Clinical Management of malignant disease

Question 1

acute effects of radiotherapy

Answer 1

 Brain- nausea and vomiting, alopecia
 Upper GI tract- mucositis, dysphagia
 Skin- radiotherapy burns, sore skin
 Lower abdomen- diarrhoea, bowel damage
 Upper abdomen- nausea and vomiting

Question 2

late effects of radiotherapy

Answer 2

Lung, bladder or skin fibrosis
 Bowel structure

Question 3

skin management of side effects

Answer 3

Avoid soaps deodorants in treated areas
 Dab skin gently to dry
 Avoid tight fitting clothes
 Use baby powder to keep areas dry after washing
 Can treat mild symptomatic erythema with 1%
hydrocortisone or aqueous cream
 Treat moist desquamation with silver sulphadiazine
(flamazine®)

Question 4

management of dysphagia

Answer 4

Liquid medications
 Thickened fluids
 Oxetacaine/antacid

Question 5

side effects of chemotherapy

Answer 5

 Bone marrow suppression
 Chemotherapy- induced Nausea and Vomiting
(CINV)
 Mucositis
 Diarrhoea
 Extravasation

Question 6

low emetic protococal (post chemo)

Answer 6

Metoclopramide PO 10mg TDS PRN post chemo

Question 7

moderate to high emetogenic protocol (with chemo)

Answer 7

Dexamethasone 8mg PO and ondansetron 8mg PO stat with chemo (Day 1)

Question 8

moderate to high emetogenic protocol (post chemo)

Answer 8

Dexamethasone 4mg BD PO 3 days and metoclopramide 10mg TDS PO prn

Question 9

very high emetogenic protocol (with chemo)

Answer 9

Dexamethasone 8mg and ondansetron 8mg PO stat with chemo (Day 1)

Question 10

very high emetogenic protocol (post chemo)

Answer 10

 Ondansetron 8mg BD PO 2 days
 Dexamethasone 4mg BD PO 3 days
 Metoclopramide 10mg TDS PO prn

Question 11

what is mucositis common with

Answer 11

5-Fluorouracil, Capecitabine and
Methotrexate

Question 12

how do you treat mucositis

Answer 12

Mouthcare
 Pain relief
 Mouthwashes
 Chlorhexidine, Benzydamine, caphosol
 Ascorbic acid
 Artificial saliva

Question 13

what is mucositis

Answer 13

Painful, dry mouth, loss of taste.

Question 14

what is diarrhoea common with

Answer 14

5-fluorouracil, capecitabine
Irinotecan

Question 15

how do you treat diarrhoea

Answer 15

Discontinue/ dose reduce subsequent
chemotherapy
 Codeine phosphate
 Loperamide
 Octreotide (used in carcinoid tumours)
 Atropine (Irinotecan)

Question 16

what is extravasation

Answer 16

 Leakage of drug from vasculature into
surrounding tissue

Question 17

what are the ysmptoms of extravasation

Answer 17

Pain, erythema, skin blistering and
exfoliation, discolouration, tissue necrosis

Question 18

what is important information for extravasation

Answer 18

special care in diabetics and unconscious
patients who may not feel pain associated
with extravasation

Question 19

what are side effects of immunotherapy

Answer 19

Pneumonitis
 Rash
 Adrenal insufficiency
 Nephritis or renal
dysfunction
 Diarrhoea or colitis
 Diabetes
 Hepatitis
 Hypothyroidism
 Hypothyroidism
 Hypophysitis
 Uveitis

Question 20

how do you treat rash covering 1-30% with or without symptoms (immunotherapy)

Answer 20

Topical moisturising
cream/ointment,
oral or topical antihistamines for
and/or topical corticosteroid
cream
Continue treatment

Question 21

how do you treat a rash covering 30% of bsa(immunotherapy)

Answer 21

Topical moisturising
cream/ointment, oral or topical
antihistamines or Topical
corticosteroid cream plus
intravenous corticosteroids;
treatment will be withheld, but
may be restarted if symptoms
reduce to Grade 1 or mild Grade 2

Question 22

how do you treat a rash covering over 30%(immunotherapy)

Answer 22

Urgent specialist review,
permanently discontinue

Question 23

how would you treat 3 liquid stools per day more than before treatment (immunotherapy)

Answer 23

Loperamide and oral electrolyte
supplementation if required treatment
can continue.

Question 24

how would you treat Four to six liquid stools per day more
than before treatment started, or
abdominal pain, or blood in stool, or
nausea, or night-time symptoms.

Answer 24

Oral Prednisolone and further tests
(e.g. sigmoidoscopy/colonoscopy);
treatment must be withheld until
symptoms resolve

Question 25

how would you treat , over six liquid stools per day more than before treatment started, or symptoms occurring within 1 hour of eating; also applies to patients with Grade 1/2 stool frequency who have other symptoms such as dehydration, fever or a rapid heart rate.

Answer 25

Hospital admission, intravenous Methylprednisolone and further tests (e.g. Sigmoidoscopy/colonoscopy if there is no response to methylprednisolone, infliximab can be used therapy must be discontinued

Question 26

how would you treat pneumonitis Breathlessness, cough, chest pain.

Answer 26

Antibiotics (if infection suspected), Prednisolone if no improvement on antibiotics or no infection found, further tests (including CT scan and bronchoscopy); treatment will be withheld

Question 27

how would you treat worsening symptoms of pneumonitis

Answer 27

Hospital admission, intravenous Methylprednisolone, other stronger immunosuppressive drugs if no improvement; treatment must be discontinued permanently

Question 28

how would you treat tiredness, feeling unwell, mild joint or muscle pains, decreased appetite/weight loss, nausea, itching, rash, diarrhoea, bloating; may have fever even no symptoms. (hepatitis)

Answer 28

Oral or intravenous corticosteroids, depending on liver enzyme levels; therapy will be stopped. 4 Hospital admission, intravenous methylprednisolone and specialist review; treatment must be discontinued permanently

Question 29

how would you treat hyperthryroidism

Answer 29

For symptomatic hyperthyroidism, treatment is initiated with betablockers; therapy will be interrupted until symptoms resolve. Monitor level of thyroid hormone by blood test

Question 30

how would you treat hypothyroidism

Answer 30

For hypothyroidism, treatment is with long-term hormone replacement therapy (with thyroid hormones, depending on severity) and oral corticosteroids if thyroid gland inflamed; therapy may be interrupted until symptoms resolve