oncology Flashcards
Cervical cancer management?/positive pap smear?
If positive for HPV 16, 18, or 33 = refer for colposcopy
If positive for non cancerous strains which cause genital warts (6 &11) = normal 3 yearly screening + discuss safe sex
Key side effect of cisplatin?
methotrexate?
doxorubicin?
cyclophosphamide?
Bleomycin?
Vincristine?
tyrosin kinase inhibitors eg imatinib?
cisplatin = hypomagnesemia
methotrexate = myelosupression, liver fibrosis, oral mucositis
doxorubicin (and other anthracyclines eg idarubicin) = cardiomyopathy
cyclophosphamide = hemorrhagic cystitis
bleomycin = lung fibrosis, pneumonitis (treat with steroids)
vincristine = peripheral neuropathy
tyrosine kinase inhibitors = rash
Breast cancer management?
monitor CA 15-3
neoplastic spinal cord compression management?
high dose of oral dexamethasone
(dex also used to suppress nausea and vomiting in patients with raised ICP in brain tumours)
for SVC obstruction, give dex, followed by stent. give chemo for tumour
dex often prescribed with PPI
most common tumour causing bone metastases?
- prostate
- breast
- lung
tumour markers for testicular teratoma?
AFP and HCG
tumour marker for colorectal cancer?
CEA - Carcinoembryonic antigen
causes of raised AFP?
hepatocellular carcinoma, teratoma
adenocarcinoma - peripheral, most common in non smokers
squamous cell - central, associated with hypercalcemia, finger clubbing HPOA
ovarian cancer
often presents with non specific abdominal symptoms eg abdominal swelling weight loss, nausea etc
check CA125
Pain relief choice for patients in palliative care?
Oral morphine - to convert total daily oral dose to subcut, divide by 2. To convert to subcutaneous diamorphine, divide by 3. Breakthrough pain dose should always be 1/6 to 1/10 daily dose morphine delivered subcut
In palliative patients increase morphine doses by 30-50% if pain not controlled
If mild to moderate renal impairment = oxycodone
If severe renal impairment eGFR<30ml/min) = sublingual fentanyl is first line. Buprenorphine also an option
Treatment for painful mouth at end of life?
Benzydamine hydrochloride mouthwash
Options for metastatic bone pain?
Analgesia, bisphosphonates, radiotherapy
Dex only considered for metastatic spinal cord compression
Treatment for agitation and confusion in palliative care
Rule out alternative causes
1st line = haloperidol
Terminal phase = midazolam
Palliative treatment for respiratory secretions and bowel colick?
hyoscine hydrobromide first line , or glycopyrronium bromide.
