onc Flashcards
hypercalcaemia of pregnancy
many mechanisms for it to come about
humoral- tumour secretion of parathyroid hormone related peptide (PTHrP) - renal, ovarian, breast, endometrial, squamous cell carcinoma.
osteolytic hypercalcaemia- breast, myeloma
calcitriol -lymphoma + granulomas
ectopic hyperparathyroidism- rare.
RF: no metastatic cancer.
MSK involvement, lymphoma.
Ix: bloods, ecg.
Rx: if mod-severe (3 or more)
Iv saline 1L bolus + 2-500/hr
Iv bisphosphinate/ denosumab.
calcitonin
frusi
resolve the cancer.
types of brain cancer
menigioma- 1/3 of all, mostly benign but can be ca. - MRI to Dx.
medulloblastoma- malignant- incasive from cerebella vermis- first 2 decades of life. 15-20% of all brain tumours. mass effect, ct/ mri. Rx with surgery.
gliomas- age, white, industrial countries. elevated ICP + symptoms appropriate to location. can be benign or ca.
prolactinomas
pituitary adenomas etc.
sarcoma
rare, solid tumour of connective tissue.
presents as a soft tissue swelling, +/- pain.
50 histological subtypes.
1% of adult malignancies.
soft tissues or bone usually dividing point.
RF: radiation, inherited syndromes, herpes 8 infection. congen disorders.
S+S: mass, bleed (GI, uterine) rash, mac pap rash, increaced abdo girth.
Ix: MRI + and - contrast. , biopsy.
Rx: gen surgery– wide local excition– upto amputation or removal or organ if spread enough.
discuss bone tumours
v rare- about 0.2% of all ca.
origionates from mesenchymal cells within bone.
osteosarcoma- worsening pain over weeks to months- 13-16 kind of age. male, limited rom.
X-ray, biopsy, mri with gadolinium.
Rx: surgery with adjuvinant chaemo before, after or both.
condrosarcoma 50-60- severe pain worse at night, not relieved by pain. - pelvic bone. - chop chop.
ewing sarcoma. - simalar to osteosarcoma, same age range male etc, type 2 syptoms more commonly seen. - quite aggressive and neees swift treatment.
superior vena carva syndrome.
obstruction of the SVC
commonly due to malignancy
interrupted venous return from the head, thorax and upper limbs.
rarely fatal, but can cause upper airway obstruction.
S+S: oedema head neck and arms, cyanosis, plethora, distanded subcutaneous vessels. headache, anoraxia, wt loss, haemoptysis.
RF: smoking, pacemaker leads, central venous catheters.
Ix: cxr, CT with contrast.
Rx: if actue airway obstruction- secure + radio + steroids.
If cancer driven- radio/ chaemo as cancer appropriate.
or palliate.
tumour lysis syndrome
commonly seen in leukaemia - B-ALL.
when any cancer cells break- release K+, phosphate, DNA.
can go very high
high phos, means low ca– seziure.
renal faliure from the purines, – give allopurinol.
high risk tumours: burkitt, leukaemia,
S+S: abdo pain, weakness, arrthymia, tacycardia, dec urine, seziure.
RF: big tumour, leukaemia, reduced renal output.
Rx: allopurinol, lots of fluids, phosphate, binders, calcium gluconate.
dialysis if really bad.
