Clinical Flashcards
What is leukaemia
What’s the result of it?
Un regulated proliferation of immature WBC Accumulation in BM BM can’t function - anaemia - thrombocytopenia, bruises - leukopenia, infections
People with leukaemia normally die ofwhat
Fetal infection or bleeding if untreated
What type of population makes bone transplant difficult
Life long smokers
What are the symptoms for leukaemia
- anaemia
- tired
- bruises
- bleeding
- freq inf
- SOB
- petechiae sm red spot on skin caused by minor bleeding
Types of leukaemia
Acute (>30% blast in BM upon diagnosis
Chronic (manage symp not cure
Lymphoid leuk
Myeloid leuk
Which type of leukaemia is the most common in childhood 75% of childhood leuk
ALL
Acute lymphoblastic leuk
What are the diseases that can be treated by bone marrow transplant
Leukaemia,lymphoma, myeloma, bm failure, metabolic disorders
What are the indications for autologous bone marrow transplant
Lymphomas
Myeloma
Not leuk bc there will always be some leuk cells in pt bm
How does high-dose therapy (of chemo) work? Administered before the transplant
To eradicate any residue leukaemic or cancer cells in the bone marrow
Immunosuppresses patient
Ensure bm can’t be recovered wo stem cell infusion
What’s leukapheresis
Separation of leuk cells from blood
What are the two main sources of stem cells
Peripheral blood
Or
pelvic hipbones
What are the two methods of collecting stem cell
Peripheral blood stem cells from circulating blood
Bone marrow harvest from hipbone - Needle to hip bone where large amount of marrow exists
A way of collecting stem cells
What are the post transplant complications
Infections Anaemia SOB bleeding (GIT, etc ) petechiae UE imbalance Graft vs host Mucosités (breakdown of tissue lining the mouth and throat caused by chemo on rapid dividing cells (eg methotrexate -symp dsyphasia - TPN
Trt for GvHD
High dose corticosteroid
Mabs- immunosuppress anti-tnf
Etanercept
Medenchymal stem cell- increase repair
Symptoms for lung cancer
Often asymptomatic at early stage Haemoptysis (coughing blood) Persistent cough >3w Chest pain Dyspnoea Wt loss Hoarseness
Staging TNM - T
T1 <3cm
T2 3-7cm, partial collapse
T3 >7cm collapsed lung, chest wall invasion
T4 invasion of mediastinum/ spine. Nodules in other lobes of same lung
Stage TNM -N
N0 none
N1 ipsilateral hilar
N2 ipsilateral hilar. Subcarinal
N3 contralateral (opposite side of same lung) supraclavicular
Late presentation of lung cancer
1/3 present as an emergency to hospital
Surgery suitability
N0 or N1
Not T4
Lung function & co morbidities (smokers)
Adjuvant chemo for lung cancer
Indication
Drug of choice
Tumour size > 4cm
And/or nodal involvement
4 cycles of cisplatin doublet (vinorelbine) 3weekly
Start w/i in 12 week of surgery
What’s SABR
Indication
Steoreotactic ablative body radiotherapy - very high dose of radiotherapy in a few fractions
- peripheral lung cancer < 5cm w/o nodal involvement
- not fit for surgery
Conventional radiotherapy indications
M0
Invasion or more extensive nodal (N2) involvement
Conventional radiotherapy s/e
Dose to Sc
Volume of treated lung (acute pneumonitis)
Baseline lung function n development of fibrosis
What are SACT?
Systemic anti cancer therapy
- chemo
- immunotherapy mabs
- target therapy nibs
Chemotherapy SACT how is it given
CT scan at baseline and …
Max cycles
When to stop
1 dose every 3 weeks (1 cycle) for 3 months (12 week’s) Total 4 cycles After 3 cycles (9 weeks) 4-6 cycles max If toxicity
1st gen EGFR inhibitors for lung cancer
Gefitinib 250mg od
Erlotinib 150mg od
1st gen EGFR inhibitor s/e
Diarrhoea Acne like skin rash Stomatitis -inflam of mouth or lips Paronychia - nail deformation Hepatitis
2nd gen EGFR inhibitor for lung cancer
Afatinib 40mg od
Increase to 50mg od after 1m
3rd gen EGFR inhibitor for lung cancer
Osimertinib 80mg od
Target mutated Lung cancer T790M
Reduced metastasis due to better brain penetration
1st line
List the three ALK inhibitors
Crizotinib 250 bd
Ceritinib 750mg od
Alectinib best evidence
S/e with crizotinib
Visual disturbance (overlapping tails of light — driving! NV diarrhoea Rash Oedema QT prolongation Bradycardia
Name the I-O (immunotherapy) used in lung cancer
Pembrolizumab
What is pembrolizumab
A PDL1. / PD1 inhibitor
What is PDL1 /PD1
Programmed cell death 1 PD1
Its ligand is PDL1
They are immune checkpoint proteins that inhibits T cell response
Why use immunotherapy?
But what’s the se
No chemo s/e such as diarrhoea rash NV stomatitis hairloss neutropenia
Autoimmune response eg cytokines storm
What are the two main groups of Lung cancer
SCLC 15% - aggressive, metastatic, high response rate but replapse quickly, 100% are smokers
NSCLC - 85%, three types - squamous cell/ adénocarcinoma / large cell carcinoma
Cancer profiling important - EGFR ALK
What’s the name of cancer that is occurred on the pleura of lung
Mesothelioma
Can you do surgery in SCLC? what’s the trt options
No surgery If limited stage RT AND CHEMO Cisplatin / carbo + et opposed If extensive stage no RT
How to reduce the risk of brain metastasis in lung cancer
Prophylactic cranial irradiation PCI
What are the clinical features of the lung cancer
Palpable cervical Clubbing Obstruction of vena cava Stridor Pleural effusion Pancoast syndrome Metastasis Hypercalcium Hyponataemia
Referralnoathway for lung cancer
- refer by GP
- CT in 2 weeks
- biopsy for diagnosis
- imaging for staging
- magement plan
- trt within 62 day
What are the main diagnostic tools for lung caner
Bronchoscopy (central)
CT guided lung biopsy (peripheral)
EBUS - ultrasound
What do we use for imaging of cancer
CXr
CT
PETCT - positron emission tomography - more sensitive to metastasis and N involvement - use flurodeoxyglycose
