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CCC > CCC: Oncology > Flashcards

CCC: Oncology Flashcards

1
Q

What is an objective system for measuring the response of tumour to treatment?

A
  1. Complete response - no evidence of cancer radiologically (CT/MRI)
  2. Partial response - >30% decrease in all lesion tumour sizes
  3. Stable disease - < 30% decrease in tumour size or no more than >20% increase in tumour size
  4. Progressive disease - new lesions or >20% increase in tumour size
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2
Q

Give a brief summary of MRI

A

Protons - non-ionising (no radiation)
Duration = hours
Best detail = Soft tissue (gold standard)

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3
Q

Give a brief summary of USS

A

Ultrasonic waves - no radiation
Duration = minutes
Best detail = Soft tissue
Duplex feature = detects blood flow

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4
Q

Give a brief summary of USS

A

Ultrasonic waves - no radiation
Duration = minutes
Best detail = soft tissue
Duplex feature = detects tumour blood flow

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5
Q

Give a brief summary of Nuclear medicine

A

Radio-isotope labelled substances detected via γ-camera
- e.g. technetium IV (measuring GFR), radioactive iodine

Function = detects structure and function

example:
1. Bone scintigraphy - detects bony mets

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6
Q

Give a brief summary of PET

A

Positron-emission-tomography
Detects photons of radio-isotope labelled drugs
- e.g. fluoroquinolone-18 (FGD-18) is radioactive glucose (taken up by malignant cells and other normal tissues e.g. brain)

function = visualise and differentiate between benign and malignant cancer

Often combined with CT to give colour image

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7
Q

Give a brief summary of Fluoroscopy

A

Live digital radiography using ionising radiation imaging using contrast (barium swallow) to intensify image

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8
Q

CEA, is the tumour mark for which cancer?

A

Colorectal cancer

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9
Q

What are the symptoms and signs of MSSC?

A
  1. Back pain (90%)
    - Tender
    - Localised, Band like or Radicular
    - U/L or B/L
    - Worse with straining, coughing, lying down
    - Nocturnal
  2. Motor weakness or loss
    - Leg weakness
    - Gradual onset usually, subtly presents 3 months before pain
    - Can be sudden onset
  3. Sensory disturbance or loss
    - Paraesthesia
    - Sensory loss
    - Saddle anaesthesia (buttocks)
  4. Urinary/bowel dysfunction
    - Urinary retention
    - Constipation
  5. Clonus
  6. Reflexes
    - absent at level
    - increased below level
    - normal above level
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10
Q

At what levels is MSSC most common?

A

Thoracic (66%)

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11
Q

What are the investigations that must be done for suspected MSSC?

A
  1. Focused CNS and full PNS exam
  2. MRI within 24hrs
    - not all patients present with back pain, but if MSSC suspected, must do MRI
    - CT as alternative
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12
Q

What is the treatment ladder for MSSC?

A
  1. Dexamethasone (16mg) with PPI (omperazole) cover for elderly
  2. Radiotherapy
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13
Q

Which cancers commonly cause MSSC?

A 
Breast 
Lung 
Prostate 
Myeloma 
Lymphoma
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14
Q

What is the most common cause of SVC obstruction?

A

Malignant disease (>75%)

  • Lung (most common)
  • Mediastinal lymphoma
  • Oesophageal carcinoma
  • Thymoma
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15
Q

What is the common presentation of SVC obstruction?

A
  1. Dyspnoea –> Orthopnoea –> Cough
  2. Headache
    - worse on straining
  3. Distended neck and chest veins
  4. Cyanosis
  5. Oedema
    - Typically face, neck and arm
    - May also see conjunctival + peri-orbital
  6. Hoarse voice
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16
Q

What are the key investigations for SVC obstruction?

A
  1. Pembertons test
    - Distended neck veins
    - Cyanosis
    - Dyspnoea
  2. Urgent CXR –> Contrast CT Thorax
17
Q

What is the treatment ladder for SVC obstruction?

A
  1. Dexamethasone (16mg) with PPI cover (omeprazole)
  2. SVC balloon venoplasty and stent
    - Rapid relief of symptoms
18
Q

What are the symptoms of hypercalcaemia?

A 
1. Mild < 2.8mmol
Polyuria
Polydipsia 
Dyspepsia
Dehydration 
Mild cognitive impairment 
2. Moderate <3.5mmol 
Muscle weakness 
Constipation
Anorexia 
Fatigue  
3. Severe > 3.5mmol 
Abdominal pain 
Nausea and vomiting 
Arrhythmias 
Confusion, drowsy, fits, coma 
Death
19
Q

What are the investigative definition of hypercalcaemia?

A

Serum calcium adjusted for albumin > 2.5 mmol

normal calcium = 2.25 - 2.5 mmol

20
Q

What is the investigative findings of hypercalcaemia?

A 
1. Bloods
Raised Ca2+ > 2.5 mmol
Raised ALP
Low Phosphate 
High PTH
  1. Urine
    High phosphate
3. ECG 
Short QT 
Wide PR 
Wide T 
BBB
21
Q

What is the treatment for hypercalcaemia?

A
  1. Fluids - Saline 0.9% 500ml bolus then maintenance
    - give furosemide if fluid overloaded
  2. Bisphosphonates - IV Pamidronate or Zolindronic acid
    - inhibits osteoclast resorption
  3. Salmon Calcitonin and Prednisolone (last line)
    - rappidly reduces Ca2+
22
Q

What is the definition of neutropenic sepsis?

A

Absolute neutrophil count (ANC) < 1.0

Fever > 38.5 or two readings of > 38.0 for > 1 hour

23
Q

What are the symptoms of neutropoenic sepsis?

A 
High HR, RR, CRT, Temp
Low BP, UO 
Hypothermia
Fever and rigors 
Systemically unwell 
Nausea, vomiting, diarrhoea (depends on source)
24
Q

What is the key investigation?

A

FBC

  • Low Neut, Hb, Platelets, WCC
  • Transient progression to nadir over 10-12 d
  • Prolonged nadir indicates bone marrow infiltration

Blood/Urine/Stool cultures

25
Q

What is the treatment for neutropenic sepsis?

A

Sepsis 6 (BUFALO)

  1. Blood culture (line and peripheral)
  2. Monitor UO - catheterise
  3. Fluids - 500ml Saline 0.9% Stat then maintenance
  4. Abx
    - Tazocin (1st line - tazobactam and piperacillin)
    - Aztreonam and Vancomycin (2nd line)
  5. Lactate - measure via ABG or VBG
  6. Oxygen 15L/min via NRBM

Also can give CGSF (filgrastim, lenograstim) - acts as prophylaxis and reduces duration of neutropenia

26
Q

What is the definition of anaemia?

What are the symptoms and how would you treat?

A

Hb < 10gldl
Dyspnoea + Fatigue
Blood transfusion or recombinant EPO

27
Q

What is the definition of thrombocytopenia?

What are the symptoms and how would you treat?

A

Platlets < 20 x 10^9
Nose bleeds, petechial + corneal haemorrhage, haematuria

Platelet < 10 x 10^9 = urgent platelet transfusion
Platelet between 10 x 10^9 and 20 x 10^9 = consider platelet transfusion

28
Q

What if platelets do not rise following platelet transfusion for thrombocytopenia?

A

Suggests patient has created Ab against platelets

–> Single donor transfusion or HLA matched platelets required

CCC (7 decks)

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