Oncology Flashcards
Give 3 tests you would do in a suspected neutropenic septic patient?
Blood culture
MSU
Swabs from exit sites or other infected foci
Define neutropenic sepsis?
Fever > 38 degrees OR > 37.5 over 1hr
Neutropenia < 0.5 OR < 1 & falling
Which Abx. would you administer in neutropenic sepsis?
IV Tazocin (IV Imipenem if penicillin allergic)
How can you prevent neutropenic sepsis? 3 things
Dose reduction of chemotherapy
Prophylactic GCSF (Granulocyte colony stimulating factor)
?Stop chemo
Give 5 symptoms that might be felt with a metastatic spinal chord compression?
Pain Weakness Sensory change Urinary retention Constipation/Incontinence
What is the investigation of choice in MSCC?
MRI
Give 3 treatment options for MSCC?
Radiotherapy - mainstay Rx.
Steroids - high dose glucocorticoids (dexamethasone)
Surgery - with RT
Urgent chemotherapy - very sensitive tumours
Give 5 situations that you would consider surgery to treat MSCC?
Single vertebral involvement No evidence of widespread disease Radio resistant tumour To obtain diagnosis Previous Radiotherapy to site
Give 5 causes of a Superior vena cava obstruction?
EXTRINSIC
Right sided tumours
Superior mediastinal lymphadenopathy
INTRINSIC
Thrombosis
Foreign body (catheter)
Tumour
Give 4 symptoms experienced with SVCC?
Swelling of the face and upper body in general Distended neck veins SOB Headache Lethargy
Give 3 possible oncology related causes of hypercalcaemia?
Humoural - Tumour secretion of PTH
Osteolytic mets with local cytokine release
Tumour production of calcitrol
What’s the normal range of calcium?
2.1-2.6
Give 4 blood tests you would do in a suspected hypercalcaemia?
Calcium U&E - Dehydration? PTH - Cause? Phosphate - low in hyperparathyroidism Myeloma screen - cause?
How do you manage hypercalcaemia?
Rehydration 1st
Bisphosphonates
Others: Calcitonin, corticosteroids
Managements of malignancy
What is tumour lysis syndrome?
Metabolic complication of treatments of rapidly dividing cancers causing: Hyperuricemia Hyperkalaemia Hyperphosphatemia Acute renal failure Hypocalcaemia
How do you manage tumour lysis syndrome prophylactically? 3 things
Prehydration and vigorous hydration throughout treatmenr
Monitor electrolytes and fluid balance
Allopurinol - Uric acid
Give 5 risk factors for developing breast cancer?
Age (over 50)
Early mernache and late menopause
Nulliparity and late age of 1st pregnancy
Family history - 1st degree (BRCA 1 & 2)
Exogenous oestrogens
Diet (fat, obesity, alcohol)
What is the triple assessment?
Full clinical exam Bilateral mammography (?with US) FNA cytology (?with core biopsy)
Give 6 indications for referral to a breast clinic?
Screen detected breast cancer Breast lump Pain Nipple discharge Nipple retraction, distortion or eczema Change in breast contour
Give 5 indications for a mastectomy?
Patient choice Tumour size >40mm Multifocality of cancer Recurrent cancer after conservative Radiotherapy is contraindicated
What 2 risks are associated with aromatase inhibitor use?
Osteoporosis
Endometrial carcinoma
How can a cancer develop resistance to treatment? 5 things
Decreased drug uptake Increased drug efflux Increased DNA repair Alteration of drug target Increased catabolism Increased drug detoxification
Give 4 risk factors for developing prostate cancer?
Increasing Age
Family history
BRCA 2 gene mutation
Ethnicity (Black)
Give 3 possible presentations of prostate ca?
Asymptommatic
Urinary symptoms
Bone pain
Give 3 diagnostic tests for prostate ca?
DRE
PSA
Biopsy (Transrectal US)
How can you manage metastatic prostate ca? 3 things
Hormonal - Surgical/Medical castration
Radiotherapy
Bisphosphanates
Give 3 management options for localised prostate ca?
Active monitoring/watchful waiting
Radical prostatectomy
Radiotherapy
Give 3 risk factors for developing bladder cancer?
Smoking
Occupational exposure
Schistosomiasis
How often is the bowel screening and what does it involve?
Every 2 years
Ages 60-69
FOB & Colonoscopy
Give 4 suspicious symptoms for colorectal ca?
Rectal bleeding Change in bowel habit Weight loss Anaemia Palpable abdominal mass
Give 3 non metastatic manifestations of bronchial carcinoma?
Inappropriate ADH secretion -
Hyponatraemia
Ectopic ACTH secretion - Cushing
Hypercalcaemia - PTH release
Give 3 common presenting symptoms in bladder ca?
Haematuria
Dysuria
Increased frequency of micturition
Give management options for superficial bladder ca?
Resection by diathermy
BCG or mytomycin C injections
How can you treat muscle invasive bladder cancer?
Radiotherapy
Surgery
What are common side effects seen in radiotherapy to the bladder? 3 things
Radiation fibrosis
Cystitis
Proctitis
State 6 possible acute side effects of chemotherapy?
Myelosupression: anaemia, infection, bleeding (thrombocytopenia). The most serious problem being Neutropenic sepsis.
GI effects: nausea and vomiting, diarrhoea, constipation, fatigue,
Skin damage: oral mucositis, rash, skin changes, nail changes
Alopecia
Organ damage: especially the kidneys, liver, lungs and heart.
Gonadal failure: infertility
Teratogenicity
Give 5 possible long term side effects of chemotherapy?
Lung fibrosis Cardiac dysfunction Neurological damage Renal impairment Secondary malignancy Psychological problems.
Give 5 possible acute side effects of radiotherapy?
General fatigue Skin changes: erythema, dry desquamation skin tanning, hair loss GI effects Myelosuppresion Pneumonitis
State 5 possible long term side effects of radiotherapy?
Renal impairment Neck fibrosis (woody texture) Muscles of mastication fibrosis Lymphodema Dry mouth (xerostomia)
Give 5 examples of hormonal and biological treatments?
Hormone
Tamoxifen (breast cancer) - Selective oestrogen receptor modulator (SERM) which blocks oestrogen receptors
GnRH agonist (prostate cancer) - excessive testerone stimulation of prostate leading to down regulating of receptors
Biological
Herceptin (breast) - monoclonal antibody targeting HER 2 receptors
Rituximab (non-hodgkin lymphoma) - B cell lysis
GCSF (granulocyte colony stimulating factor) - stimulated bone marrow to produce white cells
Which age group is breast cancer screening undertaken?
Women 47-73 years old
What factors are included in the Nottingham prognostic index for breast cancer?
Size of the lesion
Number of lymph nodes involved
Grade of tumour
Give 5 common locations for lung cancer spread?
Liver Brain Bone Adrenal gland Skin
State 4 poor prognostic factors in breast cancer?
Cancer >2cms High grade (2/3) Young patient Metastasis present Negative oestrogen/progesterone receptors
Give 4 risk factors for developing malignant melanoma?
Sun exposure
FHx
Fair skinned people
Albinos
How is melanoma diagnosed?
Glasgow 7 point checklist
State 4 risk factors for developing colorectal carcinoma?
Environmental (high fat diet, alcohol, red meat)
IBD
Neoplastic polyps
Low fibre diet
How is a malignant melanoma managed? 4 things
Use dermatoscope to analyse lesion
Refer to dermatologist
Excisional surgery
Biopsy sentinel nodes for mets
When would you refer a ?Melanoma?
ABCDE Asymmetry Border irregular Colour irregularity Diameter > 6mm Evolving over time
Refer if >3
Give 4 types of melanoma?
Nodular melanoma
Lentigo maligna melanoma
Superficial spreading melanoma
Acral lentiginous melanoma
