ModC: Oncology & palliative care Flashcards by M Y

Bladder cancer

Px: painless haematuria
RFs: smoking, chronic schistosoma haematobium infection (in Africa and Middle East), rubber industry previously a RF prior to 1949

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Bowel cancer

Colon
Px: bowel habit changes, unintentional weight loss, vague abdominal discomfort
Ix: colonoscopy (to visualise up to caecum)
45% left-sided, 25% sigmoid colon

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Breast cancer

Breast
Px: breast lump (check mobility, skin tethering, regularity), bloody discharge
Ductal carcinoma (most common) associated with bloody discharge, age 50-70
Ix: triple assessment (examination, imaging (USS or mammogram), FNA/core biopsy

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Cervical cancer

Cervix

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Endometrial cancer

Womb

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Gastric cancer

Stomach

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Lymphoma

Haem

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Leukaemia

Haem

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Myeloma

Haem

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Laryngeal cancer

Larynx

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Liver cancer

Alcohol

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Lung cancer

Small cell and non-small cell

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Malignant bowel obstruction

bowel

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Neutropenic sepsis

Emergency

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Bone metastases

bone

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Liver metastases

liver

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Brain metastases

brain

Spinal cord metastases

spine

Oesophageal cancer

oesophagus
RFs: previous achalasia (suggests upper tumour), smoking, alcohol
Px: 
- upper (20%) = hoarseness, cough
- middle =
- lower =
- lower oesophageal sphincter =

Ovarian cancer

ovary

Complications: intra-abdominal metastases resulting in bowel obstruction

Pancreatic cancer

Poor prognosis unless diagnosed early

Prostate cancer

common

Px: asymptomatic with significantly raised PSA

Renal cancer

poor prognosis

Spinal cord compression

spine

Superior vena cava obstruction

Seen with advanced lung cancer especially if pt has received multiple lines of treatment Px: SOB, neck/upper arm swelling Ix: CXR (mediastinal widening) Mx: high dose steroids until further ix available

Testicular cancer

Testicles

Lynch syndrome

Improved prognosis if microsatellite instability identified via genetic testing

Tumour lysis syndrome

Due to rapid breakdown of tumour cells after initiation of tx, high uric acid levels can result in renal tubular necrosis Typically associated with acute leukaemia and non-Hodgkin's lymphoma (Burkitt's) Px: dysuria, oliguria, abdominal pain, weakness Ix: U&E, calcium, uric acid, ECG Complications: renal tubular acidosis, arrhythmia secondary to hyperkalaemia Prevention: hydration to improve blood flow, allopurinol or urate oxidase to remove uric acid Tx: correct electrolyte abnormalities, hydration

Syringe driver medications

Morphine | Anti-emetic

Community palliative care

TPN via NG tube | Symptomatic relief e.g., pain relief

Mx if NG tube removed in palliative care pt

Anti-secretory medication to prevent excessive vomiting | Anti-emetics

Pleural effusion

Usually associated with tumour | Mx: VATs procedure

Mesothelioma

Cancer of pleura

Mx breathlessness in a palliative care pt

Lorazepam if anxiety driven | Oramorph if physical cause identified for breathlessness

Opioid toxicity

May cause drowsiness

Prescribing opioids

PRN opioid should be 1/6th a regular dose

Multiple myeloma

Px: dyspepsia, hypercalcaemia, low mood, back pain, immune paresis (increased risk of infection e.g., UTI, resp. infection), renal impairment, anaemia

Chronic lymphoid leukaemia

Ix: lymphocytosis (incidental finding)

Squamous cell carcinoma

Px: central cavitating lesion

Small cell lung cancer

cancer

Lung adenocarcinoma

cancer

Carcinoid tumour

cancer