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Finals Revision > Oncology > Flashcards

Oncology Flashcards

1
Q

At what point is a patient most likely to suffer neutropenic sepsis?

A

Nadir

Usually 12-15d after chemotherapy

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2
Q

How would you manage a patient with neutropenic sepsis?

A 
A-E assessment
IV access
SEPSIS 6 protocol
IV tazocin within 1 hour of presentation (meropenem if penicillin allergic)
Full infection screen to identify cause
ABG
CXR
Consider ITU admission for inotropic support
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3
Q

What are the symptoms/signs of metastatic spinal cord compression?

A

Thoracic back pain, band-like referral
Localised spinal tenderness
Pain worse at night/when lying down or when straining
Lower limb neurology: saddle anaesthesia, reduced power
Urine retention / incontinence (palpable bladder)
Reduced anal tone
Gait disturbance

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4
Q

How should suspected MSCC be investigated?

A

Spine examination
Neurological examination
PR exam
Urgent whole spine MRI

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5
Q

How should MSCC be managed?

A

Lie flat
Analgesia: opiate analgesia probably most appropriate
16mg dexamethasone STAT then 8mg BD (+PPI)
Bisphosphonates: IV zoledronic acid (helps with bone pain and risk of collapse)
Surgical spine stabilisation
Radiotherapy within 24hr
Consider DVT risk

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6
Q

What are the symptoms of SVC compression?

A 
Facial swelling, arm swelling
Engorged neck veins
Shortness of breath
Headache worse in the morning
Blurred vision- papilloedema
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7
Q

What is the most common cause of SVC compression?

A

Mediastinal tumours / mets

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8
Q

How is SVC compression investigated?

A

CXR- widened mediastinum

Urgent CT Thorax with contrast

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9
Q

How is SVC compression managed?

A

A-E Assessment- sit upright and give oxygen supplementation
High-dose steroids: 16mg dexamethasone STAT and 8 mg BD (+ PPI)
Can give oral morphine for dyspnoea
Chemotherapy
Radiotherapy
Symptomatic stent

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10
Q

What are the symptoms of Hypercalcaemia?

A

Painful bones, abdominal moans, renal stones, psychiatric groans

  • Bone pain
  • Constipation
  • Ureteric stones
  • Confusion and confused mental state
  • Nausea, vomiting, polyuria, polydipsia
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11
Q

What ECG changes are associated with Hypercalcaemia?

A

Short QT interval

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12
Q

What are the causes of Hypercalcaemia in cancer patients?

A

Bone mets
Paraneoplastic hyperparathyroid hormone release
-> most commonly from squamous cell carcinomas

Can also be other non-oncological causes:
Primary hyperparathyroidism
Iatrogenic: lithium, thiazides, vitamin D, calcium supplements
Thyrotoxicosis

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13
Q

How is Hypercalcaemia managed?

A 
A-E assessment
Continuous ECG monitoring
Aggressive IV fluid resuscitation
IV zoledronic acid (takes a few days to work)
Medication review 
Daily bloods

If refractory to bisphosphonates, try danosumab

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14
Q

What blood results would you expect in tumour lysis syndrome?

A

Hyperkalaemia
Hyperphosphataemia
Elevated uric acid levels
HyPOcalcaemia

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15
Q

In which patient population does tumour lysis syndrome usually occur?

A

Patients with highly chemosensitive cancers presenting shortly after chemotherapy

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16
Q

What are potential complications of tumour lysis syndrome?

A

Hyperkalaemia- cardiac arrhythmias
Elevated calcium phosphate- deposition in renal tubules, AKI
Hypocalcaemia- tetany, seizures, arrhythmia
Dehydration

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17
Q

What are the symptoms of TLS?

A 
Nausea
Fatigue
Dark urine/oliguria
Flank pain
Numbness, seizures or hallucinations
Muscle cramps and spasms
Palpitations
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18
Q

How is TLS managed?

A

A-E assessment
Continuous cardiac monitoring
Aggressive fluid rehydration (reduces phosphate)
Calcium gluconate, insulin and dextrose (lower K+)
Rasburicase (uric acid)
No need to correct calcium, lowering phosphate will correct
Haemofiltration

19
Q

How would you manage somebody with suspected brain mets?

A 
Keep head of bed at 30 degrees
Steroids- 16mg stat and 8 mg BD
Analgesia
Anti-emetics
Refer to neurosurgeons
20
Q

Which lung cancers are typically centrally located?

A

Small cell lung cancer

Squamous cell carcinoma

21
Q

Which lung cancers are typically peripherally located?

A

Adenocarcinomas

22
Q

What causes a hoarse voice in lung cancer?

A

Recurrent laryngeal nerve compression

23
Q

What paraneoplastic syndromes are especially associated with SCLC?

A

SIADH
Hyperparathyroidism
Cushing’s
Myasthenic syndromes

24
Q

What is Horner’s syndrome?

A

Ptosis, miosis, anhydrosis

Compression of the sympathetic chain by pancoast tumour

25
Q

What investigations are performed into suspected lung cancer?

A 
Bloods: FBC, U&E, bone profile, LFT
Pulmonary function tests
High resolution CT TAP with contrast
Bronchoscopy/BAL + biopsy/histology
PET CT
26
Q

What are the side effects of radiotherapy for lung cancer?

A 
Oesophagitis
Pneumonitis
Stricture formation
Dyspnoea
Hoarse voice
27
Q

What are the common sites of lung cancer metastasis?

A

Bone
Brain - <30%
Liver
Lymph

28
Q

What are associated pancoast tumour syndromes?

A
  1. Horner’s syndrome
  2. Arm pain/weakness: brachial plexus infiltration
  3. Hoarse voice: RLN compression
29
Q

What are associated mediastinal tumour syndromes?

A

SVC compression

Phrenic nerve compression: L hemidiaphragm rises to be higher than the right

30
Q

Which types of HPV can cause cervical cancer?

A

HPV 16 and 18

31
Q

How regular are smear tests?

A

3 yearly from 25-50
5 yearly after 50
From 65 only if abnormal smear

32
Q

What are the stages of cervical cancer?

A

1- remains in the cervix
2- spread beyond cervix but not to walls of pelvis or lower vagina
3- spread to walls of the pelvis and lower vagina, may have lymph node spread but no distance mets
4- Grown into bladder or rectum OR distant mets

33
Q

What chemotherapeutic agent is most commonly used in cervical cancer?

A

Cisplatin

34
Q

What are the management steps for cervical cancer?

A

Cone biopsy
Trachelectomy or modified hysterectomy
Concurrent cisplatin chemotherapy
Radiotherapy: can be external beam, brachytherapy or a combination

35
Q

What are the symptoms of Hodgkin’s lymphoma?

A 
Painless lymphadenopathy
Fatigue
Weight loss
Recurrent infection
Symptoms of mediastinal mass: dyspnoea, dry cough, chest pain
Hepato/splenomegaly

Alcohol-induced pain

36
Q

What are the investigations for Hodgkin’s lymphoma?

A 
Bloods:
FBC: raised or low WBC, anaemia, eosinophilia
Markers: LDH elevated
Lymph node USS and biopsy
CXR/CT TAP
PET
37
Q

What is the name of the staging classification for lymphoma?

What is it?

A

Lugano staging
1- found in one lymph node group/organ
2- found in 2+ groups on the same side of the diaphragm
3- found in nodes on both sides of the diaphragm
4- involvement of extra nodal tissues

38
Q

What chemotherapy regimens are commonly used in lymphoma?

A

ABVD
BEACOPP

Risk of TLS in bulky disease

39
Q

What is a phase 0 clinical trial?

A

Low dose treatment to ensure the substance itself isn’t harmful
10-20 people

40
Q

What is a phase 1 clinical trial?

A

20-50 people, non-cancer specific

Investigation into metabolism and side effects

41
Q

What is a phase 2 clinical trial?

A

10-100 people with a small selection of cancers

Looks at treatment benefit and side effects

42
Q

What is a phase 3 clinical trial?

A

Large trial with one specific cancer type to compare to standard treatment

43
Q

What is a phase 4 clinical trial?

A

Investigation into long-term benefits and side effects

Finals Revision (23 decks)

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