Oncology Flashcards
Metaplasia & 2 examples
transformation of one terminally differentiated cell into another e.g. Barrett’s = squamous -> glandular, cigarettes = respiratory to squamous
Dysplasia
Abnormal increased cell growth with 1) cellular atypia 2) decreased differentiation (pre-malignant, but reversible at early stage)
Carcinogenisis
Transformation of normal cells to neoplastic cells through permanent genetic alterations or mutations
Carcinogen
Mutagenic and cause cancers (85% of cancer risk = environmental)chemical, viral, radiation (mel), hormones (breast), parasites (schist)
Characteristics of benign tumours
Morbidity and mortality
Localised Non-invasive Closely resemble normal structure Circumscribed/encapsulated Nuclear morphology = normal
Pressure on adjacent structures
Flow obstruction
Hormone production
Transformation to malignant
Characteristics of malignant tumours
Morbidity and mortality
Invasive Metastatic Rapid growth Variable resemblance to normal structure Poorly defined border (crablike) Increased mitotic activity
Destroy surrounding tissue Metastases Blood loss ulcers Flow obstruction Hormone production Paraneoplastic syndrome
Papilloma
Adenoma
Carcinoma
Adenocarcinoma
Benign epithelial neoplasm non-glandular, non-secretory e.g. SCP
Benign epithelial neoplasm of glandular/secretory
Malignant tumour of epithelial cells e.g. transitional cell carcinoma
Malignant tumour of glandular/secretory epithelium
TMN staging
T: T0 (main tumour not found), TX (main tumour cannot be measured), T1-4 (size and extent)
N: N0 (no cancer in nearby LN), NX (cancer in LN cannot be measured), N1 (tumour to local LNs), N2 (between N1 and N3), N3 (to distant LNs)
M: MX (mets cannot be measured), M0 (no metastasis), M1 (cancer spread)
Indications for radio therapy
Pt medically unfit surgery Anatomically unresectable Close proximity to vital structures Neo-adjuvant to shrink structure, Palliative for bone/brain mets + spinal cord compression
Acute complications of radiotherapy
Fatigue (80%)
Skin - Erythema, dry and moist desquamation, irritation
GI - loss of taste, oral mucositis (complicated by yeast/bacterial superinfection), diarrhoea, nausea, vomiting
BM - cytopenias
Lungs - pneumonitis, fever, cough, dyspnoea
Chronic complications of radiotherapy
Infertility Lymphoedema Delayed healing Loss of salivary flow Transverse myelitis, Lhermitte’s Increased risk CV events/stroke Hypothyroidism
Chemo side effects
Myelosuppression - anaemia, neutropenia, thrombocytopenia (1-2 weeks)
Alopecia
Infertility
Nausea, vomiting and diarrhoea - use domperidone or metoclopramide
Fatigue
Teratogenicity
Mouth ulcers
Anaphylaxis management
Airway managment & 100% O2 Remove the cause & raise legs Adrenaline 0.5mg IM 1:1000 Iv access - Chlorenphenamine 10mg & Hydrocortisone 200mg Fluids If wheeze treat for asthma
Neutropenic sepsis What Presentation Management Risk factors
Suspect with fever in anyone who has had chemotherapy in the last 6W!
Defined as severe neutropenia = < 1 x 10^9/L (mod = 0.5-1)
Temps, new onset confusion, tachycardia, hypotension, hypothermia
Tazocin/Merepenem (if on Methotrexate - Both folate inhib) . Vanc if MRSA
+ GCSF can boost bone marrow production
Type of chemo, length of chemo, elderly
Spinal cord compression
PAIN ± sensory loss at level ± weakness below level ± loss of continence
MRI whole spine, refer to neurosurgery/spinal surgery + IV DEXAMETHASONE + prevention VTE
70% are thoracic
Oncological emergencies
Neutropenic sepsis Spinal cord compression Anaphylaxis SVC obstruction Acute tumour lysis syndrome Hypercalcemia PE
Hypercalcemia aetiology (5)
Humoral (due to tumour produced PTH related peptide) - renal, ovarian, breast, endometrial, squamous cell carcinoma
Local release of osteolytic factors - breast, multiple myeloma
Calcitriol mediated - lymphoma and granulomatous disease
Ectopic PTH (small cell lung Ca)
20% due to unrelated hyperparathyroidism
Symptoms of hypercalcemia
Dehydration + bones, stones, abdominal moans, thrones, psychic overtones
Poor skin turgor/dry mucous membranes (DEHYDRATION)
Bone pain (BONES)
Abdominal pain (STONES)
Constipation, loss of appetite, nausea (ABDOMINAL MOANS)
Polyuria + polydipsia (THRONES)
Confusion + fatigue (PSYCHIC OVERTONES)
Tretament of hypercalcemia
Mod/severe
IV normal saline (reverses dehydration secondary to hypercalcaemia induced nephrogenic diabetes insipidus)
IV bisphosphonates/denosumab (zoledronic acid) - block osteoclastic bone resorption
Furosemide to avoid fluid overload
Symptoms of SVC obstruction
Oedema of face and upper extremities (80%)
Dyspnoea (60%) - worse leaning forward
Facial plethora (venous engorgement)
Cough
Distended neck veins + chest veins - worse leaning forward
Hoarse voice
FIXED (non-pulsatile) & RAISED JVP
Tumour lysis syndrome
2 of
Hyperuricaemia + reduced urinary flow -> uric acid crystals, renal tubule obstruction and decline in renal func (AKI)
Hyperphosphataemia -> calcium phosphate crystals -> nephrocalcinosis and urinary obstruction
Secondary hypocalcaemia due to hyperphosphataemia
Hyperkalaemia from cell degradation
AKI -> fluid overload and pulmonary oedema
Acute treatment of tumour lysis syndrome
Treat hyperkalaemia Intense fluid resuscitation Phosphate binder Rasburicase Alopurinol
->If severe dialysis
Cancers that can metastasise to bone
Breast. Prostate. Lung. Kidney. Thyroid.
Lambert-Eaton Myasthenic Syndrome
Rare AI disorder of NM junction associated with SCLC (50%) + smoking + AI disease
Limb weakness (proximal legs + arms)
Dry mouth (xerostomia + metallic taste) - autonomic
Weakness (Limb girdle + waddling gait)
Dysarthria, ptosis, diplopia, impotence
Carcinoid syndrome
Symptoms due to secretion of serotonin and kinins (vasoactive peptides) from neuroendocrine tumours (gastric carcinoma, bronchial adenoma - carcinoid type, pancreatic carcinoma)
Commonly presents with flushing/diarrhoea (± wheeze, palpitations, telangiectasia, abdo pain)
Treatment - medical therapies (octreotide - somatostatin analogue) + surgical resection
Metastatic spinal compression Mx
Dexamethasone IV
Radio if multiple metastasis
Decompression surgery if single bone met
