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4th Year > Oncology > Flashcards

Oncology Flashcards

1
Q

how do you assess a cancer patients fitness for treatment (chemo or radio)

A

calculate their performance status score

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2
Q

what are the different performance status scores

A

0 - fully active, no restrictions

1- unable to do strenuous exercise but can do light house work

2- able to walk and manage self care but unable to work. Out of bed >50% of the time.

3- confined to bed or chair >50% of time

4- completely disabled, unable to do any self care, confined to bed/chair

5- death

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3
Q

step 1 on the WHO analgesic pain ladder (for mild pain)

A

non-opioid medication eg. paracetamol

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4
Q

step 2 on WHO analgesic pain ladder (mild-moderate pain)

A

opioid for mild to moderate pain (codeine) + non opioids (paracetamol)

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5
Q

step 3 on WHO analgesic pain ladder (mod-severe pain)

A

opioid for severe pain (morphine) + non opioid (paracetamol)

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6
Q

how are chemotherapy doses calculated

A

by patient’s surface area (surface area is calculated using height and weight)

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7
Q

which type of cancer caused hypercalcaemia by secreting PTH like protein

A

squamous cell lung caner

small cell causes hyponatraemia by screening ADH and cushing’s by secreting ACTH

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8
Q

which virus causes a large portion of head and neck cancers

A

HPV

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9
Q

how does spinal cord compression present (an oncological emergency)

A

back pain radiating around the rib cage - worse on coughing and straining

85% present with weakness

65% have altered sensation

55% have urinary problems

75% have bowel problems eg. constipation

5% have faecal incontinence

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10
Q

what do you do if someone presents with radicular back pain (radiates around rib cage)

A

order urgent MRI spine and start dexamethasone 8mg bd

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11
Q

treatment for spinal cord compression

A

dexamethasone 15mg IV followed by 8mg bd

surgery

radiotherapy

chemo - only for chemosensive tumours (lymphoma, teratoma, SCLC)

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12
Q

how does superior vena cava obstruction present

A

swelling of face, neck, and arms

distended veins on neck and chest wall

shortness of breath

headache

lethargy

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13
Q

what causes superior vena cava obstruction

A

clots - often from a DVT

foreign body eg. central line

tumour in vessel eg. renal cancer

extrinsic compression from other cancer mass

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14
Q

investigations for SVC obstruction

A

CXR to look for mass

venogram to look for clot

CT chest

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15
Q

treatment for SVC obstruction

A

treat cause:

clots - thrombolysis/anticoagulation

extrinsic compression - steroids, chemo, radio, stent

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16
Q

causes of malignant hypercalcaemia

A

humoural (PTHrp from SCLC)

local bone destruction (eg. in myeloma)

tumour production of vitamin D analgoues (lymphomas)

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17
Q

how does hypercalcaemia present

A

‘bones, stones, groans, psychiatric moans’

bone pain
renal stones
constipation/abdo pain
change in mental state

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18
Q

investigations for malignant hypercalcaemia

A

calcium level
urea and electrolytes
phosphate (could be low in hyperparathyroidism)

myeloma screen if no known malignancy

19
Q

treatment for malignant hypercalcaemia

A

rehydration first
-several litres of saline

bisphosphonates
-60-90mg pamidronate IV over 2 hours (can cause renal failure so need to properly hydrate first)

systemic management of malignancy

20
Q

symptoms of malignant pericardial tamponade

A

primarily SOB

fatigue

palpitations

pericarditis symptoms - pain improves moving forward

symptoms of advanced cancer

21
Q

signs of malignant pericardial tamponade (Beck’s triad)

A

low BP

raised JVP

muffled heart sounds

22
Q

investigations for pericardial tamponade

A

CXR
ECG
Echo
cytology of pericardial fluid

23
Q

treatment of pericardial tamponade

A

pericardiocentesis - put a drain into pericardium

pericardial window - surgery to drain fluid/blood into pleural cavity

systemic management of malignancy

24
Q

what is neutropenic sepsis

A

sepsis + neutrophil count <0.5

or <0.1 if chemo given within last 21 days

25
Q

treatment of neutropenic sepsis

A

if chemo within last 3 weeks and temp >37.5 or clinically sepsis - start antibiotics right away

if not check neutrophils and if >0.5 use hospital antibiotic man. If <0.5 do neutropenic sepsis protocol

26
Q

why do cancer patients get VTEs

A

hyper-coagulable state??

27
Q

presentation of PE

A

SOB
tachypnoea
tachycardia
pleuritic chest pain

28
Q

PE investigations

A

CTPA
ABGs
ECG
bloods

29
Q

management of PE

A

supportive

  • O2
  • IV fluids

anticoagulation

  • most cancer patients already on LMWH for 6 months
  • consider adding rivaroxaban
30
Q

how do you calculate the orophorph dose for break through pain in patients on regular morphine sulphate

A

1/6th of total daily dose

31
Q

how do you convert from oromorph to morphine to put in a syringe driver

A

half dose

morphine 2x strength or oromorph

32
Q

what 3 drugs should go into a syringe driver

A

analgesic
anti-emetic
anti-secretory drug (hycosine hydrobromide)

33
Q

what is tumour lysis syndrome

A

spillage of intracellular ions when cancer cells are broken down by chemo (eg. K+/phosphate)

assoc with chemosensitive tumours

34
Q

how does tumour lysis syndrome present

A 
oliguria 
cardiac arrhythmia 
seizure
tetany 
confusion

often a few days after starting chemo

35
Q

what do bloods show in tumour lysis syndrome

A

high urate
high potassium
high phosphate
low calcium

36
Q

treatment for tumour lysis syndrome

A

allopurinol - reduce uric acid

hydration

monitor biochemistry

cardio protection for Hyperkalaemia (calcium gluconate)

37
Q

emipirical antibiotics for neutropenic sepsis

A

piperacillin with tazobactam

38
Q

tumour marker for ovarian cancer

A

CA 125

39
Q

tumour marker for prostate cancer

A

PSA

40
Q

tumour marker for pancreatic cancer

A

CA 19-9

41
Q

tumour marker for bowel cancer

A

CEA

42
Q

raised tumour markers for non-seminoma testicular cancer

A

AFP
bHCG
LDH

43
Q

raised tumour markers for seminoma

A

bHCG
LDH

not AFP

4th Year (25 decks)

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