Medical Management of Cancer BW3 Sabesan

Question 1

Learning outcomes: from lecture:

Need to know these:

Answer 1

Question 2

Overall approach to management:

1) Most require tissue biopsy

Curable? yes or no? prolong life?

Need to know medan cell survival in curable cancers #

Answer 2

1) Diagnosis
2) Staging?
3) Curable vs non curable
4) Surgery/chem/hromonal/radio

NEED to know the median survival incurable cancers:

Question 3

Types of complications related to cancers+ management:

Emesis from chemotherapy:

1) we use prevention emesis
2) Early after chemo emesis/

What options do we have?

Answer 3

1. Metoclopramide
2. ondansetron
3. steroids
4. Benzo (anticipatory)

Question 4

50 year old mal just started chemo -

sick comes in N and V

Assess patient (hx and exam)

Answer 4

May not be related to chemotherapy at all

Need to take history+ exam:

Fluid assessment+ Taking prophylactic medications +inability to keep them down

Question 5

What is neutropenic fever/sepsis: (major emergency)

What is it? What does it need immediately?

Answer 5

Question 6

Management of neutropenic spesis:

What are the important management principles?

Answer 6

Question 7

Commonly cultured pathogens in febrile neutropenic patients:

Answer 7

• Most important to cover psuedomonas- piptaz
  *

Question 8

SVC obstruction: In cancers:

What is it?

Symptoms?

Causes?

Management?

Spinal cord compression? (need to remeber) Early signs (radicular pain) - Bladder dysfunction/bowel/

Answer 8

Question 9

Hormonal agents:

Breast cancer - Know side effects (osteoporosis)

Answer 9

Question 10

Side effects of hormonal agents?

Answer 10

Question 11

MEtastatic cancers- can be seen in periontenum/omental deposits

Answer 11

Question 12

Approach to metastatic cancers:

Need to understand management pathway:

What is performance status in cancer management?

What are prognostic factors for metastatic cancer?

Answer 12

• So important to discuss prognosis- with patient- Need to have framework for discussing prognosis
• if you dont know say you will

USE SPIKES

Or breaking bad new framework: OSCE!!! hint!

Question 13

Immunotherapy in cancer:

What is PDL1? CD4

Answer 13

• Essentially creating an autoimmune disease in patients

Question 14

What are the major side effects of immunotherapy in cancer management?

List 6 atleast -

Answer 14

1. Pneumonitis - fever cough/ ground glass appearance on CXR
2. Colitis - Bowel perforation- Begins with watery diarrhoea/severe blood and mucus+cramps
3. Hypophysitis/adrenalitis /Thyroiditis

Need to septic screen workup! Need to rule out sepsis:

Patients all usually require 1) Steroids 2) Oral/IV antibiotics 3) Bactrim prophylaxis

Question 15

Understand

Cancer

breast colon lung ovarain prostate cancer

+Metastatic algorithmn.

https://wiki.cancer.org.au/oncologyformedicalstudents/Clinical_Oncology_for_Medical_Students

NEED to read prior to exams

Question 16

ALL from cancer council Australia:

Screening and prevention:

Answer 16

• 1/3 of cancer deaths can be prevented from lifestyle changes alone
• population screening for cancer can detect precancerous lesions or early cancer when itd is curable surgically

Tobacco:

• Tobacco causes 20% of australia cancer burden