ONCOLOGY

Question 1

What are the 4 major oncological emergencies?

Answer 1

1 - malignant spinal cord compression
2 - hypercalcaemia
3 - neutropenic sepsis
4 - superior vena cava obstruction

Question 2

Which cancers are most at risk of bone involvement?

Answer 2

Breast
Prostate
Myeloma
Lung
Lymphoma

Question 3

How would malignant spinal cord compression present?

Answer 3

back pain - worse on LYING or COUGHING
- radicular pain

Question 4

How would you manage suspected malignant spinal cord compression?

Answer 4

1 - urgent MRI spine
2 - IV dexamethasone (+ PPI + glucose monitoring)
3 - surgical decompression

Question 5

What are the possible causes of hypercalcaemia in malignancy?

Answer 5

• osteolysis from lytic bony metastases
• tumour specific mechanisms
• dehydration

Question 6

How does hypercalcaemia present?

Answer 6

M - depression/lethargy/confusion
G - abdo pain/constipation/N&V
S - renal calculi
B - bone pain

Question 7

How do you manage someone with hypercalcaemia?

Answer 7

REHYDRATION
- 3-6L of 0.9% normal saline
- If calcium remains >3 then add bisphosphonate e.g. zoledronic acid

Question 8

How would SVC obstruction present?

Answer 8

• SOB
• swelling of face/neck/arms
• headache (worse in AM)
• visual disturbance
• pulseless jugular venous distension

Question 9

Who gets bowel cancer screening and what does it involve?

Answer 9

Age 60-74, every 2 years
FAECUL OCCULT BLOOD
Positive test = colonoscopy

Question 10

Who gets breast cancer screening and what does it involve?

Answer 10

Age 47-73, every 3 years
MAMMOGRAPHY
- if abnormal then triple breast assessment

Question 11

Who gets cervical cancer screening and what does it involve?

Answer 11

Age 25-50, every 3 years
Age 50-64, every 5 years

1. HPV test
2. If positive, then examine cytology
3. If cytology abnormal, then perform colposcopy