Oncology Flashcards
what is performance status
describes a patients fitness in relation to how well they will cope with treatment
0-5
0 fully active
5 deceased
Pancreatic cancer tumour marker
CA 19-9
Ovarian cancer tumour marker
Ca125
Breast cancer tumour marker
Ca15-3
Note tumour markers have low specificity
Features of bony metastases
Bone pain
Raised ALP
Hypercalcaemia
Pathological fractures
Management and of chemotherapy nausea and vomiting
Low risk; metaclopramide first line
High risk; 5-HT3 antagonists such as ondansetron
Higher risk, opioids, anxiety, over 50, type of chemotherapy
Signs of spinal cord compression
- back pain
- lower limb weakness
- sensory changes
- neurological signs; depending where compression occurs. If below L1 LMN signs (cauda equina) if above UMN signs
Investigation and management of spinal cord compression
Full spine MRI urgently
High dose oral dexamethasone
Urgent oncological review for radiotherapy or surgery
flat bed rest + analgesia
Spinal metastases presentation
Can precede spinal cord compression so important to detect
Unrelenting lumbar back pain
Any thoracic or cervical back pain
Nocturnal pain
Worse with sneezing/coughing
Associated tenderness
Needs MRI within a week if no neurological features
What is superior vena cava obstruction?
What cancer most associated with?
Other causes?
Oncological emergency caused by compression of the superior vena cava
Most commonly caused by lung cancer
Other causes;
- lymphoma, breast Ca and other malignancies
- aortic aneurysm
- mediastinal fibrosis
- goitre
- SVC thrombosis
Features of superior vena cava obstruction
Dyspnoea - most common symptom
Swelling of face, neck and arms
Headache
Visual disturbance
Pulseless jugular venous distention
Management superior vena cava obstruction
A-E approach
- endovascular stent for symptom relief
- certain malignancies may benefit from chemo or chemo-radiotherapy
- glucocorticoids are often given (dex)
ask oncology team; depends on individual patient and malignancy
lung cancer presentation at GP pathway
urgent CXR if 2 of following age40+ or one + a smoker
- cough
- fatigue
- SoB
- chest pain
- weight loss
- appetite loss
if CXR suggests malignancy or is unclear then 2ww to specialist
what information do radiology need before doing a CT
previous contrast reaction?
renal function
diabetes - if on metformin may need to be stopped for scan
important tests at any 2ww specialist appointment
PMHx - fitness for surgery/chemo/radio
FBC
renal function
liver function
bone profile
lung cancer specific investigations
pulmonary function tests
bronchoscopy and biopsy
CT staging scan (mot cancers need)
main oncological emergencies
neutropenic sepsis
SVCO
hypercalcaemia
spinal cord compression
management neutropenic sepsis
A-E
plus
sepsis six; Abx, oxygen, fluids in, blood cultures, urine output, lactate out
investigate for cause
involve seniors
when does neutropenia most occur after chemotherapy
around 5-12 days after treatment
treatment of hypercalcaemia
IV fluid rehydration - monitor balance and electrolytes
bisphosphonate after rehydration
small cell lung cancer features
typically centrally located
rapidly growing
often smoking related
chemo/radiosensitive but rarely cured
short prognosis
squamous cell lung cancer features
typically centrally located - early symptoms
smoking related
best survival rate
adenocarcinoma of lung features
typically peripherally located
slowest growing
can be non-smokers
can respond well to systemic agents
may metastasise early due to location
TNM staging lung cancer
T1 <3cm
T2 3-5cm
T3 5-7cm
T4 >7cm
N0-N3 (n2 and 3 mediastinal nodes, ipsi and contra)
M0
M1a, b and c
a extra nodule
b intra thoracic mets
c extra thoracic mets
brain mets presentation and investigation
headahces
confusion
MRI brain
imaging of primary
routine bloods - exclude hypercalcaemia, infections etc
immediate management of brain mets
dexamethasone
(may add PPI too)
denosumab
- action
- indications
- important side effects
RANK ligand inhibitor - works on bone remodelling
prevention of skeletal related events in bone mets from advanced breast cancer or other solid tumours except prostate
also licensed for osteoporosis
high dose every 4 weeks in cancer
important side effects; hypocalcaemia, osteonecrosis of the jaw
blood tests metastatic presentation
FBC
U+Es
LFTs
bone profile
how are skeletal metastasis assessed
isotope bone scan
treatments available for metastatic breast cancer
depending on status of cancer but
- endocrine therapy
- chemotherapy
- Herceptin therapy
- bisphosphonate/denosumab
CDK4/6 inhibitors
increasingly used in breast cancer
predominantly used alongside endocrine drugs in ER-positive HER2-negative cancers
CDk4/6 are proteins that control cell growth and division
main important reaction to immunotherapy drugs
allergic reaction
how do most immunotherapy drugs act
as checkpoint inhibitors
side effects of immunotherapy
management
immune related organ side effects; colon, lungs, liver, endocrine
fatigue and skin changes also common
typically occur weeks to months after treatment starts
severe or persistent side effects can be managed with steroids and treatment may be stopped
investigation of a suspicious lymph node
USS and biopsy
how can immunotherapies cause toxicity
immune-mediated toxicities due to activation of the immune system to target cancer cells
treated with corticosteroids to immunosuppressive
immunotherapy and PMHx of autoimmune conditions
can worsen existing autoimmune conditions by activating the immune system
grading of immunotherapy reactions
toxicity reactions/side effects are graded 1-5
1 no or mild symptoms
5 death
management of immunotherapy related diarrhoea
caused by an inflammatory colitis which can progress
needs investigation with a sigmoidoscopy and needs high dose immunosuppression
BRAF inhibitors in melanoma
about 50% of melanomas are positive for BRAF V600 mutation (oncogene) so an option for treatment in BRAF inhibitors
what does the HPV vaccine cover?
protects against HPV 16 and 18 which are responsible of approximately 70% of cases of cervical cancer, and types 6 and 11 which are associated with genital warts
who is offered the HPV vaccine
girls and boys aged 12-13 in school
catch up is available for anyone up to the age of 25
Men who have sex with men, trans women and trans men are eligible for catch up up until aged 45
when does cervical screening commence
people with a cervix are screened from age 25
up to age 49 get invitations every 3 years
aged 50-64 every 5 years presuming HPV is negative
what happens if cervical smear sample is HPV positive
cytology is carried out on the sample to triage for colposcopy. If cytology is negative then screening will be repeated in 1 year
if changes seen on cytology then invited for colposcopy
pelvic radiotherapy and fertility
likely to result in infertility
consider preservation techniques
can also cause sexual function problems
how may radiotherapy be delivered to the cervix
brachytherapy - a radioactive source inserted into the vagina/cervix
delivers local radiotherapy
how is chemotherapy typically dosed
according to body surface area
What type of lymph node biopsy in suspected lymphoma
Excisional lymph node biopsy
What information does a patient need to be aware of when discussing a clinical trial
- what the trial is + details of the treatment and follow up
- that they can withdraw at any time
- entry is voluntary and refusal will not affect their care
- the standard therapy that is available if they choose not to enter
How is neutropenic sepsis defined
Temperature >38 and neutrophil count of <0.5x10^9 per litre
what type of cancer can AFP be raised in
hepatocellular carcinoma
