Oncology Flashcards
Spinal cord compression symptoms
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
Diagnosis of spinal cord compression
URGENT MRI OF SPINE
Treatment of spinal cord compression
Steroids - Dexamethasone
(16mg IV, 8mg PO BD aim to reduce vasogenic oedema)
Surgery
Radiotherapy
Surgery for spinal cord compression
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%
Radiotherapy for spinal cord compression
Mainstay of treatment
20Gy/5#
Slowest decline in motor function have best outcome
Junior doctor and see someone with radicular pain…
CORD COMPRESSION
STEROIDS
URGENT MRI
Symptoms of superior vena cava obstruction
Swelling of face, neck and one or both arms (one arm suggest more distal)
Distended veins
SOB
Headache
Lethargy
Signs of SVCO
Early
Puffy neck, neck veins don’t collapse
Later
Distended neck and chest wall veins. Swollen face, neck and arms
Advanced
Injected conjunctiva. Sedated
SVCO Ix
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
SVCO Treatment of clot
Thrombolysis - alteplase
Anti coagulate - LMWH or warfarin
SVCO Treatment of extrinsic compression
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)
Hypercalcaemia Causes
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)
Symptoms of hypercalcaemia
Nauseated, anorexic
Thirsty
Polydipsia and polyuria
Constipated
Confused
Poor concentration, drowsy
Investigations of hypercalcaemia
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
Treatment of hypercalcaemia
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
Pericardial Effusion Causes
Malignant Trauma - injury, post op, iatrogenic Infection - TB, viral Post MI Connective tissue disease eg SLE Rheumatoid Drugs eg hydralazine, isoniazid Uraemia
Symptoms of malignant pericardial tamponade
SOB
Fatigue
Palpitations
Pericarditis symptoms eg chest pain improves on sitting forward
Signs on advanced cancer
Diastolic heart failure
Malignant Pericardial Tamponade
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
Malignant Pericardial Tamponade - Ix
CXR - enlargement of cardiac silhouette
ECG - reduced complex size
Echocardiogram - rim of pericardial fluid
Cytology of pericardial fluid
Treatment of Malignant Pericardial Tamponade
Pericardiocentesis - drain into pericardium
Pericardial window - operation to allow pericardial fluid to drain into pleural cavity
Systemic management of malignancy
Definition of neutropenia sepsis
Sepsis + Neutrophil under 0.5
Or under 1 if chemotherapy given within last 21 days
Neutropaenic Sepsis Manage
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
Signs and symptoms of pulmonary embolism
Acute deterioration in SOB Tachypnoea Tachycardia Low pa CO2 - blowing it off Pleuritic chest pain Unilateral leg swelling
Ix for pulmonary embolism
CTPA ABG O2 sats ECG Bloods
