Oncology Flashcards
Most common cancers
BREAST (1 in 8 w) LUNG (1 in 16) CRC (1 in 17) PROSTATE (1 in 14 m) -- Bladder NH Lymphoma Melanoma
Most cancer deaths
LUNG CRC BREAST PROSTATE -- Pancreas Oesoph
4 cancer assoc w obesity
colon
renal
endometrial } think oestrogen
breast }
Infections linked to cancer
HPV - cervical, head and neck HBV - liver flukes EBV - nasopharyngeal, burkitts, H Pylori - gastric, MALT Schistosomiasis - SCC of bladder (not transitional)
HIV/AIDS linked
- cervical, lymphoma, Kaposi (HHV8)
Occupational cancer causes
asbestos - mesothelioma dyes - bladder UV - skin benzene - lymphoma radon - lung
TNM staging
T1 - small
T2 - larger
T3 - to capsule
T4 - adjacent organs
N1 - small
N2 - larger
N3 multiple
Histology of cancers
Anal - SCC
CRC, stomach - adenocarcinoma
Prostate - adenocarcinoma
Breast - adenocarcinoma
Kidney - renal cell carcinoma
Bladder - transitional cell
Radiotherapy SE
First show in adjacent tissues w fast turnover
- skin, hair,
- bowel
- bone marrow
Delayed SE in organs w slower turnover
- CNS, kidney, lung
Spinal cord compression
first see
- back pain
- leg weakness
- sensory distrub
—> do MRI
if above L1 - get UMN signs in legs w sensory level
if below L2 - get LMN signs w saddle anaesthesia
Mx: DEXAMETHASONE 10mg IV stat
SURGERY OR RADIOTHRAPY
SVC obstruction
sob, swelling of face, haeadache,
visual distrubance
venous engorgement
seen w SCLC, lymphoma, squamous cell
Mx:
ABC - sit upright
DEXAMETHASONE 4mg po
STENT/ BALLOON
4 Common Palliative Care drugs
Morphine 5-10mg hourly prn Midazolam 5mg sc Hyoscine hydrobromide 400mcg sc Cyclizine 50mg tds sc - central, anticholinergic - but can used more specific approach to nausea
Targeted treatment of nausea
stomach, partial GI obs - metoclopramide 10mg tds
total bowel obstruc
- hyoscine butylbromide
- cyclizine 50mg tds
- ng tube
blood chemistry eg ca - haoperidol 1-5mg per 24hrs
raised ICP - cyclizine 50mg tds
also steroids - good adjuvant in many cause
motion sickness - antihistamine - cinnarizine, promethazine
vertigo - phenothiazines - prochlorpromazine
Opiate conversions
breakthrough = 1/6 of 24hr
increasing uncontrolled pain - by 30-50%
codeine <1/6 stength of morphine
ie 30mg cod = 4.5 mg morph
fentanyl 25mcg/hr patch = 120mg over 24hr morphine
10mg oxycodone = 20mg morphine
10mg diamorphine sc = 30mg morphine
Cancers linked to smoking
head and neck (mouth, pharyng, oesoph)
lung
bladder
pancreas
Cancers linked to booze
head and neck (mouth, pharyng, oesoph)
CRC
liver
Chemo side effects
Bleomycin
Doxorubicin
Cyclophosphamide
Bleomycin - lung fibrosis
Doxorubicin - cardiomyop
Cyclophosphamide
- hemorrahgic cystitis
- myelosuppression
- TCC (kidney/bladder)
Chemo SE
methotrexate
5 FU
vincristine
cisplatin
methotrexate
- myelosup
- mucositis
- lung and liver fibrosis
5 FU
- myelosup
- mucositis
- dermatitis
vincristine - nerves
cisplatin
- ototoxic
- periph nerves
- renal toxicity
Screening breast
47 - 73 mammo every 3 yrs
- stong FH - start at 40, offer MRI
- yearly mammo surveillance if prev breast cancer
Screening
60 - 69 every 2 years
foecal occult blood test
- annually for high risk (offer colonoscopy)
- – FPC, HNPCC, UC
Cervical ca screening
25 - 49 3 yearlys
50 - 64 5 yearly
Breast cancer
BRCA accounts for 5% of all but over 50% of those under 40yrs
25% express HER-2
- worse prognosis
- but can use HERCEPTIN
DCIS - ductal carcinoma in situ
Pagets - eczema of nipple
Tx - surgery, inc test sentinel nodes
- radio adjuvant
- systemic adjuvant
systemic treat
- chemo - anthracycline
- hormonal - tamoxifen (pre meno) or aromatase inhib (anastrozole - post meno)
- targetted - herceptin
Prostate
TNM staging
Gleason scoring 1 - 5(poorly diff)
PSA normally under 4 over 10 is suspicious
do TRUS
do TR biopsy
follow w cxr, ct stage, bone scan, renal us (look for 2dry)
T
- wait
- surgery - turp or radical
- radio or brachytherapy
- if metastasized use antiandrogen - eg GOSERELIN (gnrh analogue)
Lung cancers
Squamous cell 40-60%
- central large airway
- slow growth/slow met
- cavitating
- PTH - hypercalcaemia
Adeno 10-20%
- peripheral
- non smokers
- slow growth
Large cell 5-15%
SMALL CELL LUNG CANCER
- poor prog - inoperable -> chemo
- central
- rapid growth and metastasis - often disseminated
- SIADH
- ACTH
- Lambert Eaton (like MG)
Colorectal cancer
familial
- FAP (apc gene) - prophylactic colectomy age 20
- HNPCC (mlh, msh gene) - aut dom, annual surveil
dukes staging A submucosa B serosa C lympho nodes D metastasized
Neutropeonic sepsis
comp of chemotherapy
seen between day 10-14 post chemo
neutrophils 0.5 or lower
temp over 38
aggressive IV abx
Testicular cancer
most common cancer in men aged 20-30
- PAINLESS LUMP
semanoma or teratoma
teratoma - 20-30, germ cell (afp, bhcg)
semanoma - 30-40
risk - mumps orchitis, orchidopexy (undescended), cryptoorchidism, infertility, klinfelters
sclc
not tnm - use ‘limited’ or ‘extensive’
limited ~2y surv, extensive ~1y surv (with treatment)
is chemo and radiosensitive
nsclc
use tnm staging
and also stage 1 - 4 (4= chemo only)
Carotid body tumour
May be functional (rare) or non functional
Functional - behave like phaeochromocytoma
- palps sweat etc
performance status
important in deciding treatment for lung cancer
0 = fully active 1 = ambulatory, light work 2 = amb, self care, up and about >50% 3 = bed/chair > 50% of time, limited self care 4 = needs care 5 = dead
avoid chemo if PS 4
