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Revision lectures > Oncology > Flashcards

Oncology Flashcards

1
Q

Spinal cord compression symptoms

A

Pain in spine

Worse on coughing and straining

RADICULAR - band like burning pain sometimes with hypersensitivity - precedes weakness

Weakness, sensory changes, bladder retention, constipation

Usually thoracic region

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2
Q

Diagnosis of spinal cord compression

A

URGENT MRI OF SPINE

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3
Q

Treatment of spinal cord compression

A

Steroids - Dexamethasone
(16mg IV, 8mg PO BD aim to reduce vasogenic oedema)

Surgery

Radiotherapy

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4
Q

Surgery for spinal cord compression

A 
Should be considered in any patient with...
Single vertebral region of involvement
No evidence of widespread mets
Radio resistant primary eg renal sarcoma
Previous RT to site
Unknown primary (can get tissue)

Improves pain in 75-100%
Improves neurology in 50-75%

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5
Q

Radiotherapy for spinal cord compression

A

Mainstay of treatment
20Gy/5#

Slowest decline in motor function have best outcome

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6
Q

Junior doctor and see someone with radicular pain…

A

CORD COMPRESSION

STEROIDS

URGENT MRI

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7
Q

Symptoms of superior vena cava obstruction

A

Swelling of face, neck and one or both arms (one arm suggest more distal)

Distended veins

SOB

Headache

Lethargy

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8
Q

Signs of SVCO

A

Early
Puffy neck, neck veins don’t collapse

Later
Distended neck and chest wall veins. Swollen face, neck and arms

Advanced
Injected conjunctiva. Sedated

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9
Q

SVCO Ix

A

Main aim

  • is obstruction from within - clot (fast onset), foreign body, tumour in vessel
  • is obstruction from without - extrinsic compression from mass

Ix
CXR for mass
Venogram for clot
CT Chest

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10
Q

SVCO Treatment of clot

A

Thrombolysis - alteplase

Anti coagulate - LMWH or warfarin

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11
Q

SVCO Treatment of extrinsic compression

A

Steroids (frequently prescribed but no evidence)

Chemotherapy (used for SCLC, lymphoma and teratoma, response 70%)

Radiotherapy (used for other malignant causes, response 60%)

Stent (95% response and rapid relief if symptoms but doesn’t treat cause)

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12
Q

Hypercalcaemia Causes

A

Affects 10-30% of cancer patients

Humoural (often mediated by PTHrP)

Local bone destruction (esp. lung breast and myeloma)

Tumour production of Vit D analogues (esp. lymphomas)

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13
Q

Symptoms of hypercalcaemia

A

Nauseated, anorexic

Thirsty

Polydipsia and polyuria

Constipated

Confused

Poor concentration, drowsy

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14
Q

Investigations of hypercalcaemia

A

Calcium (normal 2.1-2.6)

Albumin to correct calcium

U&Es - looking for dehydration

Phosphate - low in hyperparathyroidism

If no known malignancy - myeloma screen

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15
Q

Treatment of hypercalcaemia

A

REHYDRATION FIRST
several litres of normal saline
If risk of cardiac failure consider CVP measurements

BISPHOSPHONATES
60-90mg pamidronage IV over 2 hours
Rehydrate first incase of renal failure
Takes up to a week to work

Systematic management of malignancy

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16
Q

Pericardial Effusion Causes

A 
Malignant
Trauma - injury, post op, iatrogenic 
Infection - TB, viral
Post MI
Connective tissue disease eg SLE Rheumatoid
Drugs eg hydralazine, isoniazid
Uraemia
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17
Q

Symptoms of malignant pericardial tamponade

A

SOB

Fatigue

Palpitations

Pericarditis symptoms eg chest pain improves on sitting forward

Signs on advanced cancer

Diastolic heart failure

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18
Q

Malignant Pericardial Tamponade

A

Signs - Becks Triad

Jugular venous distension

Pulsus paradoxus - venous return drops when intra thoracic pressure raised

Soft heart sounds or pericardial rub

Poor cardiac output - tachycardia with low BP and poor peripheral perfusion

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19
Q

Malignant Pericardial Tamponade - Ix

A

CXR - enlargement of cardiac silhouette

ECG - reduced complex size

Echocardiogram - rim of pericardial fluid

Cytology of pericardial fluid

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20
Q

Treatment of Malignant Pericardial Tamponade

A

Pericardiocentesis - drain into pericardium

Pericardial window - operation to allow pericardial fluid to drain into pleural cavity

Systemic management of malignancy

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21
Q

Definition of neutropenia sepsis

A

Sepsis + Neutrophil under 0.5

Or under 1 if chemotherapy given within last 21 days

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22
Q

Neutropaenic Sepsis Manage

A

Assess within 15 mins

If chemotherapy in last three weeks AND temp above 37.5
OR
clinically septic
= initiate antibiotics within 1 hr

Don’t wait for bloods before full septic screen
If neutrophils over 0.5 use antibiotic man
If neutrophils equal or under 0.5 use neutropenic sepsis protocol

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23
Q

Signs and symptoms of pulmonary embolism

A 
Acute deterioration in SOB
Tachypnoea
Tachycardia
Low pa CO2 - blowing it off
Pleuritic chest pain
Unilateral leg swelling
24
Q

Ix for pulmonary embolism

A 
CTPA 
ABG
O2 sats
ECG
Bloods
25
Q

Management of pulmonary embolism

A

Supportive - O2, IV fluids, resus
Anticoagulation
For most cancer patients this is LMWH for 6 months

Consider rivaroxaban if recurrent DVTs/PE

Prevention better than cure

High mortality rate

26
Q

Breakthrough dosing of morphine

A

1/6th of total daily dose

27
Q

Performance Status

A

0 - no restrictions
1 - unable to do strenuous activities but able to do light housework
2 - able to walk and manage self care, unable to work, out of bed more than 50% waking hours
3- confined to bed or chair more than 50% waking hours. Limited self care
4 - completely disabled, totally bed or chair confined, unable to do any self care
5 - death

28
Q

WHO analgesic ladder

A

Step 1
Non-opioid. With/without adjuvant analgesic

Step 2
Opioids for mild to moderate pain. Plus non- opioids. With/without adjuvant analgesic

Step 3
Opioids for moderate to severe pain. Plus non-options. With/without adjuvant analgesic

29
Q

Radiotherapy prescribed in

A

Gray

30
Q

Chemo dose calculated according to patients..

A

Calculated surface area

31
Q

SVCO caused by clot

A

Should NOT be stented

32
Q

Cancers screened for in U.K.

A

Breast
Colorectal
Cervical

33
Q

When starting a patient on opiate analgesia you should also prescribe

A

An anti-emetic
A laxative
Paracetamol

34
Q

Calcitonin is a marker for..

A

Medullary thyroid cancer

35
Q

CA125

A

Ovarian cancer

36
Q

CA 19-9

A

Pancreatic cancer

37
Q

CA 15 3

A

Breast cancer

38
Q

AFP

A

Hepatocellular carcinoma

Teratoma

39
Q

CEA (carcinoembryonic antigen)

A

Colorectal cancer

40
Q

Bombesin

A

Small cell lung carcinoma

Gastric cancer

Neuroblastoma

41
Q

S 100

A

Melanoma

Schwannoma

42
Q

Equivalent dose or oral morphine to subcut morphine is…

A

50%

So if taking 60mg BD oral morphine…

Give 60mg in 24hrs of subcut

43
Q

Codeine to morphine conversion

A

Divide by 10

44
Q

Palliative care prescribing for agitation and confusion

A

First line is oral haloperidol

45
Q

Bleomycin Side Effect

A

Lung fibrosis

46
Q

Doxorubicin side effect

A

Cardiomyopathy

47
Q

Cyclophosphamide side effect

A

Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

48
Q

Methotrexate side effects

A

Myelosuppression
Mucositis
Liver fibrosis
Lung fibrosis

49
Q

Vincristine side effects

A

Peripheral neuropathy

Paralytic ileus

50
Q

Cisplatin side effects

A

Ototoxicity
Peripheral neuropathy
Hypomagnesaemia

51
Q

Syringe drivers

Respiratory secretions

A

Hyoscine hydrobromide

52
Q

Syringe drivers

Bowel colic

A

Hyoscine butyl bromide

53
Q

Low risk of nausea and vomiting post chemo

A

Give metoclopramide

54
Q

High risk vomiting and nausea post chemo

A

Give 5HT3 receptor antagonists such as ondansetron (can combine with decamethasone)

55
Q

Conversion from oral morphine to diamorphine

A

Total daily oral dose divided by 3

56
Q

Preferred opioids in CKD

A

Alfentanil
Buprenorphine
Fentanyl

57
Q

Palliative care - treating hiccups

A

Chlorpromazine

Haloperidol

Revision lectures (15 decks)

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