Could it be cancer? Flashcards
What are the oncological emergencies. (5)
Neutropenic sepsis. Hypercalcaemia. SVCO. Cord compression. Tumour lysis syndrome.
What are some common acute presentations of cancer. (6)
Confusion/fitting. Shortness of breath. Obstruction. Pain. Liver/renal failure. Off legs.
What is the differential diagnosis for confusion. (5)
Infection. Biochemical abnormality. Drugs. Cerebrovascular event. Brain mets.
What investigations do you do for a patient with confusion. (2)
Bloods (FBC, UandE, LFTs, Mg, Ca, CRP).
CT brain.
How do you manage a patient with brain mets. (5)
Anti-epileptics if they have had a fit.
Steroids.
Surgery or radiotherapy.
Advise patient that they must not drive (notify DVLA).
Physio and occupational therapy assessment.
What is the differential diagnosis for a patient with shortness of breath. (5)
COPD. Pneumonia. Heart failure. 'Wet' disease (pleural effusion, ascites, pericardial effusion (often cancer related). PE.
What investigations do you do on a patient who presents with breathlessness. (5)
CXR. Bloods. ABGs. CTPA. ECG (most spot ischaemic changes, but don't forget small complexes seen with pericardial effusion - tachycardia, low voltage, electrical alternans).
How do you treat a PE.
LMWH (low molecular weight heparin).
What markedly increases the risk of PE>
Malignancy.
What should you do in a patient who presents with PE.
Look for the cause (eg recent surgery).
After diagnosis of pneumonia, when should you image again and why.
You should image again after 6 weeks to ensure that the changes have resolves.
This is because the consolidation may have been hiding an underlying malignancy.
How should you treat ‘wet’ diseases of the lung. (2)
Drain the fluid.
Send the fluid for cytology.
If malignancy is the underlying cause of a pleural effusion, what is the most effective treatment initially.
Chemotherapy.
What is the differential diagnosis for GI obstructions. (3)
Severe constipation. Malignant obstruction (single site, multifocal). Adhesions.
What investigations should be carried out if an obstruction is suspected.
CT abdomen.
AbdominalXR.
What tumours commonly cause obstructions. (3)
Colon.
Ovary.
Gastric.
Why might ovarian and gastric cancers cause obstructions.
Ovarian and gastric cancers have a tendency to metastasise across the peritoneum leading to “studding” across much of the bowel. This leads to interference with peristalsis and a functional bowel obstruction.
What is the treatment of choice for a single transition point obstruction. (2)
Surgery or stenting.
When would you treat obstruction conservatively.
Multifocal subacute bowel obstruction (often seen with ovarian cancer).
What is involved in the conservative management of bowel obstruction. (5)
Drip & Suck. NBM. Iv fluids. Normalise electrolytes. Chemo once resolved if possible. If not palliation may be only option.
What are some metastatic causes of liver failure. (3)
Colon cancer.
Breast cancer.
Upper GI cancers.
What are some obstructive oncological causes of liver failure. (3)
Pancreatic cancer.
Cholangiocarcinoma.
Portal metastases from other cancers.
How do you treat parenchymal liver metastases.
Need systemic therapy if possible ASAP.
If the disease is so bad that liver function is deranged, then the patient is unlikely to be fit for chemotherapy.
What are the main biochemical derangements that you seen in an obstructed liver.
Raised alkaline phsophate.
Raised bilirubin.
