Oncology Flashcards
What is the management in suspected spinal cord compression?
Urgent MRI
Dex 8mg BD + PPI
Flat bed rest
AHP referral for assessment
Discuss with oncology team and spinal cord compression coordinator
What is the difference between curative, adjuvant, radio-sensitive and palliative chemotherapy?
Curative - cure chemo-sensitive tumors
Adjuvant - reduce risk of relapse
Radiosensitive - increase efficacy of radical radiotherapy
Palliative - relieve symptoms from wide-spread incurable tumor
How is chemotherapy administered and over how many cycles, over how long?
Once every 2-4 weeks
Allows for blood count to recover
No more than 6 cycles / 5 months of treatment
What is the triad of neutropenic sepsis?
Neutropaenia
Anaemia
Thrombocytopaenia
Any Pt with on CHEMOTHERAPY with PYREXIA needs URGENT FBC + ABX / RESUS
If PYREXIC + Neutrophil count < 1.0 = NEUTROPENIC SEPSIS
Management of neutropenic sepsis?
Treat as sepsis 6 (3 in 3 out)
3 in
- IV fluids
- IV Abx broad spec
- Oxygen
3 out
- Blood culture
- Urine output
- Lactate (ABGs)
What are the signs and symptoms of hypersensitivity reaction due to chemotherapy?
Think: Anaphylaxis
Fever Hypotension Tachycardic Low SaO2 Wheeze Oropharyngeal oedema
What is the immediate management of a chemotherapy hypersensitivity reaction?
- STOP infusion!
OIAIA
- O2
- IV Fluids stat (0.5-1l)
- Antihistamine chlorampheniramine stat
- IV steroids (hydrocortisone)
- Adrenaline IM
consier Salbutamol / Adrenaline nebulisers
What are the diagnostic features of tumor lysis syndrome?
Hyperuricaemia
Hyperkalaemia (cardiac arrythmias / VT)
Hyperphosphataemia / Hypocalcaemia
Renal failure (as a result of hyperuricaemia and hypocalcamia build up of crystals in kidneys)
Management of tumor lysis syndrome?
Prevention is better than cure!
IV Fluids (lots!) Prophylactic allopurinol or rasburicase
Twice daily biochemistry with physician review of minor changes
Correct abnormalities, lots of IVF
Discuss with renal team / critical care if tumor lysis syndrome established
What are the red flag symptoms of lung cancer?
Cough Haemoptysis Dypnoea Hoarse voice Chest pain Fatigue Appetite loss Weight loss
What scale is used to determine performance status?
ECOG scale (Eastern Cooperative Oncology Group)
0 Fully active, able to carry out all pre-disease performance without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out light work
2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about >50% waking hours
3 Capable of only limited selfcare. Confined to bed/chair > 50% waking hours
4 Completely disabled and confined to bed/chair. No self care
5 Deceased
What are the symptoms suggestive of metastatic spinal cord compression?
According to NICE
Progressive pain in spine Unremitting severity Band-like Straining aggravates Tenderness localised Nocturnal Neurological symptoms
An MRI scan shows infiltration of the spinal cord with metastesis. What treatment should you consider at this point?
Steroids - Oral dex
Analgesia - Morphine
Neurosurgical consult
Radiotherapy
Blood test of a patient with metastatic cord compression reveals hypercalcaemia, hyperuricaemia and raised alk phos.
What treatment would you administer?
- Saline infusion - dehydration from hypercalcaemia results in hyperuricaemia
- Dex - for cord compression
- Zoledronic acid - to correct calcium if still high after infusion of saline
What questions would you ask if you suspect brain mets in a patients history?
- Seizures, including focal fits or absences
- Weakness, poor coordination
- Visual symptoms such as double vision
