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
Management of tumour lysis syndrome?
IV fluids
Rasburicase
What is Adult T-cell leukaemia?
Rare Ca (30 people Dx in UK/yr)
Type of non-Hodgkin’s lymphoma
Affects people who have the HTLV-1 virus
Top 5 most common cancers?
- Breast
- Lung
- Colorectal
- Prostate
- Bladder
Top 5 most common deaths from cancers?
- Lung
- Colorectal
- Breast
- Prostate
- Pancreas
What is S-100 a tumour marker for?
Melanoma, schwannomas
What is Bombesin a tumour marker for?
Small cell lung carcinoma, gastric cancer, neuroblastoma
What is the MOA of rasburicase?
converts uric acid to allantoin. Allantoin is much more water-soluble than uric acid and is, therefore, more easily excreted by the kidneys.
When does tumour lysis syndrome usually occur?
Usually occurs within 3/7 before or 7/7 after chemo
Which viruses (3)/bacteria (1)/protozoa (1) predispose to which cancers?
Viruses
EBV: Hodgkin’s and Burkitt’s lymphoma, nasopharyngeal carcinoma
HTLV-1: Adult T-cell leukaemia/lymphoma
HIV-1: High-grade B-cell lymphoma
Bacteria
Helicobacter pylori: gastric lymphoma (MALT)
Protozoa
malaria: Burkitt’s lymphoma
Infection with which virus is implicated in the pathogenesis of Burkitt’s lymphoma?
EBV infection
Exposure to which toxin increases your risk of HCC?
Aflatoxin
Exposure to which toxin increases your risk of gastric/oesophageal Ca?
Nitrosamine
Exposure to which toxin increases your risk of TCC?
Aniline dye
Exposure to which toxin increases your risk of lung Ca/liver angiosarcoma?
Arsenic
Exposure to which toxin increases your risk of leukaemia?
Benzene
Most common symptoms of SVCO?
Dyspnoea
Antiemetics in chemo use?
Low-risk: metoclopramide
High-risk: 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone
What does a PET scan demonstrate?
Glucose uptake
What can be used to treat NEUTROPAENIA in patients undergoing chemo?
Filgrastim - granulocyte-colony stimulating factor (G-CSF)
