Oncology Flashcards
Describe the WHO performance status
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
What is adjuvant chemo?
Given following radical treatment
What is neo-adjuvant chemo?
Given before surgery/radical treatment
What does radical mean?
Curative
Name the traditional classes of chemo
Antimetabolites
Anti-tumour antibiotics
Alkylating agents
Anti-microtubule agents
Hormones/cytokines
Give examples of some antimetabolites
Folate antagonist - methotrexate
Pyrimidine analogue - flurouracil
Purine analogues - cladribine
Give an example of anti-tumour antibiotics
Bleomycin, doxorubicin
What are the alkylating agents?
Platinum drugs - cisplatin, carboplatin
Nitroureas
Name anti-microtubule agents
Taxanes
Give examples of hormones/cytokines that can be used
Steroids
Tamoxifen
Aromatase inhibitor
GnRH agonist
Interferon alpha
State the chemo toxicities
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
What are the acute side effects of radiotherapy?
Anorexia, malaise, mucositis, oesophagitis, nausea, diarrhoea, bone marrow suppression
What are the long term side effects of radiotherapy?
Dry mouth, SOB, fibrosis, bowel stenosis/fistual, incontinence, vaginal stenosis, bone necrosis/fracture, secondary malignancy
State seven oncological emergencies
Spinal cord compression
SVCO
Hypercalcaemia
Pericardial Tamponade
Neutropenic sepsis
Pulmonary embolism
Tumour lysis syndrome
How does spinal cord compression present?
Pain in spine, worse on coughing/straining, band like burning pain (radicular), sometimes hypersensitivity
Weakness, sensory changes
Urinary retention
Constipation
How do you investigate suspected MSCC?
Urgent MRI
How do you treat MSCC?
Steroids
Dexamethasone
Surgery - single vertebrate with no widespread mets
Radiotherapy
Chemotherapy if sensitive tumour
How does SVCO present?
Swelling of the face, neck, arms, distended veins, SOB, headache, lethargy
What investigation is done in SVCO?
Find the cause
- clot
- foreign body
- tumour
- extrinsic
CXR, venogram, CT chest
How do you treat SVCO?
Depends on cause
Clot - thrombolysis
Anticoagulation
Extrinsic - sterodis, chemo, RT or stent
Describe the presentation of hypercalcaemia
Nausea, anorexia, thirst, polydypsia/polyuria, constipation, confusion, drowsy
What causes hypercalcaemia?
Humoural (PTHrP)
Local bone destruction
Tumour production of vit D analogues
How do you investigate hypercalcaemia?
Calcium
Albumin to correct calcium
U and E - dehydration
Phosphate
Myeloma screen
What is the treatment for hypercalcaemia?
Rehydration
Bisphosphonates
Treat malignancy
Describe the process by which a pericardial tamponade develops
Effusion develops and compresses the ventricles reducing cardiac output and collapsing the right atrium increasing venous back pressure
How does pericardial tamponade present?
SOB, fatigue, palpitations, symptoms of pericarditis, advanced cancer
What causes pericardial tamponade?
Malignancy
Trauma
Infection
Post MI
CTD
Drugs
Uraemia
Describe Beck’s Triad
- Jugular venous distention
- Pulsus paradoxus
- Soft heart sounds/pericardial rub
- Poor cardiac output
What is pulsus paradoxus?
Venous return drops when intra-thoracic pressure increases
How do you investigate pericardial tamponade?
CXR - enlarged silhouette
ECG - large complexes
ECHO
Cytology
What is the treatment for pericardial tamponade?
Pericardiocentesis
Pericardial window
What is neutropenic sepsis?
Sepsis in a patient with cancer - neutrophil count <0.5 or <1.0 if chemo given in last 21 days
How quickly should antibiotics be given in neutropenic sepsis?
Within 1 hour
What antibiotics are given in neutropenic sepsis?
Tazocin
+ gentamicin if high risk
Why are cancer patients at risk of PE?
Cancer is pro-thrombotic state, SOB is common in malignancy, reduced mobility and recent surgery
How does a PE present?
Acute worsening of SOB, tachypnoea, tachycardia, low paCO2, pleuritic chest pain, unilateral leg swelling
How do you investigate a PE?
CTPA
ABGs
O2 stats
ECG
Bloods
Describe the management of a PE
Support
Anticoagulation
LMWH for 6 months
What is tumour lysis syndrome?
Rapid destruction of malignant cells in response to chemotherapy causes intracellular contents into the blood
What electrolyte abnormalities occur in tumour lysis syndrome?
Hyperkalaemia
Hyperuricaemia
Hyperphosphataemia
Hypocalcaemia
Describe the presentation of tumour lysis syndrome
AKI
Arrhythmia
Muscle cramps
Cognitive changes
How do you prevent/treat tumour lysis syndrome?
Treat disturbance
Hydrate prior to chemo and give allopurinol if high risk
