Key topic lectures Flashcards

1
Q

How much does 1 bag of red cells raise the Hb

A

10 g/L (in 70 kg male)

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2
Q

What are some long term lines that can be inserted for cancer treatment

A

Tunnelled central lines (between chest wall and superior vena cava)

PICC line (between anterior cubital fossa and heart)

Implantable ports

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3
Q

What is tumour lysis syndrome

A

Tumour lysis releases cellular components into circulation

Imbalance: high uric acid, high potassium, high phosphorus, low calcium

Can cause: arrhythmias, sudden death, seizures

Management: allopurinol (blocks uric acid production), rasburicase (urate oxidase)

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4
Q

What is the guidance around pregnancy and chemotherapy

A

Avoid pregnancy whilst on chemotherapy

Can use norethisterone (stops periods)

Avoid COCP (high thrombotic risk)

Advise barrier protection (to protect partners)

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5
Q

What is criteria for neutropenic sepsis

A

Fever > 38

Fever > 37.5 for > 1 hour

Neutropenia < 0.5

Neutropenia < 1 and falling

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6
Q

What is the management for neutropenic sepsis

A

Follow hospital neutropenic sepsis protocol (similar to sepsis 6)

G-CSF (granulocyte colony stimulating factor): SC injection, can reduce severity and duration of neutropenia, side effects (bone pain, headaches, nausea, fever)

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7
Q

Which cells come from the myeloid line

A

Megakaryocytes (thrombocytes)

Erythrocytes

Mast cells

Myeloblasts (basophils, neutrophils, eosinophils, monocytes (macrophages))

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8
Q

Which cells come from the lymphoid line

A

Small cells (B cells (plasma cells), T cells)

Natural killer cells

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9
Q

What are the symptoms of hypercalcaemia

A

Fatigue

Abdominal pain

Nausea and vomiting

Constipation

Confusion

Headaches

Polydipsia

Polyuria

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10
Q

What are the symptoms of hyperviscosity

A

Headaches

Somnolence

Visual disturbance

Ischaemic events

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11
Q

Which drugs are now potentially curable for CML

A

Tyrosine kinase inhibitors (imatinib)

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12
Q

What are the properties of cancer cells that promote growth

A

Evade apoptosis

Self-sufficiency in growth signal

Insensitive to anti-growth signal

Tissue invasion and metastasis

Limitless replicative potential

Sustained angiogenesis

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13
Q

What is neoadjuvant therapy

A

Given before definitive management

Shrink tumour

Optimise outcome

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14
Q

What is adjuvant therapy

A

Given after treatment

Reduce risk of recurrence

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15
Q

What is palliative care

A

Symptom relief

Improve quality of life

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16
Q

What is 5-fluorouracil

A

Inhibits thymidylate synthesis

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17
Q

How do cancer cells develop drug resistance

A

Decreased uptake of drug

Increased drug metabolism

Altered drug targets

Impaired apoptotic pathways

Altered cell cycle checkpoints

Efflux pumps

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18
Q

What things are important to remember when prescribing chemotherapy drugs

A

Narrow therapeutic index

Alter doses based on: BMI, renal/hepatic function, performance status

Often give drugs in combination (synergistic effecr)

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19
Q

What are the side effects of chemotherapy

A

Brain (chemo-brain, peripheral neuropathy, fatigue)

Hair (alopecia)

Circulation (neutropenic sepsis, cardiomyopathy, myelosuppression)

GI tract (vomiting, mucositis)

Bladder (haemorrhagic cystitis)

Large intestine (diarrhoea, constipation)

Skin (rash, nail ridging/loss)

Reproductive organs (impaired fertility, decreased libido, premature menopause)

Kidneys (AKI, electrolyte disturbance)

Liver (deranged LFTs)

Lungs (pneumonitis, PE)

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20
Q

What are some examples of antiemetics used in cancer treatment

A

5HT3 antagonists (ondansetron)

Dopamine receptor antagonists (metoclopramide)

Steroids (dexamethasone)

Antihistamines (cyclizine)

NK1 receptor antagonists (aprepitant)

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21
Q

How do monoclonal antibodies work

A

Bind to cancer cell antigen

Block downstream signalling pathways

Arrest cell cycle proliferation

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22
Q

What are the side effects of immunotherapy

A

Skin toxicity

Hair growth disorders

Pruritus

Nail changes

Fatigue

Myelosuppression

Diarrhoea

Nausea and vomiting

Hypertension

Proteinuria

GI perforation

Delayed wound healing

Arterial thromboembolic events

Cardiac ischaemia

Abnormal LFTs

Allergic reaction

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23
Q

What are immunotherapy checkpoint inhibitors

A

Aid binding of PD-1 (on T cell) and PD-L1 (on tumour cell)

Block proteins that stop immune system from killing cancer cells

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24
Q

What are the aims of radiotherapy

A

Deliver maximum dose to tumour

Minimise dose to surrounding normal tissue

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25
What is radical radiotherapy
Aim to cure 4 - 7 weeks 20 - 37 individual sessions Small fields of irradiation
26
What is palliative radiotherapy
Alleviates symptoms 1 - 10 individual sessions Large field of irradiation
27
What are the short-term side effects of radiotherapy
Fatigue Hair loss Dysphagia Sore throat Oral mucositis Diarrhoea Sterility Dysuria Radiation cystitis Pancytopenia Lymphoedema Erythema Nausea and vomiting
28
What are the late side effects of chemotherapy
Skin pigmentation/necrosis/ulceration Bone necrosis/fracture/impaired growth Mouth ulcers/dryness Cataracts Loss of sight Lung fibrosis Cardiomyopathy Pericardiafibrosis Infertility Menopause Bowel strictures/adhesions/fistulas
29
What is imitinib
A BCR-ABL tyrosine kinase inhibitor 'Magic bullet' Very tumour selective Has very few side effects
30
What is growth fraction
The proportion of cells dividing at any given time Useful indicator of the sensitivity of cancer cells to chemo drugs (large growth fraction = more responsive)
31
Which cancers are highly sensitive to chemotherapy
Lymphomas Germ cell tumours Small cell lung cancers Neuroblastomas Wilm's tumours
32
Which cancers have a moderate sensitivity to chemotherapy
Breast Colorectal Bladder Ovary Cervix
33
Which cancers have a low sensitivity to chemotherapy
Prostate Renal Brain Endometrial
34
What is the main side effect of cisplatin and carboplatin
Ototoxicity Nephrotoxicity
35
What is the main side effect of vincristine
Peripheral neuropathy
36
What is the main side effect of bleomycin and busulfan
Pulmonary fibrosis
37
What is the main side effect of transtuzuman and doxorubicin
Cardiotoxicity
38
What is the main side effect of cyclophosphamide
Haemorrhagic cystitis
39
What is the main side effect of methotrexate, 5-FU and 6-MP
Myelosuppression
40
What are the risk factors for prostate cancer
Increasing age Family history Genetic conditions (BRCA2...) Ethnicity (black > white > asian)
41
How might a patient with prostate cancer present
Often asymptomatic Raised PSA LUTS Bone pain Ejaculatory symptoms (rare)
42
What investigations are needed for suspected prostate cancer
DRE PSA MRI prostate/pelvis (usually pre-biopsy) Biopsy (TRUS (transrectal ultrasound), transperineal)
43
What are the common causes of raised PSA
Prostate cancer Urinary infection Prostatitis BPH Acute urinary retention Intense exercise Sexual activity
44
What is the management for metastasis of prostate cancer
Hormones (surgical/medical castration) Palliation (single-dose radiotherapy, bisphosphonates)
45
What is the management for locally advanced prostate cancer
Radical radiotherapy Adjuvant hormones
46
What is the management for localised prostate cancer
Criteria: T1/2, N0, M0, PSA < 20 Curative intent (active surveillance, radical prostatectomy, radiotherapy) Palliative care
47
What are the cancer-related differentials of haematuria
Renal cell carcinoma Transitional cell carcinoma Bladder carcinoma Advanced prostate carcinoma
48
What are the non-cancer differentials of haematuria
Stones Infection Inflammation Large BPH
49
What investigations are needed for haematuria
Ultrasound Flexible cystoscopy Urine cytology
50
What are the tumour markers for testicular cancer
aFP hCG LDH
51
When should cancer be suspected in a penile lump/ulcer
STI ruled out Persistent despite treatment
52
What are the risk factors for bladder transitional cell carcinoma
Male White Smoking Occupational exposure (rubber/plastic manufacturing, painting, hairdressing...)
53
What is the management for bladder transitional cell carcinoma
Low risk, non-muscle invasive (monitoring cystoscopies) Intermediate/high risk, non-muscle invasive (monitoring cystoscopies, intravesical chemotherapy/immunotherapy) Muscle invasion (neoadjuvant chemotherapy, radical cystectomy/radiotherapy, palliative care) Metastasis (systemic chemotherapy, immunotherapy, palliation)
54
Give an overview of renal cell carcinoma
95% of upper urinary tract tumours Presentation: haematuria, incidental, palpable mass M>F White > non-white Risk factors: smoking, obesity, dialysis Management: surveillance, excision, biological therapies, palliation
55
Give an overview of testicular cancer
Germ cell tumour Usually <45 Risk factor: undescended testis Treatment: inguinal orchidectomy
56
What are the risk factors for penile cancer
Phimosis (hygiene, smegma) HPV (16 and 18)
57
How quickly does cancer treatment need to start
62 days from GP referral to treatment 31 days from diagnosis to treatment
58
What are the risk factors for lung cancer
High smoking pack years Airway obstruction Increasing age Family history Exposure to carcinogens (asbestos...)
59
How might a patient with lung cancer present
Often asymptomatic Unexplained cough Weight loss Shortness of breath Lethargy Weakness Hoarse voice Dysphagia Chest pain Wheeze Fever Clinical signs of: SVCO, hypercalcaemia, anaemia, SIADH, Cushing's, VTE
60
How is the T staging for lung cancer calculated
T1 - < 3 cm T2 - 3 - 7 cm, invades visceral pleura/main bronchus T3 - > 7 cm, invades phrenic nerve/diaphragm/chest wall/mediastinal pleura T4 - invades mediastinal organs/vertebral bodies/carina/different lobes
61
How is the N staging for lung cancer calculated
N0 - no nodal involvement N1 - ipsilateral bronchopulmonary/hilar nodes N2 - ipsilateral mediastinal/subcarinal nodes N3 - contralateral/supraclavicular nodes
62
What are the common sites of metastases in lung cancer
Liver Adrenals Lung Lymph nodes Pleura Brain Bone
63
What diagnostic tests are needed for lung cancer
Bloods (routine, calcium, INR) CXR Staging CT Histology (ultrasound guided FNA, bronchoscopy, CT biopsy, thoracoscopy)
64
What is a malignant pleural effusion
Diagnosed by ultrasound-guided aspirate Exudate Indicates advanced disease (M1)
65
What are the differentials for incidental pulmonary nodes on CT
Primary bronchial carcinoma Infection (TB, fungal) Non-infectious granuloma (granulomatosis with polyangiitis) Rheumatoid nodules Bronchial carcinoid Hamartoma Metastasis Management: CT surveillance for 24 months, consider removal
66
How is SIADH related to lung cancer
Due to paraneoplastic syndrome Get hyponatraemia Presentation: headache, lethargy, confusion, seizures Management: fluid restriction, hypertonic saline, diuretics
67
What is the management for brain metastasis
Dexamethasone Urgent radiotherapy
68
What is mesothelioma
Cancer of pleura Due to asbestos exposure
69
What is Horner syndrome
Due to compression of sympathetic ganglion by Pancoast's tumour Ptosis, miosis, anhidrosis, exophthalmos
70
How might non-small cell lung cancer present
Horner syndrome Hypercalcaemia
71
How might small cell lung cancer present
Rapidly progressing symptoms SVCO SIADH Paraneoplastic syndrome Bulky mediastinal disease Bone metastasis Brain metastasis
72
What are the tumour markers for lung cancer
(All non-specific) CEA Ca 19-9 Ca 125 PSA aFP b-HCG
73
What are the types of non-small cell lung cancer
Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Large cell with neuroendocrine features Adenosquamous
74
What are the genetic conditions that can increase the risk of colorectal cancer
Familial adenomatous polyposis (autosomal dominant, develop cancer by 40 if untreated) Hereditary non-polyposis colorectal cancer (aka Lynch syndrome, autosomal dominant, 85% cancer by age 70) Familial colorectal cancer Inflammatory bowel disease
75
What lifestyle factors increase the risk of colorectal cancer
Western diet (low fibre, high fat, red meat) Obesity Smoking Alcohol Lack of exercise
76
How might a patient with right colon cancer present
Weight loss Fatigue Obstruction rare Iron deficiency anaemia
77
How might a patient with left colon cancer present
Constipation Abdominal pain Alternating bowel habits Bright red rectal bleeding Large bowel obstruction
78
How might a patient with rectal cancer present
Obstruction Tenesmus Bright red rectal bleeding Palpable mass
79
What investigations are needed for colorectal cancer
Baseline bloods Tumour markers (CEA) Colonoscopy Flexible sigmoidoscopy Barium enema CT colonography Biopsy CT CAP
80
What is the management of liver metastasis in colorectal cancer
Surgical resection Microwave ablation Radiofrequency ablation Selective internal radiotherapy
81
What are the common sites of metastasis from prostate cancer
Liver Bone Bladder Lymph nodes
82
How is the Gleason's pattern calculated in prostate cancer
1 - small, uniform glands 2 - more stroma between glands 3 - distinctly infiltrative margins 4 - irregular masses of neoplastic glands 5 - only occasional gland formation
83
What is the relationship between grade and Gleason's score for prostate cancer
Grade 1 - 3+3 Grade 2 - 3+4 Grade 3 - 4+3 Grade 4 - 4+4 Grade 5 - Gleason 9-10 (lack of gland formation)
84
What is the difference between active surveillance and watchful waiting for PSA testing
Active surveillance - closely monitor, regular examinations and tests, give potentially curative treatment if have progression Watchful waiting - less intense follow-up, few tests, aim to control symptoms
85
What is the management for prostate cancer
Brachytherapy (for small, solid tumours that have not spread) Radical prostatectomy External beam radiation therapy Androgen deprivation therapy (GnRH analogues - suppress FSH)
86
Head and neck cancers are mainly what type of cancer
Squamous cell carcinoma
87
What are the risk factors for developing head and neck cancers
Smoking Alcohol Betel nuts HPV EBV Asbestos exposure Formaldehyde exposure
88
What do head and neck cancers often present with
Lymphadenopathy Difficulty breathing Dysphagia Difficulty speaking
89
What are the NICE guidelines for likely presentations of head and neck cancers
Lip/oral cavity lump - oral cancer Persistent/unexplained neck lump - oral cancer Unexplained neck lump in > 45 - laryngeal cancer Persistent and unexplained hoarse voice in > 45 - laryngeal cancer Read and white patches in oral cavity - oral cancer Unexplained ulceration in oral cavity for > 3 weeks - oral cancer
90
Where do head and neck cancers commonly metastasise to
Lymph nodes Lung Bone Liver Brain
91
What is the management for head and neck cancers
Surgery (resection, laser, excision) Radiotherapy Chemotherapy Biological therapies Immunotherapy
92
What is the criteria for neutropenic sepsis
Undergoing systemic anticancer treatment Temperature > 38 Neutrophil count > 0.5
93
When should neutropenic sepsis be suspected
In all chemotherapy patients who become unwell Some may not have a fever due to corticosteroid use
94
When are patients usually most susceptible to neutropenic sepsis
Around day 10 | Bigger range for haematological malignancy
95
What are the signs and symptoms of neutropenic sepsis
Fever Tachycardia > 90 Hypotension < 90 Respiratory rate > 20 Symptoms related to specific systems (cough, shortness of breath, mucositis) Drowsiness Confusion
96
What factors increase the risk of infection in cancer patients
Prolonged neutropenia (> 7 days) Severe neutropenia Significant co-morbidities Aggressive cancer Central lines Mucosal disruption Hospital admission
97
What investigations are needed in neutropenic sepsis
Bloods Blood cultures (often negative) Swabs CXR
98
What are the common causative organisms of neutropenic sepsis
Staph aureus Staph epidermidis Enterococcus Streptococcus 80% due to endogenous flora
99
What is the management for neutropenic sepsis
Don't wait for FBC to confirm neutropenia Empirical IV broad spectrum antibiotics within 1 hour Sepsis 6 Involve seniors early
100
What is the further management for neutropenic sepsis
Granulocyte colony stimulating factor Patient education Antibiotic prophylaxis Dose reduction for further chemotherapy Stop treatment
101
Why does metastatic spinal cord compression need to be urgently treated
To preserve function
102
How does metastatic spinal cord compression occur
Dural sac and its contents compressed at level of spinal cord/corda equina 80-85% due to collapse/compression of vertebral bodies that have metastatic spread 10% due to direct spread of tumour into epidural space (especially lymphomas)
103
What are the signs of the reversible stage of metastatic spinal cord compression
Oedema Venous congestion Demyelination
104
What are the signs of the irreversible stage of metastatic spinal cord compression
Prolonged compression Vascular injury Cord necrosis
105
Which cancers commonly cause metastatic spinal cord compression
Breast Prostate Lung Lymphoma Myeloma Renal Thyroid
106
How might a patient with metastatic spinal cord compression present
Motor symptoms (reduced power, difficulty standing/walking/climbing stairs, often symmetrical) Sensory loss Sphincter dysfunction (hesitancy, frequency, retention, overflow, incontinence) Reduced performance status Back pain Poor response to normal analgesia Exacerbated by: neck flexion, coughing, sneezing, straining, lying down
107
What are the investigations for metastatic spinal cord compression
Pain suggestive of spinal metastasis - MRI spine within 1 week Signs of metastatic spinal cord compression - MRI within 24 hours
108
What is the management for metastatic spinal cord compression
Within 24 hours of diagnosis Dexamethasone Analgesia Surgery Radiotherapy
109
What is the prognosis for metastatic spinal cord compression
Depends on mobility at presentation Loss of sphincter control - poor sign Good in radiosensitive tumours - lymphoma, myeloma, breast, prostate, NSCLC
110
Which cancer types does hypercalcaemia commonly occur in
Breast SCLC Renal Myeloma Lymphoma
111
What are the causes of hypercalcaemia in cancer patients
Humeral (80%, chemicals released by tumour affect calcium levels (PTH-related protein, vitamin D)) Bone invasion (20%, osteolytic metastasis with local release of cytokines) 20% do not have bone metastasis
112
How might a patient with hypercalcaemia present
Nausea Anorexia Thirst Polydipsia Polyuria Fatigue Constipation Confusion Poor concentration Drowsiness Bone pain Severe: nausea, vomiting, ileus, delirium, coma, death
113
What is the treatment for hypercalcaemia
Rehydration Bisphosphonates (inhibit osteoclastic bone resorption) Denosumab (SC) Systemic treatment of malignancy Consider: regular blood tests, bisphosphonate infusions
114
What is the prognosis for cancer patients with hypercalcaemia
Many die within 3 months
115
How might a patient with superior vena cava obstruction present
Swelling in face/neck/arms Distended neck and chest veins Shortness of breath Cyanosis Stridor Hoarse voice Lethargy Headaches Confusion Conjunctival swelling Blurred vision Pemberton's sign
116
How can superior vena cava obstruction lead to death
Laryngeal oedema Airway obstruction
117
What investigation is needed for superior vena cava obstruction
CT with contrast
118
What is the management for superior vena cava obstruction
Sit upright, elevate head Oxygen Dexamethasone Opioids Benzodiazepines Stent insertion Anticoagulation (if due to thrombosis)
119
What are the features of tumour lysis syndrome
Hyperuricemia Hyperkalaemia Hyperphosphatemia AKI (uric acid or calcium phosphate in renal tubules) Hypocalcaemia
120
Which cancers are most susceptible to tumour lysis syndrome
Haematological malignancy Bulky chemo-responsive tumours
121
What are the risk factors for developing tumour lysis syndrome
High volume/bulky disease Pre-treatment LDH high High circulating WCC Pre-existing renal dysfunction/nephropathy Pre-treatment hyperuricaemia Hypovolemia Diuretic use Urinary tract obstruction from tumour
122
How might a patient with tumour lysis syndrome present
3-7 days after chemotherapy Nausea and vomiting Diarrhoea Anorexia Lethargy Haematuria Anuria Fluid overload Cardiac arrhythmias (tented T waves, QTc derangement) Muscle cramps Tetany Seizures
123
What is the treatment for tumour lysis syndrome
Good hydration and fluid balance Monitor electrolytes Allopurinol (xanthine oxidase inhibitor, get less hyperuricemia) Rasburicase (degrades uric acid) Dialysis
124
What is palliative care
Active, total care of patients whose disease is not responsive to curative treatment Aim to control pain and other symptoms Deal with social, psychological, and spiritual issues
125
When is a patient said to be end of life
Likely to die within the next 12 months
126
What are the general indicators of decline
Unplanned hospital admissions Poor/deteriorating performance status Dependence on carers Carers need more help and support Significant weight loss Persistent symptoms despite optimal treatment Decision to reduce/stop treatment
127
What are the stages of the clinical frailty score
1 - very fit 2 - well 3 - managing well 4 - vulnerable 5 - mildly frail 6 - moderately frail 7 - severely frail 8 - very severely frail 9 - terminally ill
128
What are the factors that indicate that death is approaching
Bedbound Drowsiness Impaired cognition Difficulty taking oral medications Reduced food and fluid intake Increased symptom burden
129
What are the signs that a patient is entering the dying phase
Shallow breathing Use of accessory muscles Respiratory secretions Skin colour changes Temperature at extremes Decreased consciousness Agitation Restlessness Decreased urine output Incontinence Decreased/absent oral intake Difficulty swallowing
130
What are some commonly used medications in the last few days of life
Morphine (pain and breathlessness) Midazolam (anxiety, agitation, seizures) Levomepromazine (nausea, vomiting, hallucinations) Glycopyrronium (respiratory secretions)
131
What are the features of pain in advanced disease
Usually persistent Can have multiple aetiologies Impairs function Threatens independence Invokes fear of further suffering Aim to optimise quality of life right up until death
132
What are the types of pain
Nociceptive Neuropathic Mixed
133
What is nociceptive pain
Normal nervous system, pain due to tissue damage Somatic - from skin/muscle/bone, sharp/throbbing/well-localised Visceral - from hollow viscus/solid organ, diffuse ache, difficult to localise
134
What is neuropathic pain
Malfunctioning nervous system Nerve structure damaged Stabbing, shooting, burning, stinging, numbness, hypersensitivity
135
Which NSAIDs/COX-2 inhibitors should be prescribed when there is no cardiovascular/GI risk
Ibuprofen Diclofenac Naproxen
136
Which NSAIDs/COX-2 inhibitors should be prescribed when there is GI risk
Celecoxib
137
Which NSAIDs/COX-2 inhibitors should be prescribed when there is cardiovascular risk
Naproxen Ibuprofen
138
What should be prescribed alongside all NSAIDS/COX-2 inhibitors
PPI
139
What are some adjuvant (co-analgesic) medications
Antidepressants (amitriptyline, duloxetine) Anticonvulsants (gabapentin, pregabalin) Benzodiazepines (diazepam, clonazepam) Steroids (dexamethasone) Bisphosphonates
140
Which medications are on step 1 of the WHO pain ladder
Paracetamol NSAIDs
141
Which medications are on step 2 of the WHO pain ladder
Dihydrocodeine Codeine phosphate Tramadol Co-codamol
142
Which medications are on step 3 of the WHO pain ladder
Oxycodone Morphine Fentanyl Diamorphine
143
How does pain respond to opioids in different parts of the body
Soft tissue - good response Viscera - good/partial response Bone - partial response Neuropathic - poor response
144
What is the codeine to morphine conversion ratio
10 : 1
145
How is the morphine dose calculated
TDD / 2 = slow release dose TDD / 6 = PRN dose
146
Which is the name of the slow release morphine
Zomorph
147
What is the name of the immediate release morphine
Oramorph
148
What are the common side effects of opioids
Constipation (give laxatives) Dry mouth Nausea (give antiemetics) Vomiting Drowsiness Sedation
149
What are fentanyl patches
Transdermal opioid Non-renal excretion 12-24 hours to reach steady state Use oramorph PRN for breakthrough pain
150
What are the signs of opioid toxicity
Pinpoint pupils Hallucinations Drowsiness Vomiting Confusion Myoclonic jerks Respiratory depression
151
Why does opioid toxicity occur
Fast dose escalation Renal impairment Poor response to pain Given with a nerve block
152
How is breathlessness as a palliative symptom managed
Stay calm Sit upright Air flow across face Oxygen Consider medications: morphine, lorazepam, midazolam
153
Which receptors are found in the chemoreceptor trigger zone of the brain
NK1 D2 5HT3
154
Which receptors are found in the vomiting centre of the brain
NK1 ACh H1 5HT2
155
What factors increase the risk of chemo-induced nausea and vomiting
Specific chemo drugs Female < 50 Past history of nausea and vomiting
156
What are the causes of constipation in cancer patients
Disease-related Fluid depletion Weakness Intestinal obstruction Medications Biochemical (hypercalcaemia, hypokalaemia) Pain
157
How is malignant bowel obstruction managed
Non-surgical: rest bowel, limit oral fluids, NG tube for vomiting, correct electrolyte imbalance, analgesia, trial dexamethasone Surgical: endoscopic stenting, venting gastrostomy (to decompress)
158
What are the principles of the double effect
Action must be morally good Only good effect must be intended Good effect must not be achieved by way of bad effect Good result must outweigh the bad effect
159
How does alkylating agent chemotherapy work
Makes cross-links between DNA stands Prevents DNA replication
160
How does platinum agent chemotherapy work
Makes cross-links between DNA stands Prevents DNA replication
161
How does antimetabolite chemotherapy work
Acts as substitute for metabolites needed for DNA synthesis
162
How does topoisomerase inhibitor chemotherapy work
Prevents unwinding of DNA strands for replication
163
How does tubulin-active agent chemotherapy work
Stops spindle formation
164
What are the immediate side effects of chemotherapy
(Within minutes) Extravasation (leaking of chemo drug into adjacent tissue) Facial/body flushing Cardiac arrhythmias Hypotension Hypersensitivity Anaphylaxis Haemorrhagic cystitis
165
What are the short-medium term side effects of chemotherapy
(Hours - 7 days) Discolouration of urine Tumour lysis syndrome Nausea and vomiting Mucositis Constipation Diarrhoea Fatigue
166
What are the medium-long term side effects of chemotherapy
(> 7 days) Bone marrow suppression Alopecia Liver dysfunction Renal toxicity Cardiac toxicity Peripheral neuropathy Pulmonary fibrosis Changes in fertility
167
What are the modes of chemotherapy resistance
Modified cell membrane composition Reduced drug transporters Increased efflux pumps Drug inactivation mechanisms develop Drug target modification/loss Up-regulation of pro-survival genes
168
How does checkpoint inhibitor immunotherapy work
Decrease suppression of T cell immune response (encourage immune cells to kill cancer cells)
169
How does adoptive cell therapy immunotherapy work
T cells isolated from patient, modified, multiplied, re-injected
170
How does cancer vaccine immunotherapy work
Use patient's own dendritic cells Used in metastatic prostate cancer
171
How does cytokine immunotherapy work
Increase signalling between immune cells and other body cells
172
How does oncolytic virus immunotherapy work
Viruses target particular cancer cells
173
What is the main side effect of immunotherapy
Organitis
174
What is the NICE urgent CXR criteria for lung cancer
> 40 and 2 of (or smoker and 1 of): cough, fatigue, shortness of breath, chest pain, anorexia, weight loss > 40 and: persistent/recurrent chest infections, finger clubbing, persistent lymphadenopathy, chest signs consistent with lung cancer, thrombocytosis
175
Give an overview of small cell lung cancer
Rare in non-smokers 60% metastatic at presentation Aggressive Poor prognosis Very sensitive to chemotherapy High relapse rate Often use radiotherapy Give prophylactic cranial irradiation
176
What are radiosensitizers
Drugs that make cancer cells more susceptible to radiotherapy
177
Which cancers are commonly treated with chemoradiotherapy
Head and neck cancers Cervical cancer Bladder cancer Anal cancer
178
What are the side effects of radiotherapy
Hair loss Dysphagia Sore throat Oral mucositis Diarrhoea Sterility Dysuria Radiation cystitis Low blood counts Lymphoedema Erythema Nausea and vomiting Fatigue