Oncology Flashcards
What are the indications for testing for BRCA1 and 2?
Tumour supressor genes
1st degree relative under 40 years OR male OR bilateral
More than one 1st degree relative OR two 2nd degree
What are the screening rules for known BRCA mutations?
Annual MRI 30-49 years
Annual mammogram 50-69 years
What is the risk of breast and ovarian cancer with BRCA mutations?
BRCA1 - 60% and 40%
BRCA2 - 45% and 10%
What are the criteria for testing for hereditary bowel cancer?
Two first degree relative under 60 years
What are the red flags for lung cancer?
Over 40 years and haemoptysis, suggestive CXR
Urgent CXR:
Over 40 and recurrent chest infections OR finger clubbing OR 2 of: SOB, cough, fatigue, weight loss, smoker
What are the red flags for upper GI cancer?
Over 40 + jaundice or abdo mass
Over 55 + weight loss + abdo pain or reflux
Dysphagia
Over 60 + weight loss + one of: diarrhoea, abdo pain, constipation, new onset diabetes
What are the red flags for lower GI cancer?
Positive faecal occult blood
Over 40 + abdo pain + weight loss
Over 50 + rectal bleeding
Over 60 + IDA or change in bowel habit
What are the red flags for gynaelogocial cancer?
Ascites
Pelvic mass (fibroids excluded)
Post-menopausal bleeding
What are the red flags for breast cancer?
Over 30 + breast lump
Over 50 + symptoms or nipple change
What are the red flags for urological cancer?
Irregular prostate
Abnormal age specific PSA
Over 40 + visible haematuria
Over 60 + non-visible haematuria + dysuria
What are the criteria for neutropenic sepsis?
Temperature over 38, neutrophils less than 0.5/10x9/L
Which cancers metastasise to bone?
Lung, prostate, breast, myeloma, melanoma
What are the red flags for spinal cord compression?
Cancer history, thoracic back pain, nocturnal pain, sensory loss, bowel/bladder dysfunction
What is the treatment for spinal cord compression?
Admit for bed rest and urgent MRI
Dexamethasone 16mg + PPI
Decompressive surgery/radiotherapy
What are the signs of SVC obstruction?
SOB, orthopnoea, stridor
Plethora or cyanosis
Oedema of face and arm
Engorged neck and chest veins
How is SVC obstruction treated?
Prop up, assess for hypoxia, O2 if needed
16mg dexamethasone
CT
Balloon venoplasty and stenting
What is the treatment of hypercalcaemia?
Aggressive rehydration
Bisphosphonates e.g. zolendronic acid
When does tumour lysis occur?
During chemotherapy for rapidly proliferating tumours
Leukaemia, lymphoma, myeloma
What are the affects of tumour lysis syndrome?
Cell death
High urate, hyperkalaemia, hyperphosphataemia, hypocalcaemia
Risk of arrhythmias and renal failure
What is AFP a marker for?
Germ cell/testicular cancer
Hepatocellular carcinoma
What is calcitonin a marker for?
Medullary thyroid tumours
What is Ca125 a marker for?
Ovarian cancer
What is Ca19-9 a marker for?
Pancreatic cancer
What is Ca15-3 a marker for?
Breast cancer
What is CEA a marker for?
Colorectal cancer
What are paraproteins a marker for?
Myeloma
What cancer screening pathways are available?
Mammography - every 3 years, age 50-75
Cervical smear - every 3 years, age 25-64
Faecal occult blood - every 2 years, age 60-74
How should opioids for palliative care be started?
5mg every 4 hours + 5mg PRN
Increase by 30-50% every 24 hours till pain controlled
Divide daily dose into 2x12hr modified releases
Allow 1/10th-16th as PRN
What are the signs of opioid toxicity?
Sedation, respiratory depression, hallucination, jerks, delirium
Which anti-emetic is contraindicated in PD?
Metoclopramide
How should breathlessness in be treated in palliative care?
Check for underlying effusion, infection, anaemia, VTE
If distressed give opioids
If anxiety related give benzodiazepines
Which drugs can be used for end of life care?
Haloperidol for agitation Midazolam for agitation and anxiety Levomepromazine for nausea Glycopyronium for respiratory secretions Morphine for pain
