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CCC blue book > CCC chapters 16-20 > Flashcards

CCC chapters 16-20 Flashcards

1
Q

In QOL studies, what does FACT stand for?

A

Functional assessment of cancer therapy

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2
Q

In the field of quality of life, what does QTWIST stand for? (not an exact mnemonic).

A

Quality of time without symptoms or treatment side effects.

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3
Q

Define morbidity

A

A diseased condition or state

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4
Q

Ages for cervical screening programme?

A

Every 3 years 25-49 years. Every 5 years form 50 onwards. Scotland and wales it starts at 20.

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5
Q

Who is screened for breast cancer and how often?

A

Women between the ages of 50 and 70 every 3 years.

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6
Q

How does colorectal cancer screening work?

A

England+Northern Ireland faecal occult blood test (FOB) every 2 years from 60-69, being extended to 74. Scotland 50-74). Wales (60-74).

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7
Q

How does randomisation work in clinical trials?

A

Reduces bias by assigning individuals to each arm of the trial by chance alone.

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8
Q

What is the name of the curve often used for cancer survival?

A

Kaplan Meier.

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9
Q

Which three types of decisions can be made under Advanced care planning (Mental capacity act 2005)?

A
  1. Advanced communication of tx wishes to be taken into account when making future “best interests” decisions
  2. Advanced refusals of specific treatments, legally binding if valid and applicable
  3. Appoint lasting power of attorney for “health and welfare” or “property and affairs”
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10
Q

How do pts often describe bone pain? And how is it treated?

A

Either dull ache over large area or well localised tenderness. Often worse on weight bearing/movement.

NSAIDs (e.g. diclofenac), radiotherapy and bisphosphenates (e.g. pamidronate infusion)

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11
Q

How is visceral pain treated in cancer?

a) Constant dull visceral pain
b) caused by visceral stretch
c) Colic pain

A

a) Constant dull visceral pain: analgesic ladder
b) caused by visceral stretchː NSAIDs or corticosteroids to reduce inflammation
c) Colic pain: anticholinergic drugs e.g. subcut hyoscine butylbromide for bowel colic and oral oxybutinin for bladder spasm

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12
Q

How is headache due to raised IC treated?

A

Dexamethsone 16mg P.O. daily, NSAIDs and paracetamol

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13
Q

How is neuropathic pain treated?

A

Amitriptyline 10-75mg nocte, gabapentin 100-1200mg td, pregablin 25-300mg)

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14
Q

With opioids will N&V settle?

A

Usually within a few days

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15
Q

Opioids can cause drowsiness which usually improves within 48 hours, if it doesn’t what 2 things should you consider?

A

1) Excessive dosing

2) Renal impairment

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16
Q

When progressing up the analgesic ladder, if patient has been on max dose co-codamol, what dose of opioid should they start on?

A

MST 20mg PO BD. Elderly/frail can have lower doses. Renal fun can cause it to accumulate, can use fentanyl (not really excreted) or adjust the dose.

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17
Q

How much morphine should be prescribed for breakthrough pain for patients on opioids? If on 20mg MST BD how much should they have PRN?

A

1/6th of their total 24 hour morphine dose. E.g. if on 20mg BD then breakthrough dose is 5-10mg.

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18
Q

1) What is the second line opioid when morphine is not tolerated?
2) What are the slow release and fast release forms called?

A

1) Oxycodone
2) Fast=oxynorm
Slow=oxycontin

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19
Q

What is xerostomia?

A

Dry mouth

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20
Q

How is vomiting due to gastric stasis treated?

-Early fullness, feeling full, hiccups, heartburn, minimal nausea between vomits.

A

10-20mg PO 30 mins before meals, 30-60mg SC over 24 hours

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21
Q

How is toxic caused vomit treated?
-Persistent or intermittent nausea, small vomits “possets” and retching. Caused by hypercalcaemia, uraemia, opioids, digoxin, anti epileptics or infections.

A

Halloperiodol 1.5-5mg po/sc nocte

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22
Q

How is raised ICP vomiting treated (may have little nausea)?

A

Dexamethosone 8-16mg po OD plus cyclizine 50mg TDS po/sc or 150mg

23
Q

Name a laxative that is both a softener or stimulant

A

Co-danthrusate (dantron+docusate)

24
Q

Cancers with highest incidence of bowel obstruction?

A

Ovarian cancer and bowel cancer.

25
Q

Treatment of dyspnoea due to congestive cardiac failure?

A

Diuretics, digoxin, ACE inhibitors

26
Q

Which part of the spinal cord do 2/3 of MSCC occur?

A

Thoracic and remainder in cervical or lumbar spine.

27
Q

Which cancers is MSCC most common in?

A

Breast, bronchus and prostate

28
Q

What are the symptoms of MSCC?

A
  • Back pain (in 90%)
  • Motor weakness (can be quick or slow onset)
  • Sensory changes (can precede objective physical signs)
  • Bladder/bowel issues (occur late, can be insidious)
29
Q

Symptoms of SVCO?

A 
Headache
Breathlessness (can be worse when flat)
Puffy face
Cough
Hoarse voice
Visual problems
30
Q

Signs of SVCO?

A

Cyanosis

Prominent blood vessels of face, neck and arm

31
Q

Most common cancers that cause hypercalcaemia?

NOTE: Do not have to have spread to bone!

A

Breast, myeloma, lung, squamous cell carcinomas

32
Q

Investigations in suspected hypercalcaemia?

A

Serum calcium corrected for serum albumin

33
Q

When a dying patient can no longer swallow, most medications are stopped. Which 4 medications should they continue to be prescribed?

A

An antiemetic, antiaxiolytic, analgesia and antisecretory.

34
Q

What is the treatment for terminal restlessness?

A
  1. 5-5mg midazolam SC or infusion (starting at 10mg in 24 hours)
    * can also use levopromazine
35
Q

What angle is the butterfly needle inserted at when using syringe drivers?

Where can they be sited?

A

45 degrees

Upper arm, abdomen, chest, thigh

36
Q

Which anti emetics can cause skin irritation if delivered via submit?

A

Cyclizine and levopromazine

37
Q

Which gene is linked to breast cancer (especially early onset or male) but not ovarian cancer?

A

BRCA 2

38
Q

After mammogram, how is breast Ca diagnosis confirmed?

A

FNAC (fine needle aspiration cytology), needle biopsy or incisional/excisional biopsy.

39
Q

In breast cancer, what T stage is a tumour of between 2 and 5cm in size?

A

T2 (which would be part of at least stage 2 disease)

40
Q

What do all breast cancer patients need post conservative surgery?

A

Radiotherapy to the residual breast tissue

41
Q

Tamoxifen reduces the risk or recurrence by 25% and death by 17%, which patients will benefit from taking this? (20mg/day)

A

Those with ER positive primary tumours

NOTE: also reduces risk of contralateral breast cancers in all women

42
Q

What are aromatase inhibitors?

A

Drugs for post menopausal women who have had breast cancer, less side effects (vascular and malignant) than tamoxifen. E.g. anastrozole, letrozole

43
Q

Risk factors for colorectal cancer?

A
  1. Diet (high in animal fat, low in fibre
  2. Inflamm disease (UC mainly, link with crohns is debateable
  3. Genetics (FAP, Gardners syndrome, HNPCC)
44
Q

FAP can is associated with APC mutations, which changes in the bowel does this lead to?

A

Development of benign adenomas, progression to invasive carcinoma requires further mutations e.g. p53, DCC and RAS

45
Q

Which histological type are 95% bowel cancers?

A

Adenocarcinomas (remember most [40%] of large bowel tumours occur in the rectum)

46
Q

Which occupations are associated with lung cancer?

A

Absestos exposure, ship building, uranium mining and petroleum refining

47
Q

Which chromosomal deletions can lead to loss of tumour suppressor genes and malignant transformation that causes lung tumours?

A

3p, 13q and 17p.

48
Q

What are ras, myc and c-erb-b2

A

Oncogenes, overexpression can lead to increased risk of lung cancer

49
Q

What syndromes are produced by mediastinal lung tumours?

A

Recurrent laryngeal nerve palsy and SVCO

50
Q

Tumour markers are not routinely used in lung cancer, but two sometimes provide useful indications of tumour activity. Name these.

A

Neuron specific enolase (NSE) and lactate dehydrogenase (LDH)

51
Q

Which cancer responds quicker to chemo, NSCLC or SCLC?

A

SCLC responds to chemo within days, can treat MSCC or SVCO.

52
Q

What is Continuous hyperfractionated accelerated radiotherpy? (CHART)

A

Radiotherapyu given 3 times a day for 12 days, improves survival rates in NSCLC. Giving radio and chemo at same time can improve survival rates.

53
Q

What is cytoreductive surgery?

A

Surgery to debulk a tumour. Useful in ovarian Ca when used with chemo. Only usually of benfit if there is therapy to target remaining tumour.

CCC blue book (2 decks)

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