Could it be cancer? The cancer patient in hospital Flashcards
Is most cancer managed as an inpatient or outpatient?
Outpatient.
Asymptomatic lesions could be investigates as an outpatient.
Refer to relevant MDT- include details of PMH and overall fitness.
What proportion of cancers present as an emergency?
25%- they are the sickest.
Especially CNS, lung, HPB and upper GI.
Rarely melanoma or breast.
Which cancers commonly present as an emergency?
Especially CNS, lung, HPB and upper GI.
Which cancers are less likely to present as an emergency?
Melanoma
Breast
What are the reasons for emergency cancer admission?
Off legs Confused Weakness Breathless Fits Pain Bleeding Incidental
What investigations are required for emergency cancer admissions?
Blood tests: FBC, renal function (U&E), biochemical, calcium, ?anaemia, ?deranged clotting, ?sepsis, etc.
Radiological: x-ray, CT, MRI.
Endoscopic, e.g. severe haematemesis.
Surgical: biopsy, excision, etc.
Biochemical (bloods).
Specialist clinics- e.g. breast clinics- mammography, biopsy, etc.
List radiological investigations for emergency cancer admissions.
CT chest/abdo/pelvis- good place to start. CT or MRI brain. MRI whole spine. USS. Ba swallow. PET-CT- if MDT recommends one.
What is carcinoembryonic antigen CEA?
Tumour marker.
Associated with lower GI tumours.
Normal range <2.5ng/mL non-smokers, <5.0ng/mL smokers.
Other causes for CEA rise: cancers of stomach, lung, breast, pancreas; infections, pancreatitis, inflammatory bowel disease.
What is Ca 19-9, and Ca 15-3?
Tumour marker.
Associated with pancreatic cancer.
Poor sensitivity and specificity.
Elevated levels typically associated with metastatic disease.
May be elevated in other GI tumours.
Main use is for oncologists tracking chemo response or FU.
What is PSA?
Prostate specific antigen.
Tumour marker.
Protein produced almost exclusively by prostate tissue.
Normal range 1.0-4.0ng/mL.
PSA >10.0ng/mL associated with 43-65% risk of cancer.
May be elevated by BPH, prostatitis, catheterisation.
What is Ca 125?
Tumour marker.
Associated with ovarian cancer.
Normal range <25-35u/mL.
History is key, may be elevated for many reasons both benign and malignant.
List endoscopic investigations.
OGD. ERCP. Colonosocopy. Bronchoscopy. Nasendoscopy.
What are the advantages of endoscopic investigations?
Ability to obtain tissue.
Therapeutic intervention, e.g. stents.
Detect small lesions not visible radiologically.
Give examples of surgical investigations for cancer.
Examination under anaesthetic, e.g. for anal cancer.
Laparoscopy.
Laparotomy.
What is the importance of tissue diagnosis in cancer?
Crucial before starting anti-cancer therapy.
Referrals to MDT that turn out to be TB not uncommon.
Anticancer therapy varies depending on histopathological subtype.
Prognostic information.
