Metastatic Bone Pain, Spinal Cord Compression and an Overview of Radiotherapy Flashcards

Question

what types of cancer is radiotherapy curative on its own?

Answer 1

``` Early stage Prostate Cervix Vocal cord Skin (non melanoma) ```

Answer 2

``` Prostate Breast GYN H&N Sarcoma Lung Oesophagus Bowel Skin (non-melanoma) ```

Answer 3

``` Advance H&N lymphoma palliative pain control control bleeding spinal cord compression (cauda equina) reduce tumour mass so relieving mass effect ```

Answer 4

``` Curative on its own Curative before or after surgery Curative with chemotherapy Palliative care (extending life) Shrink tumour ```

Answer 5

Maintenance of healthy blood calcium levels include the kidneys, parathyroid glands, intestines and bones 2.2-2.6mmol/L Serum calcium is bound to albumin and measurements should be adjusted for serum albumin

Answer 6

Significant bone lysis directly by the tumour-multiple myeloma Paraneoplastic syndrome (most of the cancer). PTHr protein secretion - Enhance osteoclast activation and bone resorption - Increases renal tubular calcium reabsorption

Answer 7

``` Lethargy Dehydration Anorexia Nausea Polydipsia Constipation Renal impairment Polyuria Mood disturbance Cognitive dysfunction Confusion Coma Limb weakness Shortened QT interval Dysrhythmias Chronic: pancreatitis, gastric ulcer, kidney stones ```

Answer 8

``` General and abdominal examination Urine output Other cancer symptoms and signs Electrolytes, albumin, ALP T3 and T4 Medications ECG changes ```

Answer 9

``` Infection Deranged kidney function/renal failure Brain metastases Spinal cord compression Depression Sub-acute or acute bowel obstruction Opioids related side effects ```

Answer 10

``` Lung-squamous cell and small cell Any advance squamous cell cancer (H&N, bladder, anal, vulva) Multiple myeloma Renal cell cancer-release of parathyroid hormones or other growth factors Advance breast cancer Primary hyperparathyroidism Sarcoidosis Vit D intoxication Thyrotoxicosis Medications ```

Answer 11

Hydration – 2-4L of 0.9% saline over 24 hours (caution in elderly, cardiac history, obstructive uropathy, renal failure) Mobilise IV bisphosphanate Glucocorticoid (inhibit 1,25 OH vitamin D production) Manage malignancy Resistant cases-consider calcitonin Check medication lists-calcium and vitamin D supplement Loop diuretics? -fluid overload

Answer 12

Treat patient not calcium level Adjusted calcium <3mmol/L and rising (often asymptomatic)- give fluids and bisphosphonates if persistent or symptomatic Adjusted calcium 3-3.5mmol/L -fluids, bisphosphonates, glucocorticoids Adjusted calcium >3.5mmol/L – risk of dysrrhymia and coma End of life care-discuss and evaluate

Answer 13

Inhibits osteoclasts Pamidronate -30-90mg over 90 mins (starts working over 2-3 days and max effect over 1 week) Zoledronic acid – 4mg over 15 mins, longer duration. Caution: renal function, flu like symptoms, hypocalcaemia, long use can cause bone (jaw) necrosis

Answer 14

decreased QT interval

Answer 15

Lung Liver BONE (3rd most common site of metastasis)

Answer 16

``` Prostate Breast Lung Kidney Myeloma ```

Answer 17

``` Vertebrae Pelvis Ribs Femur Humerus Acrometastases- distal to elbow and knee are rare and usually due to renal and lung cancer as primary tumour) ```

Answer 18

Asymptomatic Pain (dependent on what structures are being affected.) Pathologic fractures/spinal cord compression if cortex affected increased risk of fracture. If outside of cortex-risk of spinal cord compression Hypercalcaemia-secretion of parathyroid hormone secreted from primary tumour or soft tissue metastasis. This is rare.

Answer 19

Bone undergoes constant remodelling maintaining osteoclastic (resorptive) and osteoblastic (Bone forming) activity Tumour cell seeding through blood-bone marrow-cortex Disrupts the balance between osteoclast and osteoblast activity Osteoclast predominant-lytic metastases, greater chance of fracture than osteoblast predominant Osteoblast predominant-disorganised ossification, still fractures

Answer 20

Mostly lytic metastasis - Multiple myeloma - Thyroid cancer - Renal cell cancer - Melanoma Mostly sclerotic metastasis - Prostate - Breast - Mucinous cancer of the bowel Mixed sclerotic and lytic - Lung cancer - Bladder cancer

Answer 21

Bloods - FBC - Bone related ALP - Kidney and liver function - PSA - Paraproteins Urine -Proteins (bence jones-multiple myeloma) Imaging - Plain x ray-more specific, less sensitive - Bone scan-more sensitive, less specific - Cross sectional imaging (CT, MRI)

Answer 22

``` Primary bone tumour (benign or malignant) bone islands osteomyelitis healing fracture pagets disease endocrine and metabolic disease ```

Answer 23

Ladder 1 = paracetamol `and anti-inflammatory Ladder 2 = weak opioids, codeine, tramadol Ladder 3 = stronger opioids; morphine, oxycodone, fentanyl

Answer 24

Palliative radiotherapy Bisphosphonates -zolidronic acid (IV every couple of weeks) Orthopaedic intervention if fracture or at risk

Answer 25

Paracetamol-hepatotoxic Anti-inflammatory – renal function, gastritis Opioids (titrate dose) – short acting then replace with long acting Constipation, nausea, drowsiness, confusion Bisphosphonates – nephrotoxic and jaw necrosis

Answer 26

Neurological symptoms and signs caused by mechanical pressure over the spinal cord (from epidural extension of metastasis in vertebra, from paravertebral region, from meningeal deposits). Similar features occurring at vertebral level below L1 is cauda equina compression

Answer 27

Pain 90% of patient Worse lying down If bone collapses pain worse on movement Increases with Valsalva maneouver If nerve root involved radicular pain Tenderness Muscle weakness 75% of patients (jelly legs, give way) Sensory deficits-50-75% Autonomic dysfunction 50-60% of patients Symptoms and signs depend on timing, level of compression, pain and pre-existing condition

Answer 28

Medulla to conus medularis L1-L2 Cord projects 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal Conus meddularis-tapered structure at spinal cord end. At intervertebral disc between the first and second lumbar vertebrae. Consist of sacral spinal cord segments Cauda equina – bundle of intradural nerve roots at end of the spinal cord Filum terminale – fibrous extension of the cord. Non neural element that extends down the coccyx

Answer 29

``` Pain Functional status Mobility Difficulty in bowel and bladder numbness Comorbidities medications ```

Answer 30

``` mobility and gait elicit tenderness power, tone and rigidity tendon reflexes including plantars light touch (sensory level) bladder fullness (urinary catheter?) anal tone and perianal sensation ```

Answer 31

pain-localised or radicular motor-low power, rigidity bladder-urge incontinence reflexes-hyper

Answer 32

localised or radicular pain motor-flaccid paralyses bladder-overflow incontinence reflexes absent

Answer 33

lung, prostate, breast, multiple myeloma, kidney, lymphoma, melanoma

Answer 34

``` osteoporotic fracture disc herniation brain metastases vascular lesion demyelination disorder injury primary tumour ```

Answer 35

immobilisation, steroids (dexamethasone 8mg BD with PPI), MRI, neurosurgery, radiotherapy, rehabilitation if leukaemia and lymphoma-steroid and chemotherapy

Answer 36

taper off dexamethasone (risk of hyperglycaemia and gastric ulcer) treat primary cancer physiotherapy with gradual mobilisation pain control other specialty input (macmilln nurse, palliative care team, physiotherapist, occupational therapist, GP

Answer 37

single lesion respond to steroid ambulatory/limited neurological deficit radiation sensitive-multiple myeloma and small cell lung cancer moderately sensitive-prostate and brest early surgery and radiotherapy (within 24 hours)

Answer 38

``` multiple location extra spinal metastases non ambulatory/paraplegic radioresistant tumour (renal cell cancer, melanoma) cord compression with vertebral fracture ```

Metastatic Bone Pain, Spinal Cord Compression and an Overview of Radiotherapy Flashcards

(62 cards)