Clin Shonc Flashcards
Tumour Lysis
1) Pathophys including sequalae:
2) Broadly differentiated into? Key blood results?
Large volume tumour cell death eith spontaneouly or in response to treatment -> Release of intracellular ions, nucleic acids, proteins and their metabolites into the systemic circulation.
Leads to: metabolic abnormalities such as hyperuricaemia, hyperK, hyperphosphataemia, secondary hypoCa and uraemia, can in turn lead to renal failure, arrhythmias, seizures, neurological sx.
2) Laboratory TLS, Clinical TLS
The presence of 2 or more of: HyperUric acid, HyperK, HyperP04-, HYPO Ca (adjusted)
For clinical note the Cairo-Bishop grading of clinical tumour lysis syndrome
Prophylaxis/Mx of tumour Lysis syndrome?
1) Evaluate risk:
High proliferation rate, rapid response to Tx anticipated (chemo or radio sensitive), large volume, HR Cancer (lymphoma e.g Burkitts, SCLC), pre-existing metabolic disturbance.
2) Aggressive Hydration, ideally begin 24Hrs prior to Tx. Aim UO >100ml/msqr/Hr.
3) Allopurinol TDS
4)Consider Rasburicase (converts uric acid to excretable)
5) Close monitoring
Describe Child-Pugh class.
Rad onc relevance?
Assesses the severity of liver disease, particularly cirrhosis, using 5clinical and lab factors:
Serum bilirubin,
Serum albumin,
Prothrombin time/INR,
Ascites,
Encephalopathy.
Factors scored (1-3) based on severity, and the total score determines Child-Pugh class (A, B, or C)
Liver SABR if <=7 points = A or very low B
In DVT Mx (prophylaxis or haem stable) give the two main classes of drug, a brand name for each, MOA.
What drug if patient has HITs?
Haemodynamically stable.
1) Preferred - Rivaroxaban (e.g Xaralto) - Factor Xa inhibitor. Factor Xa promotes coagulation by binding to factor Va on to form the prothrombinase.
More kidney friendly (GFR>15), high caution if previous haemorrhagic stroke - prefer LMWH.
2) LMWH - e.g Enoxaparin: Activates Antithrombin which inhibits FactorXa.
Not if GFR<30, Hyper K or thrombocytopenia.
Prophylaxis low risk = 20mg/day
HR = 40mg/day
If patient has HITS:
Selective Factor Xa inhibitor Fondoparinux.
Medication Mx of PE.
If Haemstable:
Intervention being considered (thrombolysis or pulmonary embolectomy): LMWH, or UFH until intervention.
No Thrombolysis: Rivaroxaban 15 mg BD for 3 weeks
then 20 mg XARELTO once daily.
Unstable:
High bleeding risk: consider pulmonary embolectomy.
Low bleeding risk: Alteplase.
Duration of medicaal Mx PE/DVT
- DVT Provoked limited and distal - do 6 weeks
- PE or Unprovoked = 3 months
- Cancer Related!!! 6 months, consider with LMWH then oral Rivaroxaban,
List the late toxicities (Mx where applicable) after definitive Chemo RT for stage 3B cervix cancer:
1) Infertility: preTx counseling ect
2) Gynae: Dryness (estrogen cream), stenosis - dilators/reg intercourse
3) Ovarian failure: Address oseoporotic RFs (smoking, lack of weight bearing exercise), vit D, encourage exercise, consider dxa scan. HRT an option with risks.
4) Proctitis: Improve diet, avoid triggers, lopermide PRN.
5) Cystitis.
6) Pelvic insufficiency #s: vit D, analgesia, physio, consider bone denisty
7) Lymphoedema: stay active, weight loss/avoid obesity, lymphoedema practitioner - compression garmets.
8) 2nd maligancy - increased surveillance, lower threshold for Ix.
Give grades for urinary toxicity (e.g. after bladder RT):
Grade 0: No toxicity.
Grade 1: Mild symptoms, no intervention needed.
Grade 2: Moderate symptoms, requiring minor or local intervention.
Grade 3: Severe symptoms, requiring hospitalization or significant intervention.
Grade 4: Life-threatening toxicity, requiring urgent intervention.
Grade 5: Death
