oncology

Question 1

when would emergency radiotherapy be indicated?

Answer 1

-spinal cord compression caused by metastasis

Question 2

what would you do if you suspect spinal cord compression

Answer 2

• start dexamethasone 8mg BD with PPI
• arrange an urgent MRI scan with contrast
• contact the oncology team
• contact the spinal cord compression coordinator
• refer for assessment

Question 3

how would someone with spinal cord compression present?

Answer 3

• pain: tight and band like ! radiates from back to front
• UMN signs below the level of compression, eg weakness
• sensory level
• bladder and bowel symptoms

Question 4

what are the chemotherapy emergencies?

Answer 4

• neutropenic sepsis
• hypersensitivity reactions
• tumour lysis syndrome

Question 5

what do you do if you suspect neutropenic sepsis!

Answer 5

• urgent FBC,blood cultures etc

get IV access start Antibiotics, start resuscitation

Question 6

how would you diagnose neutropenic sepsis?

Answer 6

WCC <1.0 and pyrexial

Question 7

how would you recognise a hypersensitivity reaction?

Answer 7

• hypotension
• fever
• dyspnoea
• oedema of the oropharyync
• tachycardia
• wheeze
• low O2 sats

Question 8

how would you manage a hypersensitivity reaction?

Answer 8

• Stop the causative agent!
• administer O2 sats
• give IV fluid challenge
• give antihistamine : stat dose 10mg chlorpheniramine STAT
• give IV steroids hydrocortisone 200mg
• give adrenaline IM 0.5ml 1:1000
• consider salbutamol/adrenaline nebuliser

Question 9

how would you treat tumour lysis syndrome

Answer 9

lots of IV fluids
correct the electrolyte abnormalities
discuss with the renal team and critical care team
prophylaxis: use urate inhibitors eg allopurinol or rasburicase

Question 10

how would the bloods look in tumour lysis syndrome?

Answer 10

raised potassium, raised phosphate, raised urate

decreased calcium

Question 11

which cancers commonly metastasize to the lung

Answer 11

breast, bowel, testicular, kidney, bladder, melanoma, sarcoma,

Question 12

which cancers commonly metastasize to the liver

Answer 12

breast, bowel, lung

Question 13

which cancers commonly metastasize to the bone

Answer 13

breast, lung, prostate, kidney, thyroid

Question 14

which cancers commonly metastasize to the brain

Answer 14

melanoma, breast, bowel, lung, kidney

Question 15

which factors influence tmt in lung cancer

Answer 15

• patient choice
• stage of disease
• histological characteristics (response to drugs)
• support network
• lung, renal function
• co morbidities
• fitness and performance status

Question 16

how do we measure performance status in cancer patients?

Answer 16

ECOG scale

0= normal 5= deceased

Question 17

which mutations are more common in lung ca in never smokers ?

Answer 17

EGFR mutation

makes them more responsive to tyrosine kinase inhibitors

Question 18

if a cancer patient presents with headaches and confusion what are your differentials?

Answer 18

• brain mets
  also need to exclude
  cerebrovascular accident
  electrolyte abnormalities

Question 19

what do you need to give if there is cerebral oedema?

Answer 19

• dexamethasone 8mg BD PO

Question 20

how would you treat acute hypercalcaemia?

Answer 20

• IV fluids (raised Ca can lead to diuresis and dehydration)

- IV Bisphosphonate eg ZOLEDRONIC ACID

Question 21

how would you manage imminent spinal cord compression from spinal mets?

Answer 21

• dexamethasone 8mg BD
• opioid analgesia
• neurosurgical review and stabilisation
• radiotherapy may be indicated also

Question 22

what are the features of headaches due to brain mets?

Answer 22

• different from headaches the pt may have had in the past
• non responsive to analgesia
• worse in the morning and lying down
• worse over time
• can last 1-2 days
• may be associated with nausea and vomiting

Question 23

what else do you need to ask about if you suspect brain mets ?

Answer 23

seizures
weakness
poor coordination
visual disturbances and diplopia

Question 24

what do you need to tell to do once you are aware of brian metastases?

Answer 24

the patient will need to inform the DVLA

it is likely they will need to surrender their license

Question 25

how can you manage headaches due to brain metastases?

Answer 25

dexamethasone 8-16mg in the morning with PPI cover