Haem Onco Flashcards
3 main cancers that are screened for
Breast,Cervical and Colorectal
How cancers can be prevented
HPV,EBV vaccination
Criteria for monitoring cancer treatment response
RACES for chemotherapy,modified RACES for chemotherapy
Uses of imaging in oncology
Diagnostic(biopsy), gauging response of cancer to treatment,planning treatment in terms of locations to target with treatment
Threshold for diagnosing Hypercalcemia
2.0mmol/L
Can we solely use Calcitonin for Long term treatment of HyperCalcemia
No as that will cause tachyphylaxis. For long term it is better to use Zoledronic acid(together with calcitonin)
Why is immobilisation important for radiotherapy
To ensure precision in the administration of radiation to the specific clinical and planning margins for the tumour
Primary uses for radiotherapy
Palliative,curative and as an adjunct
Indications of radiotherapy for palliative purposes
- Severe bone pain esp from metastasis
- Bleeding eg for haemoptysis for lung ca
- Obstruction eg for esophageal ca
MOA of radiotherapy
Radiotherapy mostly works by replicative failure(indirect cell kill),not direct cell kill
1st phase: Release cytokines to relieve pain
2nd phase: Cause thrombosis etc to reduce angiogenesis and bleeding
3rd phase: Mostly indirect cell kill
Take this slide with a pinch of salt
Why is LH-RH used for prostate and breast cancer
Gland(pituitary?) is first hyperstimulated which subsequently causes reduced hormone release causing reduced stimulation of the affected organ and subsequently reducing tumour growth
Preferred therapy for Haematological cancers and NPC respectively
Haemarological spreads even at early stages, chemo is important for systemic treatment for mets.
NPC in especially sensitive to radiotherapy
What is SVC syndrome
Caused by obstruction of blood flow through Superior Van Cava(Medical urgency). When collateral veins can’t compensate quickly enough or at max compensation
Pathophysiology of SVC syndrome
1)Thrombosis/Sclerosis
2)Invasion
3)Extrinsic pressure by pathology
Causes of SVC syndrome
Usually caused by malignancy(SCLC,NSCLC,NH lymphoma,metastatic disease. Less commonly benign lesions
Signs of SVC Syndrome
3 Ds: Dsypnea, Distension including upper body Edema, Dilated chest wall veins + Neurological symptoms due to cerebral edema
Investigations relevant to SVC syndrome
if no overt presentation of syndrome: Ultrasound if intravascular device, CT/MRI for Hx of malignancy, CXR to look for SVC obstruction,mediastinal widening, pleural effusion
Mgmt of SVC syndrome
Treatment: Relieve symptoms(Severe: Stent,radiotherapy,steroids vs Non severe: radio+/- Chemo)+ Treat primary malignancy
Pathophysiology of Spinal Cord Compression
Impingement of spinal cord by tumour whether primary or metastatic,is a medical emergency
Types of Spinal Cord Compression
Vertebral displacement, epidural compression and paraspinal compression
Common sources of metastasis causing Cord compression
Myeloma,NPC,prostate and breast
Symptoms of Spinal Cord Syndrome
Back pain,motor and sensory dysfunction, bladder and Bowel dysfunction
Mgmt of Spinal Cord Compression
Is a medical emergency to prevent irreversible neurological sequelae: Corticosteroids, Analgesia, radiotherapy or surgical decompression
Ways hemophilia can present
Haemarthrosis(most specific)
Ecchymoses
Prolonged bleeds
Epistaxis
Melena/Hematochezia
Haematuria
Brain bleeds
Different types of anemia and their etiology
Hypochromic Microcytic
1)Iron Deficiency
2)Thalassemia
3)Chronic disease/inflammation
Normocytic Normochromic
1)Blood loss
2)Hemolysis
3)Chronic disease and inflammation
Macrocytic
1)Folate deficiency
2) Vit B12 deficiency
Other cell lines affected: Suspect haematological malignancy or myelodysplastic syndrome
Difference between Vitamin B12 and folate
Vit B12 is cobalamin
Vit B9 is folate
Tests to dx Iron Deficiency Anemia(IDA)
?
Triad of hemolytic anemia
Pallor
Jaundice
Splenomegaly
Differentiating IDA and thalassemia
Mentzer Index: MCV/Hb
> 13 IDA
<13 Thalassemia
What is IRIDA
Iron refractory Iron Deficiency Anemia
Will probably require parenteral Iron
Inheritance of G6PD deficiency
X linked recessive, hence more common in boys
Triggers for hemolysis in G6PD deficiency
Sulphur containing drugs eg Cotrimoxazole
Anti malarials eg chloroquine
Stressors eg infection, inflammation, Acidosis
Fava beans
Moth balls
Gold standard for G6PD deficiency diagnosis
G6PD enzyme quantitative analysis
Predictors of ITP(Immune thrombocytopenic purpura)prognosis
Age more than 10 worse
Chronic, moderate thrombocytopenia worse
Gender, female worse
Gold standard to dx Hemophilia
Factor 8 or 9 Quantitative Assay
Severity of Hemophilia grading
Severe: <1%
Moderate: 1-5%
Mild: 5-40%
Electrolyte abnormalities caused by Tumour Lysis Syndrome
HypoK
HypoCa
Hyperphophatemia
Hyperuricemia
What do are myelodysplastic syndromes at risk of progressing to
Acute myeloid leukemia
What are examples of myeloproliferative neoplasms
Primary Myelofibrosis
Chronic Myeloid leukemia
Polycythemia rubra vera
Essential thrombocytosis
What are the etiologies of myelodysplastic syndromes
Primary idiopathic
Secondary eg to radiation or drugs
What is contraindicated in Hemophiliac with hematuria
Tranexamic acid
Treatment of overwarfarinisation
Vitamin K
FFP
PCC(Prothrombin Complex concentrate)
Mnemonic for multiple myeloma clinical manifestations
CRAB
Calcium high
Renal impairment
Anemia
Bone disease
Types of malignancies that commonly cause tumor lysis syndrome
Hematological: lymphoma and leukemia and some solid organ tumors eg SC lung Ca
Electrolyte derangements in tumor lysis syndrome
Hyperkalemia, Hyperuricemia, Hyperphosphatemia and hypocalcemia
Salt and pepper appearance of bones on MRI
Multiple myeloma
Causes of massive splenomegaly
- Myelofibrosis
- Kala Azar
- Tropical Malaria
Malignancy associated with Philadelphia chromosome
Acute lymphoblastic leukemia
Reversal agent for heparin
Protamine sulfate, binds and inactivates heparin
Common sites of bleeding in Hemophilia A and B
- Haemarthrosis
- Intracranial hemorrhage
- Mucosal bleed: BGIT
- Hematuria
