Cauda equina + Cancer chemo Flashcards
how is cauda equina managed
- immobilisation
- steroids dexa 8mg
- MRI
- Neurosurgery referral
- pain relief
- radiology or oncology referral if leukaemia or lymphoma
what is the subsequent management of cauda equina
- taper off dexam
- treatment of primary cancer
- physio
- pain control
- other specialty input from macmillan nurses, palliative care team, physio, OT and GP
which tumours that have mets to the sc are radiation sensitive
Multiple myeloma
small cell lung cancer
which tumours that have mets to the SC are not sensitive to radiation
renal cell cancer
melanoma
what are the risk factors for prostate cancer
age
ethnicity - African americans
diet red meat
family history
BRCA2 X5 higher risk
which zone does prostate cancer affect
peripheral zone
which zone does BPH affect
transitional
symptoms of prostate cancer
obstruction: urinary hesitancy, weak stream and intermittency
irritation: increased frequency, urgency, nocturia and urge incontinence
obstruction of the ejaculatory ducts:
- haematospermia
- decrease in ejaculate
if affects neurovascular bundle = ED
Prostate cancer mets symptoms
bone pain
anaemia
leg oedema and weakness
fracture
weight loss
asymptomatic
what is the investigation of pcancer
DRE
PSA
transrectal ultrasound guided biopsy
MRI/CT
bone scan* only in high risk
routine FBC +BCP
what histological scoring is used in prostate cancer
gleason
treatment options for P cancer
external beam RT
surgical removal
what drug is used in androgen deprivation therapy
bicalutamide
side effects of ADT
hot flashes
ED
weight gain
muscle weakness
loss of bone density
CVD, DM increased risk
how does tumour induced hypercalcemia occur
- in paraneoplastic syndrome tumour cells secrete a protein called PTHR protein that stimulates the parathyroid gland to affect the following organs: bone, kidney and SI.
bone = increases osteoclast mediated bone resorption
kidneys: increases renal tubular calcium reabsorption
SI = increases absorption of Ca
- other mechanism is via bone lysis directly by the tumour in the case of multiple myeloma
what mnemonic can be used to remember symptoms of high Ca
stones (renal stones, polyuria +polydipsia)
bones
abdominal groans (constipation and anorexia)
psychiatric overtones (psychosis, anxiety, lethargy, memory loss, depression and coma)
DD for symptoms of high Ca
infection
renal failure
brain mets
SC compression
depression
acute bowel obstruction
opioid related SE
what cancers are more likely to cause high Ca
squamous cell and small cell cancer of lung
any advance squamous cell cancer eg H&N, bladder etc
MM
renal cell
advance breasy
managment of High Ca
- rehydrate
- IV bisphosphonates
- glucocorticoids (inhibit vit d activation thus reducing absorption of Ca from gut)
- manage malignancy
in resistant cases consider calcitonin
other causes of hypercalcaemia
primary hyperparathyroidism
sarcoidosis Granulomas in sarcoidosis contain activated macrophages.
These macrophages express 1α-hydroxylase, which converts inactive vitamin D (25-hydroxyvitamin D) into its active form (1,25-dihydroxyvitamin D).
thyrotoxicosis In thyrotoxicosis (e.g., Graves’ disease, toxic multinodular goiter), excess thyroid hormones (T3 & T4) stimulate osteoclast activity.
meds
cautions associated with zolendronic acid
impair renal function
flue like symptoms
hypocalcemia
jaw necrosis
