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Specialties > Oncology > Flashcards

Oncology Flashcards

1
Q

Causes of hypercalcaemia

A

Hyperparathyroidism (see endocrine for more detail)
Malignancy (1 or 2)
- Lytic bone mets
- Primary - myeloma!!
- PTHrP - renal, endometrial, ovarian, breast, SquamousC
- Ectopic PTH release - small cell carcinoma
- Calcitrol release - lymphoma

Dehydration
D vitamin D - granulomatous disease - TB, sarcoidosis
Drugs - benzos

Weird and wonderful
Addison’s
Thyrotoxicosis
Gitelmans disease

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2
Q

Presentation of hypercalcaemia

A 
Bones - bone pain
Stones - renal stones
Groans - abdominal pain 
Thrones - CONSTIPATION + polydipsia, polyuria
Psychic moans - depression

Important:
Arrhythmia - short QT
Hypertension

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3
Q

Investigations for hypercalcaemia

A 
Serum shite: 
PTH
Corrected calcium 
(0.02 x [normal albumin - pt albumin] + calcium
PTHrP 
Serum phosphate 
Vitamin D 
Calcitrol

ECG - short QT

Skeletal survey!

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4
Q

Management of hypercalcaemia

A

REHYDRATE REHYDRATE

IV fluids

IV bisphosphonates (inhibit osteoclast activity) 
- S/E - flu like symptoms, headache, jaw osteonecrosis, N+V

Denusomab (RANK-L inhibitor)

Furosemide to get rid of the calcium (but bewarre this can cause dehydration and worsen hypercalcaemia)

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5
Q

Tumour lysis syndrome TLS

Pathophysiology

A

Excessive cell lysis –> release of a lot of cell shite:

Phosphate –> hyperphosphataemia

  • Binds to free Ca –> less free Ca –> hypocalcaemia
  • Causes urinary obstruction
  • Causes arrhythmias

DNA –> uric acid excess (–> + AKI + fluid overload)

Potassium –> hyperkalaemia

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6
Q

RF for tumour lysis syndrome

A

Cancer specific

  • high cell turnover - ALL, Lymphoma (burkitt)
  • Responsive to radio/chemo

Patient specific

  • Dehydration
  • Renal impairment
  • Current high levels of uric acid
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7
Q

Features of tumour lysis syndrome

A

Arrhythmias (+ chest pain, syncope, palps)
Syncope
Seizures (hypoCa)
AKI type symptoms, dehydration, obstruction
Hypocalcaemia features including
- Troussier
- Chvostek

General electrolyte imbalance symptoms
D+N+V
Syncope

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8
Q

Investigations for tumour lysis syndrome

A

Imbalances: by 25%

  • Hyperkalaemia
  • Hyperphosphataemia
  • High uric acid
  • Hypocalcaemia

ECG - long QT (due to hypoCa)

U+Es - raised urea and creatinine (x1.5)

others:
^WCC, LDH

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9
Q

Prevention of tumour lysis syndrome

A

Moderate risk

  • IV fluids
  • Allopurinol

High risk

  • IV fluids
  • Rasburicase
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10
Q

Management of tumour lysis syndrome

A

IV fucking fluids

Phosphate binder
Treat hyperkalaemia (you know the shebang)
Calcium supplement IF symptomatic
Rasburicase

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11
Q

Causes of SVCO

A

Inside the vessel
- Thrombus

Inside the vessel wall
- Tumour invasion

Outside

  • Lymphoma - 15%
  • Lung 75% (50% non - small cell, 25% small cell
  • Mets
  • Germ cell tumour
  • ALL
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12
Q

Presentation of SVCO

A

Lungs

  • Dyspnoea
  • Cough
  • Hoarse voice
  • Resp distress
  • Cyanosis

Cardio

  • PULSELESS JVP
  • Chest pain

Visual signs (lol that isn’t a thing)

  • distended veins
  • Red ass face
  • Face, neck, arm swelling
  • Engorged conjunctiva

Neuro

  • Dizziness
  • Headache
  • Visual disturbance
  • Syncope
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13
Q

Investigations for SVCO

A

CXR - widened mediastinum. lung mass

CT

Doppler studies

Invasive contrast venography

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14
Q

Management of SVCO

A

O2
High dose steroids - DEX 10mg bolus
Endovascular stenting

Radio/chemo

Treat le cause

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15
Q

Causes of spinal cord compression

A 
METS 
Disc prolapse 
Primary cancer 
Osteomyelitis 
Haematoma 
RA changes 
Osteophytes
Fractures (actually rare)

∆∆ spinal stroke - similar symptoms

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16
Q

Presentation of spinal cord compression

A

BACK PAIN + leg pain
FND
Bowel and bladder
Saddle anaesthesia

Really cba to type this out for the 1000th time xo

REMEMBER
disc prolapse = sudden onset
metsSCC = gradual

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17
Q

Investigations for spinal cord compression

A

WHOLE SPINE MRI

Normal bloods (+ESR/CRP!)
Blood cultures if suspected infective cause
18
Q

Management of spinal cord compression

A

IF YOU SUSPECT SCC - GIVE IV DEX
16mg bolus + PPI + monitor blood sugars

Pain relief

Definitive
Radio/chemo (in the context of oncology)
Surgical decompression

VTE prophylaxis

19
Q

Definition of neutropenic sepsis

A

Neutrophil count of <1x10-9

Temp >37.5 >1 site >1hr apart

20
Q

Which primary cancers met to bone

A 
Breast 
Bronchus 
Bidney 
Brostate 
Bhyroid

lol what the F even is this

21
Q

Investigations for neutropenic sepsis

A

Sepsis 6

do NOT do a fudging LP

22
Q

Management for neutropenic sepsis

A

Abx per local Gz

Tazocin (remember this has penicillin in it)

Add gent if

  • neutropenia confirmed
  • U+E fine
23
Q

Prevention of neutropenic sepsis

A

For people undergoing specific chemo regimes that make them more susceptible

Ciprofloxacin

G-CSF (granulocyte colony stimulating factor)

24
Q

Definition of hypercalcaemia

A

> 2.6mmol/L

25
Q

Types of radiotherapy (modes)

A

External beam
Internal (brachytherapy)
Stereotherapy

26
Q

Indications for radiotherapy

A 
Before or after surgery 
Pt unfit for surgery 
Tumour inoperable 
SCC 
Brain/bone mets
27
Q

Complications/ side effects of radiotherapy

A

Acute
Fatigue
Cytopenias
GI - oral mucositis, Loss of taste, N+V, dysphagia
Lung - fever, dyspnoea, cough, penumonitits (pred.)
SKIN - erythema/desq/irritation
GU - urinary frequency

Long term 
Infertility 
Secondary cancer 
Lymphoedema 
Hypothyroidism

Delayed healing
Loss of salivary flow
Transverse myelitis

Erectile dyfunction

28
Q

N+V Rx in radiotherapy

A

Metoclopromide

29
Q

Side effects of chemotherapy

A 
Infertility 
N+V+Constipation 
Skin rashes 
Myelosuppression 
peripheral neuropathy 
Teratogenic 
ALOPECIA 
renal imp
heart failure 
hepatic imp
30
Q

Mr James Lee is a 68 year old gentleman who presented to his GP with painless haematuria. He was referred under the two week wait criteria to the urologists. They found him to have muscle invasive bladder cancer (transitional cell carcinoma).

  1. List two other sites where transitional cell carcinoma can occur?
  2. List three risk factors for bladder cancer.
A

Urethra
Ureter
Renal pelvis

Azo dyes 
Smoking 
Schistosomiasis 
Others:
Pelvic radiation
31
Q

This gentleman is found to have lymph node metastases.

  1. List 2 groups of lymph nodes that drain the bladder?
  2. The blood supply to the bladder is from the vesical arteries. Which blood vessel do these branch from?
A

Obturator
External iliac
Internal iliac
common iliac

Internal iliac arteries –> umbilical –> Superior vesical artery

32
Q

Six months later, Mr Lee is admitted with leg weakness. He is diagnosed with cauda equina syndrome.

  1. What two findings would you find when performing a PR examination on this gentleman?
A

Reduced anal tone

Reduced/absent perianal sensation

33
Q

Mrs Mel Dawes is a 49 year old receptionist. She found a 2cm breast lump and was referred to the breast surgeons.

  1. List three differential diagnoses for a breast lump.
  2. List three features of a lump that would increase your suspicions of the lump being malignant?
A 
Fibroadenoma 
Cyst 
Galactocoele 
Fat necrosis 
Intraductal pappiloma

FEATURES OF THE ACTUAL LUMP

  • Immobile
  • Rough edges
  • Painless

Others

  • Peau d’orange
  • Tethering
  • Nipple discharge/ inversion
34
Q

She undergoes a wide local excision and a sentinel node biopsy identifies a positive lymph node. She subsequently undergoes axillary clearance. Her tumour is found to be ER+, HER2+.

  1. List three treatments she is likely to be offered.
A

Tamoxifen
Herceptin
Radiotherapy
Chemo

35
Q

Two years later she (breast ca) presents to A&E with thirst and confusion. She has not opened her bowels for 5 days.

  1. What is her diagnosis and the likely underlying cause?
  2. What treatment will you instigate immediately?
A

HYPERCALCAEMIA

IV FLUIDZ

36
Q

Her mother died of breast cancer aged 40 and her grandmother died of breast cancer aged 48. Her Aunt died of ovarian cancer.

  1. What genetic mutation should Mrs Dawes’ younger sister be tested for?
A

BRCA 1+2

37
Q

Question 3 – CML

Mr Ken Smith is an elderly gentleman who has recently been diagnosed with chronic myeloid leukaemia (CML).

  1. The preceding week he had a bone marrow biopsy. Where is the most common site for a bone marrow biopsy to be taken?
  2. What is the typical genetic translocation often identified in patients with CML? What is the name given to the affected chromosome?
  3. What test is performed to identify this genetic abnormality?
  4. What class of drug is used to treat CML?
A

posterior iliac crest

Philadelphia chromosome
9-22?

karyotype or FISH

Imatinib (tyrosine kinase inhibitor)

38
Q

Jonathan Selby is a 21 year old gentleman who noticed a lump in his left testicle whilst in the shower. He went to his GP who confirmed the lump was palpable
1. State one investigation should the GP consider requesting?

He is seen by a consultant urologist and proceeds to an orchidectomy.
2. Where should the surgeon make the incision and why?

A

Testicular USS

Inguinal incision

39
Q

Dominic Fox is a gentleman who has been having urinary symptoms of frequency, urgency and nocturia for 6 months. He is not known to have a diagnosis of cancer.

  1. List 2 differential diagnosis of his symptoms?
  2. What blood test might you perform to help rule out/confirm a diagnosis of prostate cancer?
A

SIADH
Prostate cancer

PSA

40
Q

Dominic Fox is a gentleman who has been having urinary symptoms of frequency, urgency and nocturia for 6 months. He is not known to have a diagnosis of cancer.

  1. List 2 differential diagnosis of his symptoms?
  2. What blood test might you perform to help rule out/confirm a diagnosis of prostate cancer?
A

SIADH
Prostate cancer
BPH

PSA

41
Q

SCC - mets vs disc prolapse - whats the 1 thing in the Hx that will give this away

A

Mets = slow decline

Disc prolapse - acute onset

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