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DPD > Cancer Presentations and Initial Management > Flashcards

Cancer Presentations and Initial Management Flashcards

1
Q

What is the surgical sieve?

A 
VITAMIN C DEF
Vascular
Infection/Inflammatry
Trauma
Autoimmune
Metabolic
Iatrogenic
Neoplastic

Congenital

Degenerartive
Endocrine/Environment
Functional

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2
Q

What is a clinical oncologist?

A

Treat disease with radiotherapy, using drugs to support their therapy

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3
Q

What is a medical oncologist?

A

Treat disease with drugs alone

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4
Q

How can you break the news of Cancer well?

A

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

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5
Q

What are the most common presentations of cancer in secondary care?

A 
unintentional weight loss (major red flag)
confusion/fitting
shortness of breath
generalised pain 
liver/renal failure
off legs
lumps and bumps
paraneoplastic less common
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6
Q

What are the differentials of confusion/fitting?

A 
infection
biochemical abnormality
drugs
brain metastasis
primary brain cancer
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7
Q

What are your primary investigations for confusion/fitting?

A

Bloods (FBC, U&E, LFTs, Mg, Ca, CRP, toxic screen if indicated)
CT Brain

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8
Q

What is midline shift?

A

A CT scan of the brain that shows the midline shifting to the side, indicating brain metastasis

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9
Q

What is the first basic step you would initiate following suspicious CT head?

A

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

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10
Q

What are the most common cancers in the UK?

A

Lung, Bowel, Breast, Prostate

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11
Q

What is a CT CAP?

A

CT chest, abdomen, pelvis

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12
Q

What happens if it’s a solitary lesion in the brain?

A

Surgery

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13
Q

What are some of the differentials of Shortness of Breath?

A 
COPD
Heart Failure
Infections e.g. pneumonia, TB
MI
Sarcoidosis
"Wet" disease - pleural effusion, ascites, pericardial effusion, bronchiectasis
Pneumothorax
Primary Lung Cancer
Metastatic Disease
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14
Q

Investigations of SOB patient

A 
CXR
Bloods
Arterial Blood Gases
Act accordingly
CTPA
ECG
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15
Q

What is a CTPA?

A

CT Pulmonary Angiography

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16
Q

Give a complication of malignancy

A

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

17
Q

Why is warfarin not used in oncology?

A

Some cancers produce something that inhibits warfarin

Warfarin has several drug interactions

18
Q

What is a complication of pneumonia?

A

Consolidation may hide underlying malignancy

Repeat chest imaging 6 weeks post to ensure changes have resolved

19
Q

If you suspect Cancer on an abdo CT, what other imaging should you do?

A

CT CAP - chest and pelvis

20
Q

How do you manage single transition point obstruction?

A

In fitter patients - surgery

In less fit patients - stent

21
Q

How do you manage Multifocal sub-acute bowel obstruction?

A

Drip & Suck (IV fluids & Nasogastric Tubes & Nil By Mouth)
when electrolytes balanced Chemotherapy
If not possible, palliative care

22
Q

How does ovarian cancer often present?

A

Multifocal sub-acute bowel obstruction

23
Q

What are common cancerous causes of Liver Failure?

A

breast cancer
colon cancer
upper GI cancers
HCC (primary hepatocellular carcinoma)

obstructive:
pancreatic cancer
cholangiocarcinoma
portal metastases from other cancers

24
Q

What is cholangiocarcinoma?

A

Bile Duct Cancer

25
Q

What should you suspect in a patient that seems healthy but has suddenly become jaundiced/yellow?

A

pancreatic cancer

26
Q

What are two types of tumours in the liver and how do you manage them?

A

low volume disease (1 or 2 sites is OK) - surgically excision or ablation
multifocal disease - systemic therapy

27
Q

How might an obstructive Liver present differently than intrahepatic tumours?

A

obstruced liver will have a proportionally greater rise in Bilirubin and AlkP (alkaline phosphatase)

28
Q

How to manage obstructed liver?

A

Diagnose with biopsy
ERCP and stent
PTC drainage
No chemotherapy until LFTs have normalised

29
Q

How do you analyse deranged U&E’s?

A

Pre-renal
Intrinsic
Post-renal

30
Q

Describe the WHO pain ladder

A

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

DPD (8 decks)

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