CCC: Oncology Flashcards
What is an objective system for measuring the response of tumour to treatment?
- Complete response - no evidence of cancer radiologically (CT/MRI)
- Partial response - >30% decrease in all lesion tumour sizes
- Stable disease - < 30% decrease in tumour size or no more than >20% increase in tumour size
- Progressive disease - new lesions or >20% increase in tumour size
Give a brief summary of MRI
Protons - non-ionising (no radiation)
Duration = hours
Best detail = Soft tissue (gold standard)
Give a brief summary of USS
Ultrasonic waves - no radiation
Duration = minutes
Best detail = Soft tissue
Duplex feature = detects blood flow
Give a brief summary of USS
Ultrasonic waves - no radiation
Duration = minutes
Best detail = soft tissue
Duplex feature = detects tumour blood flow
Give a brief summary of Nuclear medicine
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
Give a brief summary of PET
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
Give a brief summary of Fluoroscopy
Live digital radiography using ionising radiation imaging using contrast (barium swallow) to intensify image
CEA, is the tumour mark for which cancer?
Colorectal cancer
What are the symptoms and signs of MSSC?
- Back pain (90%)
- Tender
- Localised, Band like or Radicular
- U/L or B/L
- Worse with straining, coughing, lying down
- Nocturnal - Motor weakness or loss
- Leg weakness
- Gradual onset usually, subtly presents 3 months before pain
- Can be sudden onset - Sensory disturbance or loss
- Paraesthesia
- Sensory loss
- Saddle anaesthesia (buttocks) - Urinary/bowel dysfunction
- Urinary retention
- Constipation - Clonus
- Reflexes
- absent at level
- increased below level
- normal above level
At what levels is MSSC most common?
Thoracic (66%)
What are the investigations that must be done for suspected MSSC?
- Focused CNS and full PNS exam
- MRI within 24hrs
- not all patients present with back pain, but if MSSC suspected, must do MRI
- CT as alternative
What is the treatment ladder for MSSC?
- Dexamethasone (16mg) with PPI (omperazole) cover for elderly
- Radiotherapy
Which cancers commonly cause MSSC?
Breast Lung Prostate Myeloma Lymphoma
What is the most common cause of SVC obstruction?
Malignant disease (>75%)
- Lung (most common)
- Mediastinal lymphoma
- Oesophageal carcinoma
- Thymoma
What is the common presentation of SVC obstruction?
- Dyspnoea –> Orthopnoea –> Cough
- Headache
- worse on straining - Distended neck and chest veins
- Cyanosis
- Oedema
- Typically face, neck and arm
- May also see conjunctival + peri-orbital - Hoarse voice
What are the key investigations for SVC obstruction?
- Pembertons test
- Distended neck veins
- Cyanosis
- Dyspnoea - Urgent CXR –> Contrast CT Thorax
What is the treatment ladder for SVC obstruction?
- Dexamethasone (16mg) with PPI cover (omeprazole)
- SVC balloon venoplasty and stent
- Rapid relief of symptoms
What are the symptoms of hypercalcaemia?
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
What are the investigative definition of hypercalcaemia?
Serum calcium adjusted for albumin > 2.5 mmol
normal calcium = 2.25 - 2.5 mmol
What is the investigative findings of hypercalcaemia?
1. Bloods Raised Ca2+ > 2.5 mmol Raised ALP Low Phosphate High PTH
- Urine
High phosphate
3. ECG Short QT Wide PR Wide T BBB
What is the treatment for hypercalcaemia?
- Fluids - Saline 0.9% 500ml bolus then maintenance
- give furosemide if fluid overloaded - Bisphosphonates - IV Pamidronate or Zolindronic acid
- inhibits osteoclast resorption - Salmon Calcitonin and Prednisolone (last line)
- rappidly reduces Ca2+
What is the definition of neutropenic sepsis?
Absolute neutrophil count (ANC) < 1.0
Fever > 38.5 or two readings of > 38.0 for > 1 hour
What are the symptoms of neutropoenic sepsis?
High HR, RR, CRT, Temp Low BP, UO Hypothermia Fever and rigors Systemically unwell Nausea, vomiting, diarrhoea (depends on source)
What is the key investigation?
FBC
- Low Neut, Hb, Platelets, WCC
- Transient progression to nadir over 10-12 d
- Prolonged nadir indicates bone marrow infiltration
Blood/Urine/Stool cultures
