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Cancer Care > General > Flashcards

General Flashcards

1
Q

What are the clinical features of SVCO?

A

Dyspnoea, facial plethora, orthopnoea, dilated/engorged veins, pembertons sign

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2
Q

What is pembertons test?

A

When a patient is asked to raise their arms above their head for over 1 minute and this should cause facial plethora and cyanosis in someone with SVCO

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3
Q

Which type of lung cancer is most likely to cause pleural effusion?

A

Adenocarcinoma

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4
Q

Which type of lung cancer is most common in non-smokers?

A

Adenocarcinoma

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5
Q

Where in the lung are adenocarcinomas most often found?

A

Peripherally

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6
Q

Which carcinomas are most likely to spread to the bone?

A

Lung, thyroid, renal, prostate, breast

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7
Q

What are the indications for G-CSF in neutropenia sepsis?

A

If initial treatment with sepsis six fails and there is persistent neutropenia +/- haemodynamic instability

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8
Q

What are risk factors for neutropenia sepsis?

A

Clinically unstable, persistent and significant neutropenia, receiving chemotherapy, significant co-morbidities

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9
Q

In a 62 year old woman who has had radiotherapy for breast cancer and is now presenting with dysphagia, hoarseness and cough- what could be the cause?

A

Radiotherapy induced laryngeal oedema

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10
Q

How does hepatocellular carcinoma present?

A

Features of cirrhosis (jaundice, deranged LFTs, ascites and oedema) along with a raised serum AFP

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11
Q

What does a WHO performance score of 0 mean?

A

Able to carry out all normal activity without restriction

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12
Q

What does a WHO performance score of 1 mean?

A

Restricted in strenuous activity but ambulatory and able to carry out light work

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13
Q

What does a WHO performance score of 2 mean?

A

Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours

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14
Q

What does a WHO performance score of 3 mean?

A

Symptomatic and in a chair or in a bed for more than 50% of waking hours, but not bedridden

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15
Q

What does a WHO performance score of 4 mean?

A

Completely disabled; cannot carry out any self-care; totally confined to bed or chair

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16
Q

What can cause elevated AFP levels?

A

Hepatocellular carcinoma, germ cell tumours, GI cancers, metastatic lung cancer, pregnancy

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17
Q

What diagnosis is most likely in a patient with elevated AFP levels and persistent cough, breathlessness and unexplained weight loss?

A

Metastatic lung cancer

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18
Q

What diagnosis is most likely in a patient with elevated AFP levels and abdominal pain, weight loss and jaundice?

A

Hepatocellular carcinoma

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19
Q

What diagnosis is most likely in a patient with elevated AFP levels and abdominal pain, unexplained weight loss and change in bowel habit?

A

GI cancer

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20
Q

Orphan Annie cells are pathognomonic of what cancer?

A

Papillary thyroid cancer

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21
Q

Reed stern berg cells are a feature of what cancer?

A

Hodgkins lymphoma

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22
Q

What would be the prophylactic treatment for someone at high risk of tumour lysis syndrome?

A

Intravenous hydration- promotes urinary excretion of electrolytes and prevents AKI
Allopurinol- reduce production and accumulation of uric acid

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23
Q

How is neutropenic sepsis defined?

A

A neutrophil count of <0.5 in a patient with a temperature greater than 38 or other signs/symptoms of clinically significant sepsis

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24
Q

What are the most common causative organisms in neutropenic sepsis? Why is this?

A

Coagulase negative, gram positive bacteria- particularly staph epidermidis
Due to use of indwelling lines

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25
Q

What prophylactic treatment is offered to patients with neutropenia for neutropenic sepsis?

A

A fluoroquinolone

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26
Q

When would it be suggested to order investigations for fungal infections in a patient with neutropenic sepsis?

A

If patient not responding after 4-6 days

27
Q

What is tumour lysis syndrome?

A

A serious metabolic disorder where rapid tumour cell death leads to massive release of intracellular contents into the blood

28
Q

What is associated with tumour lysis syndrome?

A

Aggressive, rapidly proliferating tumours like acute leukaemia and high-grade lymphoma. Often occurs following chemotherapy but may be caused by other treatments

29
Q

What electrolyte abnormalities are seen in tumour lysis syndrome?

A

Hypocalcaemia, hyperphosphataemia, hyperuricaemia, hyperkalaemia

30
Q

Why does hypocalcaemia occur in tumour lysis syndrome?

A

Because of increased phosphate released from tumour cells acting as a calcium chelating agent

31
Q

Why does hyperuricaemia occur in tumour lysis syndrome, what is the main complication of this?

A

The breakdown of DNA bases from tumour cells into uric acid
Uric acid then crystallises and gets deposited in kidney causing AKI

32
Q

What are signs and symptoms seen in tumour lysis syndrome?

A

Hypocalcaemia: Arrhythmias, seizures, muscle cramps, tingling and numbness in hands and feet
Hyperuricaemia: gout/joint swelling, dysuria/oliguria
Hyperkalaemia: arrhythmias, muscle weakness, palpitations
Hyperphophataemia: itching, muscle cramps, peri oral tingling/numbness

33
Q

What are key investigations to do for suspected tumour lysis syndrome?

A

U+Es (shows high K+ and phosphate and creatine), calcium, uric acid, ECG

34
Q

What is involved in the management of tumour lysis syndrome?

A

Correction of electrolyte imbalances (may require temporary dialysis)
IV fluids
Prophylaxis in those at high risk with allopurinol or rasburicase

35
Q

When is rasburicase given?

A

In individuals at high risk of tumour lysis syndrome, allopurinol given to lower risk or those with G6PD. Rasburicase also used in acute treatment whereas allopurinol only prophylaxis

36
Q

What are indications for dialysis in tumour lysis syndrome?

A

Intractable fluid overload, hyperkalaemia, hyperphosphataemia, hyperuricaemia or hypocalcaemia

37
Q

Why can gynaecomastia occur with germ cell and leydig cell testicular tumours?

A

Germ cell: HCG causes leydig dysfunction causing an increase in oestradiol production
Leydig cell: directly secrete more oestradiol

38
Q

What tumour marker is raised in around 20% of seminomas?

A

HCG

39
Q

What tumour markers can be raised in non-seminoma testicular tumours?

A

AFP and b-HCG

40
Q

What is elevated in around 40% of germ cell tumours?

A

LDH

41
Q

what is richter’s transformation?

A

when chronic lymphocytic leukaemia cells enter the lymph node and change into high grade non-hodgkins lymphoma

42
Q

What investigation should women undergo before having breast cancer surgery if there is no palpable axillary lymphadenopathy?

A

USS of the axilla, if negative they should have sentinel lymph node biopsy rather than axillary node clearance

43
Q

how do anastrazole medications work?

A

they inhibit the peripheral synthesis of oestrogen

44
Q

what type of cancer does achalasia increase the risk of?

A

squamous cell carcinoma of the oesophagus

45
Q

what is the first line imaging that should be conducted in a patient with suspected multiple myeloma?

A

whole body MRI scan

46
Q

in which chronic leukaemia is lymphadenopathy more marked?

A

CLL

47
Q

what is a characteristic finding of CLL on blood film?

A

smear/smudge cells

48
Q

HNPCC increases the risk of which cancers?

A

Bowel, pancreatic and endometrial

49
Q

what are the three components of the risk malignancy index in ovarian cancer?

A

Ca125, menopausal status and ultrasound findings

50
Q

what are poor prognostic factors for ALL?

A

male sex, presenting age <2 years or >10years, having B or T cell surface markers and WCC >20 at diagnosis

51
Q

what are riskfactors for developing cervical cancer?

A

HPV 16, 18, 33
smoking, HIV, many sexual partners, high parity, COCP, lower socioeconomic status

52
Q

what are some complications of CLL?

A

anaemia, hypogammaglobulinaemia,warm autoimmune haemolytic anaemia, transformation to high-grade lymphoma

53
Q

who is offered genetic testing for BRCA1 and BRCA2 mutations?

A

women under 50 with triple negative breast cancer

54
Q

what is the staging of ovarian cancer?

A

1- tumour confined to ovary
2- tumour outside ovary but within pelvis
3- tumour outside pelvis but within abdomen
4- distant metastasis

55
Q

what is the main ECG abnormality seen with hypercalcaemia?

A

short QT interval

56
Q

which type of lung cancer is associated with hypertrophic pulmonary osteoarthropathy?

A

squamous cell carcinoma

57
Q

radiotherapy for prostate cancer can increase the risk of which other cancers?

A

bladder, colon and rectal

58
Q

which cancers does the COCP increase the risk of? which is it protective for?

A

risk of breast and cervical
protective for endometrial

59
Q

what chemotherapy regime is used for breast cancer that is node +ve and which regime is used for node -ve?

A

node +ve = FEC-D chemotherapy
node -ve = FEC chemotherapy

60
Q

what is first line investigation for suspected endometrial cancer?

A

transvaginal ultrasound to measure endometrial thickness
if lining is thickened then a hysteroscopy is carried out with biopsy

61
Q

what is the treatment for endometrial cancer?

A

laproscopic hysterectomy with bilateral salpingo-oopherectomy, with or without radiotherapy

62
Q

which type of lung cancer is associated with gynaecomastia?

A

adenocarcinoma

63
Q
A

Cancer Care (10 decks)

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