Oncology Flashcards
What is radical treatment?
Treatment with curative intent
What is adjuvant and neo-adjuvant treatment?
Adjuvant after radical therapy to reduce risk of recurrence
Neo-adjuvant prior to radical Tx
What units is radiotherapy prescribed in?
Gray Gy
“Radiation implanted / inserted in patient to deliver a dose of radiotherapy to local tumour”
Brachytherapy
Is the staging system used for lymphoma?
Ann Arbor
What does ambulant mean?
Patient can walk / mobilize
What are the stages of the WHO performance status?
0 fully active, no restrictions on activities
1 unable to do strenuous activities
2 able to walk + manage self care, unable to work, out of bed >50% waking hours
3 confined to bed/chair >50% waking hours, capable of limited self care
4 completely disabled unable to do any self care
5 death
Which opioid can be used in patients with impaired renal function?
Fentanyl
In impaired renal function using opioids - would that make the drug ineffective or cause toxicity?
Toxicity since decreased clearance
What are the indications, names, drug classes and doses for the anticipatory care meds?
Pain: morphine opioid - varying dose
Nausea: levomepromazine antipsychotic 2.5mg
Secretions: buscopan hyoscine butylbromide 20mg
Distress: midazolam benzodiazepine 2mg
What drug should be co-prescribed for all patients on strong laxatives?
Laxatives
Which opioid is used in patients with moderate renal impairment? What is used in patients with severe renal impairment?
Moderate: oxycodone
Severe: fentanyl or buprenorphine
Name 3 Mx options for metastatic bone pain
Opioids, bisphosphonates, radiotherapy
When increasing opioid dose … by how much?
30 - 50%
How do you convert from oral codeine to oral morphine?
X 10
How you convert from oral morphine to subcut morphine?
/ 2
What are the components of the WHO analgesic ladder?
1 non-opioid +-adjuvant
2 mild/moderate opioid + non-opioid +-adjuvant
3 strong opioid + non opioid +- adjuvant
What is the max daily dose of paracetamol?
4 grams
BCR-ABL
- tyrosine kinase translocation between what chromosomes?
- inheritance pattern?
- what cancers is it assoc?
BCR-ABL Philadelphia
- 9 and 22
- always de novo
- 100% CML, some AML/ALL
HNPCC
- what inheritance pattern?
- assoc what cancers?
- what mutation?
HNPCC
- AD
- bowel > endometrial > ovarian
- MLH/MSH
Retinoblastoma
- autosomal dominant
- what cancer?
- what age group
- Rb1 mutation
Childhood eye cancer
BRCA
- inheritance pattern?
- assoc cancers?
AD
Breast > ovarian
Chemotherapy side effects - which causes cardiomyopathy?
Anthracyclines (-orubicin) and herceptin
Chemotherapy side effects - which cause peripheral neuropathy?
Platinum agents (cisplatin, carboplatin)
What chemotherapy increases risk of endometrial cancer?
Tamoxifen
Chemotherapy side effects - which causes lung fibrosis?
Bleomycin
Name 3 antiemetics used in chemotherapy assoc N&V
Ondansetron + dexamethasone + aprepitant (used for acute vomiting or preventatively)
(Metoclopramide if prolonged)
Ondansetron causes diarrhoea or constipation?
Constipation
How frequently is MST morphine slow release prescribed? eg how long does it last
12hr
Opioid side effects -drowsy or alert -paraesthesia or pruritus -hallucinations or delusions Also: nausea, myoclonus, constipation
Drowsy, pruritus, hallucinations
How to convert oral oxycodone to oral morphine dose?
X2
How to convert oral oxycodone to subcut oxycodone?
/ 2
What 2 factors influence chemotherapy dose?
Body surface area and renal function
Which cause diarrhea or constipation
- Metoclopramide
- Cyclizine
- Ondansetron
Ondansetron + cyclizine constipate
Metoclopramide diarrhea
(so use in reverse situations)
Which antiemetic can cause acute dystonic reactions?
Metoclopramide (D2 antagonist)
commoner in females
What is the definition of neutropenic sepsis?
Fever >38 for >2hr when neutrophils <1X10
What is the empirical ABx for neutropenic sepsis?
IV taz + gent
What cultures are involved in a sepsis screen?
Blood + urine + stool + sputum
What is the term for radiotherapy delivered inside the body?
Brachytherapy (eg radioactive seeds in prostate)
In spinal cord compression what comes first - pain or weakness?
Pain precedes weakness
Describe the pain in cord compression
Radicular band like, radiates around rib cage, worse on coughing
UMN or LMN signs in cord compression?
UMN
Malignant cord compression investigation?
Urgent MRI
whole spine
What colour is CSF on T2 weighted MRI?
White
Malignant cord compression initial Mx?
16mg IV dexamethasone followed by 8mg BD PO
to reduce vasogenic oedema
Malignant cord compression Mx after dexamethasone?
Radiotherapy with or without surgery (anterior laminectomy)
What is Pemberton sign?
Raise arms above head (obstruct brachiocephalic vein); brings on symptoms in SVCO
Presentation of SVCO?
Swollen face/neck/arm, facial plethora, distended veins, SOB, HA
Give 2 causes of SVCO
Extrinsic compression eg right sided lung cancer, lymphoma
Clot (fast onset)
Intrinsic compression eg foreign body line obstruction
What is the 1st line Mx of SVCO caused by lung cancer?
Steroids + stent
Name 2 causes of malignant hypercalcaemia?
Squamous cell lung cancer (paraneoplastic PTHrP secretion)
Melanoma
Bone met osteolysis
What is the presentation of malignant hypercalcaemia?
Bones stones groans moans
Constipation, polyuria, anorexia, thirst, confusion, nausea
What is the 1st line Mx of malignant hypercalcaemia?
Rehydrate
(Several L normal saline, aim 3-4 L over 24hr)
(Bisphosphonates used following rehydration)
What are PTH levels in hypercalcaemia due to paraneoplastic ectopic PTH secretion?
Low or normal - since its PTHrP - not the same so not on the test
(check PTHrP levels)
Pericardial tamponade
- compresses which heart chamber?
- smaller or enlarged complexes on ECG?
- smaller or enlarged heart shadow on CXR?
- normal or abnormal echo?
Compresses RA
Smaller complexes
Enlarged shadow
Abnormal echo see pericardial fluid
What are the components of Beck’s triad for cardiac tamponade?
> JVP + diminished heart sounds + hypotension
What is pulsus paradoxicus?
Breath in > raised intrathoracic pressure > decreased venous return > reduced blood pressure by >10
What is Kussmaul’s sign
Rise in JVP on inspiration
Kussmaul’s sign or pulsus paradoxicus - which seen in cardiac tamponade?
Pulsus paradoxicus
Cardiac tamponade Mx
Pericardiocentesis
Neutropenic sepsis definition
Infection + neutrophil <0.5
or <1.0 if chemo within last 21 days
Neutropenic sepsis 1st line ABx
Piperacillin with tazobactam (Tazocin)
In neutropanic sepsis - what do you do first - give ABx or sepsis screen?
Give ABx
“Intracellular ions released from cells due to chemotherapy causing rising potassium + rising phosphate + falling calcium”
Tumour lysis syndrome
Tumour lysis syndrome prophylaxis?
if high risk eg leukaemia / lymphoma
Allopurinol
Tumour lysis syndrome
- high or low potassium
- high or low phosphate
- high or low calcium
High K + phos
Low Ca
SIADH
- high or low serum Na
- high or low urine Na
- hypo or hypervolaemic
Low blood
High urine
Euvolaemic
Are all woman w breast Ca checked for BRCA?
No
only if very young, strong FH, bilateral, breast + ovarian, male breast cancer
US or mammogram - which is better in young / older women?
US younger
Mammo sensitivity increases with age
OCP - which gynae cancers protective and which risk factors?
RF breast, endometrial
Protects cervical, ovarian
double check
What is Troisier’s sign?
Metastatic LN from intra-abdominal cancer often in left supraclavicular fossa, Virchow’s node
Cervical cancer can cause renal failure due to ureteric obstruction - T or F
True
When starting a PTx on opiates what should you co-prescribe?
Paracetamol + laxative + antiemetic
The pre-Tx ambulatory status is the most important prognostic factor in determining outcome for malignant cord compression - T or F
True
