Oncology Flashcards
What are the most common cancers to cause SVCO?
75% - Lung (most commonly non-small cell, also SCLC)
15% - Lymphoma (most commonly Hodgkin’s)
10% - Secondary LNs
Other causes: aortic aneurysm mediastinal fibrosis goitre SVC thrombosis
Clinical features of SVCO?
• Dyspnoea, cough, chest pain at rest • Swelling + redness – neck, face, arm • Dizziness • Headache • Disturbed vision • Nausea • Syncope Worsened by posture (leaning forward) or lifting arms above head
Investigations for SVCO?
- CXR – widening mediastinum/mass on R
- CT/Doppler/MRI
- Bronchoscopy/mediastinoscopy – useful in demonstrating primary cause
Management of SVCO?
Acute Mx
• Positional changes, oxygen
• Corticosteroids (dexamethasone) and diuretics – attempt to reduce CO and oedema
- Radiotherapy – often a primary diagnosis is sought beforehand
- Chemotherapy
Surgical – benign cause
• Stenting +/- angioplasty
• Surgical bypass of obstruction – occasionally indicated
Surgical – malignant cause
• Stenting
• Reconstructive surgery
• If reconstruction not possible, insertion of prosthesis may be considered
Which cancers is EBV associated with?
Hodgkin’s and Burkitt’s lymphoma, nasopharyngeal carcinoma
Which cancers are associated with HTLV-1?
Adult T-cell leukaemia/lymphoma
Which cancers are associated with HIV-1?
High-grade B-cell lymphoma
Which cancers are associated with malaria?
Burkitt’s lymphoma
Which gene is responsible for Burkitt’s lymphoma?
c-myc gene translocation, usually t(8:14)
What are the two different forms of Burkitt’s lymphoma?
1) Endemic (African) form – typically involves maxilla/mandible
2) Sporadic form – abdominal tumours most common, more common in HIV pts
What would you see on LN biopsy in Burkitt’s?
‘starry sky’ appearance
macrophages within B cells look white and star-like
How to manage Burkitt’s lymphoma?
Chemotherapy – watch out for tumour lysis syndrome (give rasburicase before chemo)
What triggers tumour lysis syndrome?
usually triggered by the introduction of chemotherapy to pts with leukaemias/lymphomas
What occurs in tumour lysis syndrome?
The breakdown of tumour cells and the subsequent release of cell chemicals (uric acid, K+, PO4)
This may lead to uric acid and calcium phosphate crystals deposits in the renal tubules -> may cause AKI
(also have hypocalcaemia)
How would you manage patients at high risk of tumour lysis syndrome?
give IV allopurinol/rasburicase immediately prior to/during the first days of chemo
