cancer teaching Flashcards
Clincial vs medical oncologist
Clinical - also deliver chemo teaching
Define neutropenic sepsis
Oral temp above 38.3
neutropenia
Have you taken paracetamol?
Cold neutropenic sepsis - hypothermic + sepsis
Avoid paracetamol
Buy a temp
Ensure they have capacity
Neutrophil life span = 5.4 days
IV antibiotics - door to needle time = 60 mins
When is
2 weeks after
Do they have CVADs
Central venous access device
What is the key response to neutropenic sepsis?
Bloods - FBC, U and E, LFTs, CRp, Lactate above 4,
Check allergies
Treat in rhesus
PROMPT antibiotics
Which
Double lumen pickman line - is it pussy? Angry looking? Do we need to take a swab?
Have you taken paracetamol?
Do you have a sore throat?
Cancer diagnosis?
When did you have chemo?
Sources of infection?
Portercath - permanent line - commonly seen in breast cancer patients
Grippers
PICC line
MASCC score on your phone - if <21, high risk of febrile neutropenia; but the answers can vary between patients
Management
GCSF treatment
Firstline ab - tax with amicacin
if penecillin allergic - meropenem
How to avoid neutropenic sepsis
Height and weight - adjust chemo to surface area
BLoods before chemo as some chemo is renal and hepatotoxic
Give them a cancer treatment record
UCOMS - traffic light system of symptoms
Immuno patients with diarrhoea can die if you have immunotherapy related collitis
Metastatic spinal cord compression
Direct tumoa
Collapse of vertebral body
Difference between MRI
T1 - water is white
T2 - water is dark
Most commonly in thoracic spine
Breast lung and prostate cancer most common
Back pain - 95 per cent
Tingling and numbness in extremities =
Limb weakness - can be bilateral
Difficulty passing urine
Bowel disturbance
Saddle anaestheisa - PR
Full neuroexam
When is
Most commonly in thoracic spine
Breast lung and prostate cancer most common
Back pain - 95 per cent
Tingling and numbness in extremities =
Limb weakness - can be bilateral
Difficulty passing urine
Bowel disturbance
Saddle anaestheisa - PR
Full neuroexam
How do you manage metastatic cord compression?
Management
Bed Rest
Urgent spine MRI
Liaise with MSCC coordinator
First line = Steroids and PPI; 8mg BD; shrinks the tumour but not bone; you don’t need to wait for an MRI necessarily
Treatment of MSCC?
Neurosurgery
What can neurosurgery be used for?
Diagnosis
NOTE neurosurgery should not be done after radiotherapy
How do we assess ECOG performance status?
ECOG performance status
What is radiotherapy given for?
Mechanical pain
If unsuitable for surgery
Treatment field = one above and one below
What is a side effect of radiation?
Radiation necrosis
What do you need to prescribe with
REMEMBER PPI
What common things
Lung cancer
Lymphoma
Metastatic disease to mediastinum
Syphillus, TB, central line thombus, congestive heart failure
SVCO presentation
Dysnpoea
Facial swelling
How do you manage SVCO?
Ensure airway is not compromised
Do not lie flat
Monitor vital signs and level of concsiousness
CT chest
HCG, AFP, LDH, HIV test
