Haem Onc Flashcards
presentation of SVCO
what is most common symptom
dyspnoea - most common
facial plethora
distended neck veins
headache
rx of SVCO
stent
chemo
dexamethasone
rx of malignant spinal cord compression
immobilise patient
loading dose 16mg dexamethasone
Urgent MRI whole spine within 24hrs
what type of cancer is prostate cancer
what is usual location
adenocarcinoma
peripheral zone
how is prostate cancer graded
gleason score - 2 grades given and added together - worse score is 10, best is 2
what can cause false positives for PSA
prostatitis
?DRE
UTI
BPH
exercise
ejaculation
RF for prostate cancer
increasing age
fhx
afro caribbean
presentation of prostate Ca
hesitancy
Retention
irregular hard prostate on PR
haematuria
back pain
first line ix of prostate cancer
multi parametric MRI
go on to do staging CT after if needed
Rx of prostate cancer
- localised
- locally advanced
- metastatic
- can do conservative with active monitoring, radical prostatectomy or radio
- GnRH agonists eg goserelin, radical prostatectomy, radiotherapy
- radiotherapy, hormone treatments or palliative
How do GnRH agonists work in prostate cancer
initially cause a rise in testosterone - ‘tumour flare’ but then due to negative feedback it falls in about 2-3 weeks to castration levels
common complications of radical prostatectomy
urinary incontinence and erectile dysfunction
Breast cancer rx if
- ER +ve perimenopause
- ER +ve post menopause
- HER2 +ve
- SERM - tamoxifen
- aromatase inhibitors eg anastrozole
- Herceptin + more recptove to chemo
lobotomy, mastectomy, ± axillary lymph node clearance, radiotherapy
Complication of aromatase inhibitors
osteoporosis - do DEXA scan
types of melanoma
lentigo
nodular
superficial spreading
grading of melanoma
breslows depth
shave vs punch biopsy for melanoma
shave doesn’t show whether its invasive as only samples epidermis, but can used for smaller lesions and won’t leave scar
rx of melanoma
curative - excision ±lump nodes
Chemo
Palliative
Topical imiquimod - immunotherapy
major and minor features of melanoma
major
- change in size
- change in colour
- change in shape
minor
- oozing or bleeding
- diameter >7
- altered sensation
- inflammation
excision margins based on breslows depth
Lesions 0-1mm thick 1cm
Lesions 1-2mm thick 1- 2cm
Lesions 2-4mm thick 2-3 cm
Lesions >4 mm thick 3cm
single most important prognostic factor in melanoma
breslows depth
colorectal cancer presentation
change in bowel habit
rectal bleeding
unexplained weight loss
bowel obstruction
abdo pain
2ww referral criteria for colorectal cancer
> 40 with unexplained weight loss and abdominal pain
50 with unexplained rectal bleeding
60 with iron deficiency anaemia or changes in bowel habit
what test is used first line for colorectal cancer since 2023
FIT testing
colorectal cancer screening programme
FIT test, age 60 -74 every 2 years
inherited colon cancers, which is most common
hereditary non polyposis colorectal carcinoma (Lynch syndrome) - most common inherited
Familial adenomatous polyposis
ix for staging in CRC
CEA
staging CT CAP
colonoscopy
TNM or dukes staging
name of surgery if cancer is
- right/transverse colon
- left
- sigmoid/upper rectum
- anal
- right hemicolectomy
- left hemicolectomy
- high anterior resection
- abdominoperineal resection of the rectum
what is hartmanns procedure
sigmoid resection + end colostomy
rf for colorectal cancer
- smoker
- increasing age
- male
- fix - FAP + HNPCC
- IBD
common side effects of chemo
N+v
chemo brain
weakened immune system - (bone marrow supression)
mouth sores
bruising and bleeding (thrombocytopenia)
side effects of radiotherapy
- early and late
Early:
skin reactions, mucositis, N+D, fatigue
Long term:
secondary malignancy
endocrine - irreversible diabetes and hypothyroidism
Neural or vascular damage
RADIATION PNEUMONITIS - chest pain, cough, fevers
side effects of immunotherapy
every -itis
hepatitis, scleritis, pneumonitis, myocarditis, nephritis, etc
Toxicity bear
cisplatin - ototoxic, nephrotoxic
Bleomycin - pulmonary fibrosis
vincristine - peripheral neuropathy
Doxorubicin - cardiac issues
Cyclophosphamide - bladder cancer
Methotrexate - pulmonary fibrosis
what is myeloma and its features
when does it present
proliferation of plasma cells
Hypercalcaemia - light chains stimulate osteoclasts
AKI - accumulation of light chains
Paraproteinaemia
Anaemia - bone marrow crowding surpasses erythopoeisis
peak age is 70
ix of myeloma
bone profile
FBC
protein electrophoresis - increased IgA/G in serum and Urinary bence jones proteins
U+Es - aki
Bone marrow biopsy - >10% plasma cells
Blood film - roleaux formation
Xray - osteoporosis
whole body MRI - lytic lesions
rx of myeloma
chemo + stem cell transplant + radiotherapy for bone pain and zolendronic acid to prevent bone disease
what is AML
what age group
proliferation of myeloblasts
adults - incidence increases with age
AML presentation
Symptoms of pancytopenia and general cancer sx
Rx of AML
chemo and regular blood transfusions
palliative - pretty poor prognosis
Most common haem cancer in children
ALL
which haem cancer is associated with down syndrome
ALL
Pathophys of CML
proliferation of basophils, neutrophils, eosinophils etc
Presentation of CML
What chromosome is it associated with
High white cell counts and massive splenomegaly
Can progress ti AML
Rx of CML
Tyrosine kinase inhibitors eg imatinib
generally have long remissions and normal life expectancy
FBC in chronic vs acute leukaemia
chronic - leukocytosis
acute - pancytopenia
Complications of CLL
Richters transformation - CLL to lymphoma
Hypogamaglobulinaemia - recurrent infections
who is CLL more common in
elderly
why is LDH high in cancers
bc high cell turnover
causes of pancytopenia
AML and ALL
sepsis/DIC
myelodysplasia
SLE
Radio/chemotherapy
Drugs that cause bone marrow suppression
Pathophys of myelodysplasia and what can it progress to
Abnormal myeloid progenitor cells that clog bone marrow causing pancytopenia
Can progress to AML
How is a progression to AML from myelodysplasia identified
> 20% abnormal cells in the bone marrow
Rx of myelodysplasia
RBC and plt transfusions
Abx for infections
stem cell transplant
chemo eg azacitidine to prevent AML progression
rf for hodgkins
prev EBV infection,
HIV
RA and sarcoidosis
Fhx
age - bimodal - peaks at 20 and 75
ix for Hodgkins
lymph node biopsy - reed sternberg cells
LDH
Staging CT
How many sets of lymph nodes does hodgkins usually affect
just 1
Staging system for lymphoma
Ann Arbor
1 - 1 set of lymph nodes
2 - 2 sets on same side of diaphragm
3 - 2 sets on opposite sides of diaphragm
4 - organ involvement
Rx of hodgkins
ABVD or RCHOP chemo
Radiotherapy
compare hodgkins an non hodgkins
non hodgkins more common, tends to affect more than one set of lymph nodes, older pts, extra nodal involvement more common
what is essential thrombocytosis and what are pts at increased risk of
JAK2 mutation causing increase in platelets
risk of clots, bleeding (bc plus bind to vWF causing reduced availability) and miscarriage
Rx of essential thrombocytosis
- if low risk of clots
- if high risk of clots
- aspirin, monitor
- hydroxyurea, interferon alpha, plateletpheresies
what is polycythaemia vera and features
what are they at increased risk of
JAK2 mutation causing overproduction of RBCs
- fatigue, dizziness, itchy after hot shower, splenomegaly, redness, gout
risk of clots!
Rx of PCV
regular phlebotomy
hydroxurea
Ruxolitinib - JAK2 inihibtor
Aspirin for clot prevention
antihistamines for itch
rx of neutropenic sepsis
IV tazocin
Give vanc if concerned about line infection
G CSF to stimulat neutrophil production
lab results and presentation of tumour lysis syndrome
hyperkalaemia
hyperphosphataemia - hypocalcaemia
increased uric acid
Arrythmias
Hypocalcium - tingling, muscle spasm, tetany, seizures
AKI - uric acid
who is at risk of tumour lysis
large tumour burden
rapidly dividing cancers eg AML, high grade lymphomas
when does tumour lysis occur
can occur spontaneously before treatment but most common in first few weeks after treatment
Rx of tumour lysis syndrome
Fluid resus
Allopurinol (xanthine oxidase inhibitor) to reduce uric acid levels
Rasburicase - converts uric acid so it is easily secreted
May need temp dialysis bc of electrolyte imbalances
rx options for mucositis
difflam mouthwash
oramorph
tranexamic acid mouthwash if bleeding heavily from mouth
