Oncology Flashcards
Carcinoma
begins in skin or tissue that line or cover internal organs.
Sarcoma
– begins in bone, cartilage, fat, muscle, blood vessels, connective or supportive tissue.
Leukemia
– starts in blood-forming tissue such as bone marrow (large number of abnormal cells produced and enter the bloodstream)
Lymphoma and myeloma
– begin in the cells of the immune system
Ca of Central nervous system
– begin in tissues of brain and spinal cord
Which cancers could be prevented by vaccination, behavioral changes, and antibiotics?
Cancers related to Hepatitis B, HPV, HIV, H. pylori
Screening prostate ca
ACS: PSA at age 50, 45 if AA, consider risks/benefits (false +s, too much intervention)
screening lung cancer
Lung cancer – low-dose CT scan (high risk individuals) more and more evidence, now paid for by insurance.
4 oncologic emergencies
spinal cord compression, SVC syndrome, hypercalcemia, tumor lysis syndrome
Spinal cord compression
– due to metastatic disease, back pain early, neurologic deficit of legs late sign. MRI needed. Treated with corticosteroids, RT, surgery, treat underlying malignancy.
Superior vena cava syndrome: cause
- caused by mediastinal tumors, venous catheters, clots (basically impaired blood flow).
SVC syndrome: symptoms
Symptoms neck ,facial, periocular swelling, dyspnea, cough, head pressure, hoarseness, nasal congestion, syncope.
facial swelling may subside after up all day
SVC syndrome: Dx
CT scan needed, CXR may be beneficial. US for clots (gold standard).
SVC syndrome: Tx
Chemo, pericardial window or stripping.
HOB elevated. Lasix, steroids, chemo or RT, warfarin for clot.
Hypercalcemia: cause
– bone mets, parathyroid hormone related protein production, calcitroil excretion.
hypercalcemia Sx
Symptoms confusion, lethargy, sleepiness.
hypercalcemia: dx & Tx
Lab tests for calcium and electrolytes.
IV hydration (flush system) and bisphosphonates treatment.
Tumor lysis syndrome
– rapid tumor cell destruction from chemo, multiple electrolyte abnormalities.
Tumor Lysis Syndrome: symptoms
Nausea, weakness, myalgia, dark urine, arrhythmias.
Tumor Lysis Syndrome: Dx & Tx
- Test electrolytes and uric acid.
- Prevent by hydration, allopurinal, zyloprim.
- Treat imbalances, acidosis.
alopecia: cause
caused by chemo 7 – 10 days after treatment (hair thinning) but really kicks in 3-4 weeks post.
Some people don’t lose – after 1st month usually indicates how much
alopecia mgmt
- Cut hair short, shave head. Wigs/scarves.
- Can write prescription for cranial prosthetic.
- Get wig before so can match to current hair.
Bone marrow suppression leads to…
neutropenia, anemia, thrombocytopenia
neutropenia: when and Tx
nadir at 7-10 days after treatment.
Give GCSF and/or dose reduce
Anemia: when & Tx
- several weeks after treatment start.
- R/o other causes (bleeding, hemolysis, nutritional deficiency).
- Transfuse if necessary. Give Epogen, Aranesp per guidelines.
- Be aware of religious beliefs.
- Transfusion more common for solid tumor pts
Nausea/vomiting: when and Tx
- Differs with emetogenic potential of the therapy.
- Cisplatin tends to be most emetogenic but we have good treatments – let ppl know they shouldn’t be suffering overly
Diarrhea: why & Tx
- may be side effect of treatment or disease.
- Obtain stool bacterial culture (C. diff),
- if positive Flagyl (metronidazole),
- if negative antimotility agent Imodium or Lomotil.
- Manage fluids, skin breakdown
Nutrition effects
- loss of appetite, inability to eat secondary to side effects from chemo i.e. metallic taste in mouth, loss of taste.
Body image effects
Body Image Disturbance – from surgery, weight gain from steroid treatment.
at what ANC can bacteria naturally present in the mouth or digestive tract can cause infection
ANC < 500
febrile neutropenia
- oncologic emergency
- fever of 101.0+ (may not be able to mount fever)
- Low white count ~ ANC < 1500 (cut-off varies)
- Most often no definitive infxn source
febrile neutropenia: Tx
May or may not be admitted to hospital – broad spectrum antibiotics are given.
Febrile Neutropenia: preventative Tx
colony stimulating factors (Neulasta) given 24 hours after certain chemotherapy treatment.
Risk factors that increase chance of admission for febrile neutropenia
- serum Cr > 2 mg per dL,
- LFT > 3x upper limit normal,
- uncontrolled/progressive cancer,
- pneumonia,
- significant comorbid illness,
- prolonged severe neutropenia (ANC <100 or <500 x 7 days) - likely admission.
Factors that increase chance of outpatient Tx of febrile neutropenia
- no comorbid illness,
- short time neutropenia,
- creatinine
- LFTs < 3 times ULN,
- good functional status
- even low risk probably admitted at least 24h
Common effects of radiation therapy
mucositis, thrush, xerostomia, skin burn, trauma to areas in radiation field
Mucositis
– painful inflammation and ulceration of the mucous membranes lining digestive tract.
Mucositis Tx
- Saline/bicarb lavage, Magic Mouthwash/Dukes Solution (viscous lidocaine, benadryl, Mylanta), Carafate slurry.
- Can disrupt eating.. Can even give opioid if really having trouble swallowing
Thrush: definition & Tx
- Thrush – patchy white coating in mouth
- Nystatin s/s, Diflucan
Xerostomia: definition & Tx
- – dry mouth with lack of saliva.
- Salagan or Evoxac to increase saliva production. Good oral care.
Skin burn: characteristics & Tx
- can be dry (sunburn) or wet desquamation (blistered oozy sunburn)
- Moisturize with Aquaphor. NO non water based products – will disrupt RT field. Monitor for cellulitis and treat with antibiotics.
Effect on areas in the radiation field, e.g. chest & lower spine/abdomen
- Chest radiation – may have difficulty eating secondary to mucositis. (esophagitis). Scar tissue may lead to stricture
- Spine/Lower abdominal radiation – may develop diarrhea.
Cancer Related Fatigue (CRF)
- Subjective feeling of tiredness or exhaustion prompted by cancer or cancer treatment disproportionate to level of recent exertion.
- Possible causes – pain, emotional distress, sleep disturbance, anemia, nutrition, activity level, other comorbidities.
CRF Assessment
- Rate fatigue on scale from 0-10 over past 7 days. (1-3 mild, 4-6 moderate, 7-10 severe).
- Multiple tools available:
- Symptoms Distress Scale, Rotterdam Symptoms Checklist, MD Anderson Symptoms Inventory. Focus on detecting presence or absence of CRF.
- Challenge – separating CRF from other related conditions (depression, anemia, effects of chemo/RT).
CRF Tx - exercise & education
- Exercise – strong evidence supports a 20 – 30 minute sessions 3 – 5 times weekly. Start low intensity and duration.
- Education – strategies for energy conservation, activity management, prioritizing.
- Massage, healing touch, relaxation
CRF Tx, Cog/behavioral interventions
- Cognitive-Behavioral Interventions – manage anxiety and depression, sleep disturbance, stress reduction.
CRF Tx, sleep disturbanes
Sleep disturbance/insomnia – sleep hygiene, consider TCA, antihistamines, benzodiazepines, Ambien/Luenesta
CRF Tx, Depression
Depression – counseling, SSRI’s
CRF Tx, anemia
Anemia – Iron studies, Transfusion, Procrit, Aranesp
CRF Tx, pain
- Mild - NSAID/Tylenol/short acting opioid,
- Moderate to severe – combination of long and short acting opioid (use opiods asap, long good)
Medication/pharmaceutical interventions for cognitive impairment
(effectiveness not established)
- Ritalin (methylphenidate)
- Aricept (donepezil) (at this point say doesn’t work, gives diarrhea)
- Provigil (modafinil)
CAM Tx for cognitive impairment
Exercise – potential benefit
Vitamin E - unsure
Hot flashes as a side effect of Ca treatment
- Subjective sensation of heat that is associated with objective signs of cutaneous vasodilation and subsequent drop in core temperature.
- Associated with facial flushing, perspiration, chills, heart palpitations, night sweats, anxiety.
- Characterized as mild, moderate, severe.
Which Txs most likely to cause hot flashes?
Most common side effect from agents used to suppress ovarian function/cause estrogen withdrawal (tamoxifen, aromatase inhibitors, androgen deprivation, hormonal therapies, surgical castration).
Ca Tx and hot flashes: incidence
- Occurs in 78% breast Ca patients
- Chemotherapy can cause premature ovarian failure with temporary or permanent amenorrhea.
- Occur in 35 – 80% of men treated with androgen deprivation therapy (prostate Ca).
Tx for hot flashes
Effexor (SSRI)
- SSRI’s (selective serotonin reuptake inhibitors) may be effective in elevating hot flashes however drug interactions may exist with tamoxifen (CYP 2D6 interaction -> decreased efficacy of tamoxifen and increased risk of relapse).
CAM for hot flashes
- Acupuncture
- Black Cohosh – herb. Evidence shows may or may not help.
- Hypnosis
- Relaxation therapy
- Vitamin E (weak study results)
- Yoga
Skin reactions to chemo or biotherapy
- mild, moderate, severe. Rarely life threatening but affects quality of life.
- Two Major Types Rash:
- Acneform
- Maculopapular
Acneform
– diffuse erythema face body progressing to follicular papules/pustules resembling acne
(clinical manifestation of rash d/t chemo / biotherapy)
Maculopapular
– flat macules and elevated papules associated with pruritus.
(clinical manifestation of rash d/t chemo / biotherapy)
Carboplatin and rashes
– allergic reactions (rash, urticaria, erythema, pruritus)
(clinical manifestation of rash d/t chemo / biotherapy)
Interleukin-2 and rashes
– erythematous rash, pruritus, dry/peeling skin. (Sarna lotion)
(clinical manifestation of rash d/t chemo / biotherapy)
Palmar-Plantar Erythrodysesthesia (Hand foot syndrome)
- Mild redness at first with discomfort on palms and soles
- tingling sensation at fingertips progressing to more intense burning pain/tenderness, swelling, desquamation, crusting, ulceration, epidermal necrosis.
- (Bag Balm, cooling pads)
(clinical manifestation of rash d/t chemo / biotherapy)
Xerosis
– abnormally dry, flaky, dull skin (moisturizer, emollients)
(clinical manifestation of rash d/t chemo / biotherapy)
Paronychia
– painful inflammation of tissue around fingernails/toenails more commonly great toes and thumbs. (Antibiotics)
(clinical manifestation of rash d/t chemo / biotherapy)
Photosensitivity
– erythematous response to ultraviolet or visible light.
(Retinoids, topical steroids, topical antiseptics)
(clinical manifestation of rash d/t chemo / biotherapy)
Pruritis
- – intense itching that may lead to scratching.
- Consider thick non-alcohol moisturizer/emollients; Benadryl, Atarax (antihistamine); topical steroid cream or Elidel (immune modulator).
(clinical manifestation of rash d/t chemo / biotherapy)
Prevention of skin reactions d/t chemo / biotherapy
- Minimize exposure to sunlight/UV light
- Sunscreen with zinc oxide/titanium dioxide
- Protect skin: Avoid temperature extremes to skin, avoid long hot showers or baths, washing dishes or cold compresses.
- Avoid constrictive clothes, shoes, jewelry.
- Keep skin moisturized with alcohol free products.
