Oncology

Question 1

Describe the WHO performance status

Answer 1

0 - fully active
1 - unable to do strenuous activity
2. Able to walk and manage self care but unable to work
3. Confined to bed/chair >50% of waking hours
4. Disabled
5. Death

Question 2

What is adjuvant chemo?

Answer 2

Given following radical treatment

Question 3

What is neo-adjuvant chemo?

Answer 3

Given before surgery/radical treatment

Question 4

What does radical mean?

Answer 4

Curative

Question 5

Name the traditional classes of chemo

Answer 5

Antimetabolites
Anti-tumour antibiotics
Alkylating agents
Anti-microtubule agents
Hormones/cytokines

Question 6

Give examples of some antimetabolites

Answer 6

Folate antagonist - methotrexate
Pyrimidine analogue - flurouracil
Purine analogues - cladribine

Question 7

Give an example of anti-tumour antibiotics

Answer 7

Bleomycin, doxorubicin

Question 8

What are the alkylating agents?

Answer 8

Platinum drugs - cisplatin, carboplatin
Nitroureas

Question 9

Name anti-microtubule agents

Answer 9

Taxanes

Question 10

Give examples of hormones/cytokines that can be used

Answer 10

Steroids
Tamoxifen
Aromatase inhibitor
GnRH agonist
Interferon alpha

Question 11

State the chemo toxicities

Answer 11

Bone marrow suppression
GI - nausea/vomiting
Reproductive
Skin/Hair - alopecia, sun, palmar plantar erythrodysthesia, extravasations
Nephrotoxicity
Hepatotoxicity
Neurotoxicity - peripheral, ototoxic, constipation
Cardiac toxicity - vasospasm
Bladder toxicity - cysitis

Question 12

What are the acute side effects of radiotherapy?

Answer 12

Anorexia, malaise, mucositis, oesophagitis, nausea, diarrhoea, bone marrow suppression

Question 13

What are the long term side effects of radiotherapy?

Answer 13

Dry mouth, SOB, fibrosis, bowel stenosis/fistual, incontinence, vaginal stenosis, bone necrosis/fracture, secondary malignancy

Question 14

State seven oncological emergencies

Answer 14

Spinal cord compression
SVCO
Hypercalcaemia
Pericardial Tamponade
Neutropenic sepsis
Pulmonary embolism
Tumour lysis syndrome

Question 15

How does spinal cord compression present?

Answer 15

Pain in spine, worse on coughing/straining, band like burning pain (radicular), sometimes hypersensitivity
Weakness, sensory changes
Urinary retention
Constipation

Question 16

How do you investigate suspected MSCC?

Answer 16

Urgent MRI

Question 17

How do you treat MSCC?

Answer 17

Steroids
Dexamethasone
Surgery - single vertebrate with no widespread mets
Radiotherapy
Chemotherapy if sensitive tumour

Question 18

How does SVCO present?

Answer 18

Swelling of the face, neck, arms, distended veins, SOB, headache, lethargy

Question 19

What investigation is done in SVCO?

Answer 19

Find the cause
- clot
- foreign body
- tumour
- extrinsic
CXR, venogram, CT chest

Question 20

How do you treat SVCO?

Answer 20

Depends on cause
Clot - thrombolysis
Anticoagulation
Extrinsic - sterodis, chemo, RT or stent

Question 21

Describe the presentation of hypercalcaemia

Answer 21

Nausea, anorexia, thirst, polydypsia/polyuria, constipation, confusion, drowsy

Question 22

What causes hypercalcaemia?

Answer 22

Humoural (PTHrP)
Local bone destruction
Tumour production of vit D analogues

Question 23

How do you investigate hypercalcaemia?

Answer 23

Calcium
Albumin to correct calcium
U and E - dehydration
Phosphate
Myeloma screen

Question 24

What is the treatment for hypercalcaemia?

Answer 24

Rehydration
Bisphosphonates
Treat malignancy

Question 25

Describe the process by which a pericardial tamponade develops

Answer 25

Effusion develops and compresses the ventricles reducing cardiac output and collapsing the right atrium increasing venous back pressure

Question 26

How does pericardial tamponade present?

Answer 26

SOB, fatigue, palpitations, symptoms of pericarditis, advanced cancer

Question 27

What causes pericardial tamponade?

Answer 27

Malignancy Trauma Infection Post MI CTD Drugs Uraemia

Question 28

Describe Beck's Triad

Answer 28

- Jugular venous distention - Pulsus paradoxus - Soft heart sounds/pericardial rub - Poor cardiac output

Question 29

What is pulsus paradoxus?

Answer 29

Venous return drops when intra-thoracic pressure increases

Question 30

How do you investigate pericardial tamponade?

Answer 30

CXR - enlarged silhouette ECG - large complexes ECHO Cytology

Question 31

What is the treatment for pericardial tamponade?

Answer 31

Pericardiocentesis Pericardial window

Question 32

What is neutropenic sepsis?

Answer 32

Sepsis in a patient with cancer - neutrophil count <0.5 or <1.0 if chemo given in last 21 days

Question 33

How quickly should antibiotics be given in neutropenic sepsis?

Answer 33

Within 1 hour

Question 34

What antibiotics are given in neutropenic sepsis?

Answer 34

Tazocin + gentamicin if high risk

Question 35

Why are cancer patients at risk of PE?

Answer 35

Cancer is pro-thrombotic state, SOB is common in malignancy, reduced mobility and recent surgery

Question 36

How does a PE present?

Answer 36

Acute worsening of SOB, tachypnoea, tachycardia, low paCO2, pleuritic chest pain, unilateral leg swelling

Question 37

How do you investigate a PE?

Answer 37

CTPA ABGs O2 stats ECG Bloods

Question 38

Describe the management of a PE

Answer 38

Support Anticoagulation LMWH for 6 months

Question 39

What is tumour lysis syndrome?

Answer 39

Rapid destruction of malignant cells in response to chemotherapy causes intracellular contents into the blood

Question 40

What electrolyte abnormalities occur in tumour lysis syndrome?

Answer 40

Hyperkalaemia Hyperuricaemia Hyperphosphataemia Hypocalcaemia

Question 41

Describe the presentation of tumour lysis syndrome

Answer 41

AKI Arrhythmia Muscle cramps Cognitive changes

Question 42

How do you prevent/treat tumour lysis syndrome?

Answer 42

Treat disturbance Hydrate prior to chemo and give allopurinol if high risk