Oncology

Question 1

What are some oncological emergencies?

Answer 1

Neutropenic sepsis
Tumour lysis syndrome
Cord compression
Hypercalcaemia
Superior Vena Caval Obstruction

Question 2

How do you confirm a diagnosis of neutropenic fever?

Answer 2

WCC < 0.5 x 109 L or < 1.0 x 109 with the expectation it is going down

a temperature higher than 38oC or

other signs or symptoms consistent with clinically significant sepsis.

Question 3

What is the mortality rate of neutropenic sepsis?

Answer 3

4-10%

Question 4

What investigations should we do in neutropenic fever?

Answer 4

FBC, U+E, creatinine, lactate, LFTs

Blood culture, MSU, CXR, swab any affected areas

Question 5

What treatment do we give in neutropenic fever?

Answer 5

IV ABX WITHIN 1 HOUR!!!

First line = cefepime 2g q8h and IV fluids
+ can add metronidazole for abdo cover too

Question 6

When can we switch to oral abx in neutropenic fever?

Answer 6

If afebrile 24hours

If neutrophil count < 0.5 – use ciprofloxacin if no source identified. (until neutrophil recovery)

Question 7

What is the patient is persistently febrile?

Answer 7

Consider Vancomycin at 72 hours
Anti-fungal therapy at 5 days if no other source can be found and after discussion with treating team

Question 8

Should patients with neutropenic fever be isolated?

Answer 8

No. Does not improve outcomes.

Question 9

Can sepsis present without fever?

Answer 9

Yes, in the elderly, those who use steroids,
if febrile at home, believe them!

Question 10

What is cord compression?

Answer 10

Compression of the fibres of the spinal cord, and epidural space.

Mechanical compression – either by soft tissue or by bone

Question 11

what will you expect to see on Plain films in cord compression?

Answer 11

the tumour but not the actual cord compression. Have to do MRI to see the cord compression.

Question 12

What could be happening in the following scenarios in the context of cancer?
- slow gradual back pain
- sudden, severe pain
- sudden paralysis

Answer 12

slow gradual - soft tissue compression
sudden severe - pathological feature
sudden paralysis - infarction

Question 13

What medication should we give if there is confirmed cord compression?

Answer 13

Dexamethasone 16mg + analgesia

Question 14

What are the symptoms of SVCO?

Answer 14

Swelling – face, arms, neck

Plethoric cyanotic appearance

Non-pulsatile engorgement of veins

Visible large collateral veins over chest

Engorged retinal veins & conjunctival oedema

SOB and hypoxic

Horner’s syndrome

Pemberton’s sign

Question 15

What are some differentials for SVCO?

Answer 15

Either non-malignant (sarcoid)
Malignant (lung cancer)
Or thrombus in the vena cava

Question 16

How should we investigate potential SVCO?

Answer 16

CXR and CT venography

Question 17

How shall we manage SVCO?

Answer 17

Usually radiation +/- chemo (small cell lung + lymphoma), and dexamethasone (UNLESS IT IS A LYMPHOMA = CYTOTOXIC, will miss differential only give if need steroids urgently)

Question 18

What electrolyte disturbances do we see in tumour lysis syndrome?

Answer 18

Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.

Question 19

How is Tumor Lysis Syndrome prevented and managed?

Answer 19

Prevention involves hydration and medications.

Management includes aggressive hydration, urate-lowering therapy, and addressing electrolyte imbalances.

Question 20

What drugs can we use to lower urate?

Answer 20

Allopurinol and rasburicase
IV hydration +/-dialysis if really bad

Question 21

What are some early side effects of radiotherapy?

Answer 21

Inflammation (reaction to cell damage and death)
 Cellular depletion and ulceration
 Capillary leakage and swelling
 Malaise and fatigue

Question 22

Late side effects of radiotherapy

Answer 22

Atrophy of tissue – loss of cell numbers
 Reduced arteriolar lumen and blood flow
 Fibrosis – muscles and subcutaneous tissue

Question 23

What is the prophylactic medication for neutropenic fever?

Answer 23

GCSF or GM-CSF, ‘granulocyte colony stimulating factor’