
CT Pulmonary Angiography
Give a complication of malignancy
Malignancy as well as Chemotherapy both increase the risk of PE - up to 10x in some cancers
Treat this with Low Molecular Weight Heparin
Identify the cause
Why is warfarin not used in oncology?
Some cancers produce something that inhibits warfarin
Warfarin has several drug interactions
What is a complication of pneumonia?
Consolidation may hide underlying malignancy
Repeat chest imaging 6 weeks post to ensure changes have resolved
If you suspect Cancer on an abdo CT, what other imaging should you do?
CT CAP - chest and pelvis
How do you manage single transition point obstruction?
In fitter patients - surgery
In less fit patients - stent
How do you manage Multifocal sub-acute bowel obstruction?
Drip & Suck (IV fluids & Nasogastric Tubes & Nil By Mouth)
when electrolytes balanced Chemotherapy
If not possible, palliative care
How does ovarian cancer often present?
Multifocal sub-acute bowel obstruction
What are common cancerous causes of Liver Failure?
breast cancer
colon cancer
upper GI cancers
HCC (primary hepatocellular carcinoma)
obstructive:
pancreatic cancer
cholangiocarcinoma
portal metastases from other cancers
What is cholangiocarcinoma?
Bile Duct Cancer
What should you suspect in a patient that seems healthy but has suddenly become jaundiced/yellow?
pancreatic cancer
What are two types of tumours in the liver and how do you manage them?
low volume disease (1 or 2 sites is OK) - surgically excision or ablation
multifocal disease - systemic therapy
How might an obstructive Liver present differently than intrahepatic tumours?
obstruced liver will have a proportionally greater rise in Bilirubin and AlkP (alkaline phosphatase)
How to manage obstructed liver?
Diagnose with biopsy
ERCP and stent
PTC drainage
No chemotherapy until LFTs have normalised
How do you analyse deranged U&E’s?
Pre-renal
Intrinsic
Post-renal
Describe the WHO pain ladder
mild pain - non-opioid analgesics (if still in pain next)
moderate pain - opioid analgesics
severe pain - high dose opioid analgesics
can give NSAIDs in addition at any stage, however contraindicated in elderly & renally impaired patients
