Oncology Flashcards
Adjuvant therapy
Given after definitive treatment
Neo-adjuvant
given before the main treatment to shrink the cancer
Concurrent
Two or more cancer therapies given simultaneously
Time limit by which radiotherapy should be started.
10 days
few days if palliative
Early side effects of radiotherapy
Fatigue pain oesophagitis pneumonitis skin reaction diarrhoea nausea cystitis raised ICP hair loss
Late SE of radiotherapy
Fibrosis Stricture Osteonecrosis Fib fracture Secondary malignancy
When might emergency radiotherapy be used?
Spinal cord compression
What is radiosensitive chemo
Low dose given to increase the efficacy of radical radiotherapy
Chemo administered every ….
2-4 weeks to allow for blood count recovery
When is blood count lowest in chemo
2 weeks in
How many cycles usually
6 cycles - 5 m
2 conditions caused by chemo in bone marrow
Neutropenia
Thrombocytopenia
Skin changes with chemo - 2
hand and foot syndrome
rash
GI conditions caused by chemo - 3
Mucositis
N&V
Diarrhoea
Chemo and heart - 2
Heart failure
Angina / MI
Lungs and chemo
pulmonary fibrosis
Kidneys and chemo
Renal impairment
Nerves and chemo
Peripheral neuropathy
Hearing loss
triad of neutropenic sepsis
neutropenia, anaemia and thrombocytopenia
in which cancers is neutropenic sepsis more common
lymphoma / leukaemia
neutropenia definition =
neutrophil count <1.0
sepsis 6
ABG - lactate IV Abx - Tax / Gent, Mero + Vanc Blood cultures Urine output IVF Oxygen
Consider inotropic support early
How would hypersensitivity reaction to chemo present
Fever Hypotension Tachy Low SpO2 Wheese oro-pharnygeal oedema
Manage hypersensitivity reaction to chemo
Stop infusion O2 IV fluid stat Anti-histamine - 10mg chlorephinramine IV steroid - hyrocortisone 200mg Adrenaline 0.5ml of 1:1000 IM
Risk factors for tumour lysis syndrome - 4
Treatment of bulky chemosensitive tumours
Any use of anti-cancer therapy
Pre-exisiting renal impairement
Malignant biochem abnormalities
TLS diagnosis (5)
Hyperuricaemia Hyperkalaemia Hyperphospataemia Hypocalcaemia Renal failure
Drug used to prevent TLS
Allopurinol
Scale used to measure fitness in oncology
ECOG
0 = fully active
5 = deceased
When to refer using suspected lung cancer pathway referral (2)
CXR findings suggest lung cancer
Aged 40+ and have unexplained haemoptysis
Urgent (2 weeks) CXR in 40+ if…
2+ unexplained symptoms
/ smoke +1 US
- cough
- fatigue
- SOB
- Chest pain
- Weight loss
- Appetite loss
Fitness investigations for possible treatments
1) Surgery
2) Chemo
3) Radio
1) lung and cardiac
2) renal and liver
3) ability to lie flat and pacemaker
staging of lung cancer
thorax and abdomen VT with contrast
Then bronchoscopy and biopsy
Important social Hx in context of lung cancer
Smoking
Alcohol
Occupation
FH
How quickly is an MR needed if
- MSCC suspected
- bony mets suspected but no compression
24hrs
1 weeks
Treatment of SCC
Nursed flat High dose dex (16mg orally BD) + PPI Opioid analgesia Catheter Neurosurgical discussion Radiotherapy considered
Investigations pre surgery for SCC
CXR
CT thorax and abdo
Treatment for acute hypercalcaemia
rehydration (3-4L per day) + Zolendronic acid
Tamoxifen mech of action
selective oestrogen receptor modulator
Aromatase inhibitors mechanism of action and what can they cause as a SE
prevent androgen - oestrogen conversion
Osteoporosis
4 causes of hypercalcaemia in oncology patients
paraneoplastic syndrome
osteolytic tumours
tumours producing vit D
metastatic bone disease
Presentation of hypercalacaemia
confusion hypertension bone pain renal stones abdo pain N&V polyuria psychiatric overtones
The information given to people with suspected cancer and their families and/or carers should cover, among other issues:
1) Where the person is being referred to.
2) How long they will have to wait for the appointment.
3) How to obtain further information about the type of cancer suspected or help before the specialist appointment.
4) What to expect from the service the person will be attending.
5) What type of tests may be carried out, and what will happen during diagnostic procedures.
6) How long it will take to get a diagnosis or test results.
7) Whether they can take someone with them to the appointment.
8) Who to contact if they do not receive confirmation of an appointment.
9) Other sources of support.
