Oncology Flashcards
how do you assess a cancer patients fitness for treatment (chemo or radio)
calculate their performance status score
what are the different performance status scores
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
step 1 on the WHO analgesic pain ladder (for mild pain)
non-opioid medication eg. paracetamol
step 2 on WHO analgesic pain ladder (mild-moderate pain)
opioid for mild to moderate pain (codeine) + non opioids (paracetamol)
step 3 on WHO analgesic pain ladder (mod-severe pain)
opioid for severe pain (morphine) + non opioid (paracetamol)
how are chemotherapy doses calculated
by patient’s surface area (surface area is calculated using height and weight)
which type of cancer caused hypercalcaemia by secreting PTH like protein
squamous cell lung caner
small cell causes hyponatraemia by screening ADH and cushing’s by secreting ACTH
which virus causes a large portion of head and neck cancers
HPV
how does spinal cord compression present (an oncological emergency)
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
what do you do if someone presents with radicular back pain (radiates around rib cage)
order urgent MRI spine and start dexamethasone 8mg bd
treatment for spinal cord compression
dexamethasone 15mg IV followed by 8mg bd
surgery
radiotherapy
chemo - only for chemosensive tumours (lymphoma, teratoma, SCLC)
how does superior vena cava obstruction present
swelling of face, neck, and arms
distended veins on neck and chest wall
shortness of breath
headache
lethargy
what causes superior vena cava obstruction
clots - often from a DVT
foreign body eg. central line
tumour in vessel eg. renal cancer
extrinsic compression from other cancer mass
investigations for SVC obstruction
CXR to look for mass
venogram to look for clot
CT chest
treatment for SVC obstruction
treat cause:
clots - thrombolysis/anticoagulation
extrinsic compression - steroids, chemo, radio, stent
causes of malignant hypercalcaemia
humoural (PTHrp from SCLC)
local bone destruction (eg. in myeloma)
tumour production of vitamin D analgoues (lymphomas)
how does hypercalcaemia present
‘bones, stones, groans, psychiatric moans’
bone pain
renal stones
constipation/abdo pain
change in mental state
investigations for malignant hypercalcaemia
calcium level
urea and electrolytes
phosphate (could be low in hyperparathyroidism)
myeloma screen if no known malignancy
treatment for malignant hypercalcaemia
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
symptoms of malignant pericardial tamponade
primarily SOB
fatigue
palpitations
pericarditis symptoms - pain improves moving forward
symptoms of advanced cancer
signs of malignant pericardial tamponade (Beck’s triad)
low BP
raised JVP
muffled heart sounds
investigations for pericardial tamponade
CXR
ECG
Echo
cytology of pericardial fluid
treatment of pericardial tamponade
pericardiocentesis - put a drain into pericardium
pericardial window - surgery to drain fluid/blood into pleural cavity
systemic management of malignancy
what is neutropenic sepsis
sepsis + neutrophil count <0.5
or <0.1 if chemo given within last 21 days
