Oncology Flashcards
At what point is a patient most likely to suffer neutropenic sepsis?
Nadir
Usually 12-15d after chemotherapy
How would you manage a patient with neutropenic sepsis?
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
What are the symptoms/signs of metastatic spinal cord compression?
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
How should suspected MSCC be investigated?
Spine examination
Neurological examination
PR exam
Urgent whole spine MRI
How should MSCC be managed?
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
What are the symptoms of SVC compression?
Facial swelling, arm swelling Engorged neck veins Shortness of breath Headache worse in the morning Blurred vision- papilloedema
What is the most common cause of SVC compression?
Mediastinal tumours / mets
How is SVC compression investigated?
CXR- widened mediastinum
Urgent CT Thorax with contrast
How is SVC compression managed?
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
What are the symptoms of Hypercalcaemia?
Painful bones, abdominal moans, renal stones, psychiatric groans
- Bone pain
- Constipation
- Ureteric stones
- Confusion and confused mental state
- Nausea, vomiting, polyuria, polydipsia
What ECG changes are associated with Hypercalcaemia?
Short QT interval
What are the causes of Hypercalcaemia in cancer patients?
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
How is Hypercalcaemia managed?
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
What blood results would you expect in tumour lysis syndrome?
Hyperkalaemia
Hyperphosphataemia
Elevated uric acid levels
HyPOcalcaemia
In which patient population does tumour lysis syndrome usually occur?
Patients with highly chemosensitive cancers presenting shortly after chemotherapy
What are potential complications of tumour lysis syndrome?
Hyperkalaemia- cardiac arrhythmias
Elevated calcium phosphate- deposition in renal tubules, AKI
Hypocalcaemia- tetany, seizures, arrhythmia
Dehydration
What are the symptoms of TLS?
Nausea Fatigue Dark urine/oliguria Flank pain Numbness, seizures or hallucinations Muscle cramps and spasms Palpitations
How is TLS managed?
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
How would you manage somebody with suspected brain mets?
Keep head of bed at 30 degrees Steroids- 16mg stat and 8 mg BD Analgesia Anti-emetics Refer to neurosurgeons
Which lung cancers are typically centrally located?
Small cell lung cancer
Squamous cell carcinoma
Which lung cancers are typically peripherally located?
Adenocarcinomas
What causes a hoarse voice in lung cancer?
Recurrent laryngeal nerve compression
What paraneoplastic syndromes are especially associated with SCLC?
SIADH
Hyperparathyroidism
Cushing’s
Myasthenic syndromes
What is Horner’s syndrome?
Ptosis, miosis, anhydrosis
Compression of the sympathetic chain by pancoast tumour
What investigations are performed into suspected lung cancer?
Bloods: FBC, U&E, bone profile, LFT Pulmonary function tests High resolution CT TAP with contrast Bronchoscopy/BAL + biopsy/histology PET CT
What are the side effects of radiotherapy for lung cancer?
Oesophagitis Pneumonitis Stricture formation Dyspnoea Hoarse voice
What are the common sites of lung cancer metastasis?
Bone
Brain - <30%
Liver
Lymph
What are associated pancoast tumour syndromes?
- Horner’s syndrome
- Arm pain/weakness: brachial plexus infiltration
- Hoarse voice: RLN compression
What are associated mediastinal tumour syndromes?
SVC compression
Phrenic nerve compression: L hemidiaphragm rises to be higher than the right
Which types of HPV can cause cervical cancer?
HPV 16 and 18
How regular are smear tests?
3 yearly from 25-50
5 yearly after 50
From 65 only if abnormal smear
What are the stages of cervical cancer?
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
What chemotherapeutic agent is most commonly used in cervical cancer?
Cisplatin
What are the management steps for cervical cancer?
Cone biopsy
Trachelectomy or modified hysterectomy
Concurrent cisplatin chemotherapy
Radiotherapy: can be external beam, brachytherapy or a combination
What are the symptoms of Hodgkin’s lymphoma?
Painless lymphadenopathy Fatigue Weight loss Recurrent infection Symptoms of mediastinal mass: dyspnoea, dry cough, chest pain Hepato/splenomegaly
Alcohol-induced pain
What are the investigations for Hodgkin’s lymphoma?
Bloods: FBC: raised or low WBC, anaemia, eosinophilia Markers: LDH elevated Lymph node USS and biopsy CXR/CT TAP PET
What is the name of the staging classification for lymphoma?
What is it?
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
What chemotherapy regimens are commonly used in lymphoma?
ABVD
BEACOPP
Risk of TLS in bulky disease
What is a phase 0 clinical trial?
Low dose treatment to ensure the substance itself isn’t harmful
10-20 people
What is a phase 1 clinical trial?
20-50 people, non-cancer specific
Investigation into metabolism and side effects
What is a phase 2 clinical trial?
10-100 people with a small selection of cancers
Looks at treatment benefit and side effects
What is a phase 3 clinical trial?
Large trial with one specific cancer type to compare to standard treatment
What is a phase 4 clinical trial?
Investigation into long-term benefits and side effects
