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phase 3b > Oncology > Flashcards

Oncology Flashcards

1
Q

What is hodgkins lymphoma?

A

malignant tumour of lymphatic system - characterised histologically by Reed Sternburg Cells

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2
Q

Describe the histology of Hodgkin’s lymphoma

A

Reed Sterburg cells (multinucleated giant cells)

abnormal and smaller mononuclear cells originating from B lymphocytes

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3
Q

Risk factors for Hodgkins lymphoma

A

EBV

previous mononucleosis

HIV

immunosuppression

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4
Q

Presentation of Hodgkins lymphoma

A
  • enlarged but asymptomatic lymph node in lower neck or supraclavicular region (pain with alcohol)
  • cyclical fever
  • chest discomfort - cough dyspnoe (mediastinal lymph node involvement)
  • B symptoms - night sweats, fever, weight loss
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5
Q

Staging of Hodgkins lymphoma

A

Ann Arbor

  1. one lymph node region or structure (spleen, thymus, waldeyers ring)
  2. >1 lymph node region on same side
  3. involvement both sides
    1. splenic, hilar, coeliac or portal
    2. para-aortic iliac or mesenteric
  4. extranodal
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6
Q

Modifying features of Hodgkins lymphoma

A

A: no symptoms

B: night sweats, fever, weight loss

X: > 1/3rd mediastium widening or >10cm diameter of mass

E: extranodal site

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7
Q

Potential examination findings of Hodgkins lymphoma

A

Lymphadenopathy

Hepatomegaly

Splenomegaly

Superior VC syndrome (facial swelling associated with SOB)

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8
Q

Hodgkins lymphoma investigations

A

FBC (leukamia, mono)

ESR (>70 bad prog)

LFT (low albumin bad prog)

HIV

CXR (lymphadenopathy and mediastinal expansion)

Lymph node and bone marrow biopsy (staging)

CT thorax and abdo (staging)

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9
Q

ABVD chemo

A

Doxorubicin

Bleomycin

Vinblastine

Dacarbazine

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10
Q

BEACOPP chemo

A

Bleomycin

Etoposide

Doxorubicin

Cyclophosphamide

Vincristine

Procarbazine

Prednisolone

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11
Q

What can additional things can you give with chemo

A
  • Abx to any pt with severe neutropenia
  • Recombinant human granulocyte colony - stimulating factor stimulates neutrophil production so could reduce duration of chemo induced neutropenia reducing incidence of associated sepsis
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12
Q

Management of Hodgkins lymphoma

A

Early: ABVD then radio (preceeded by BEACOPP in unfavourable prog)

Advanced: ABDV/BEACOPP

ASCT= autologous stem cell transplant

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13
Q

follow up for Hodgkins lymphoma

A

OPD 2-5 years

TFT if radio to neck and upper mediastinum

made aware theyre increased risk of secondary mags, CVD, pulmonary disease and infertility

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14
Q

Prognosis of Hodgkins lymphoma

A

80-90% patients achieve permanent remission

poor prognostic indicators

  • increasing age
  • male
  • B symptoms
    *
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15
Q

what are the oncological emergencies?

A
  1. neutropenic sepsis
  2. spinal cord compression
  3. SVC obstruction with airway compromise
  4. hypercalaemia
  5. tumour lysis syndrome
  6. raised ICP
  7. SIADH
  8. Haemorrhage
  9. Anaphylaxis
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16
Q

Causes and presentation of neutopenic sepsis

A

Bone marrow suppression due to chemo

usually presents 5-12 days after chemo

generally unwell, confusion or drowsiness

HR>90 RR>20

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17
Q

Investigations and management of neutropenic sepsis

A
  • Septic screen
  • neutrophils <0.5 with either temp>38 or Sx sepsis

Mx: immediate empirical Abx - IV Tazosin

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18
Q

Cause and presentation of spinal cord compression

A

causes: extradural mets, direct extension of tumour, crush fracture

Presentation: back pain, weakness, sensory loss, bowel and bladder dysfunction

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19
Q

Investigations and management of spinal cord compression

A

Ix: URGENT MRI whole spine

Mx: dexa, radio, decompression surgery

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20
Q

SVC obstruction causes

A

malignancy

  • lung
  • thymus
  • lymphoma
  • mediastinal enlargement

thrombotic disorders

thrombus around IV Central line

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21
Q

SVC obstruction presentation

A

Dyspnoea, orthopnoea

cyanosis

face/arm swelling

cough

headache

engorged veins

22
Q

SVC obstruction test, investigations and management

A

Pembertons test: hold arm about head for more than 1min = cyanosis, increased JVP, insp stridor

Ix: URGENT contract CT

Mx: dexo, SVC stent, balloon venoplasty

23
Q

Raised ICP causes and presentation

A

Causes: Primary CNS tumour, mets (breast, bowel, kidney, lung, skin)

Px: headache, focal neuro, N&V, papilloedema, fits

24
Q

Raised ICP investigations and management

A

Ix: URGENT MRI/CT

Mx: dexa, radio or surgery, mannitol for symptomatic

25
Q

Tumour lysis syndrome cause

A

rapid cell death after starting chemo causes release of cell contents

rise in serum urate K+ and phosphate precipitating renal failure

seen 12-72 hours after chemo

26
Q

Presentation of tumour lysis syndrome

A
  • fatigue
  • N&V
  • diarrhoea
  • weakness and cramps
  • seizures
27
Q

Tumour lysis syndrome investigations

A

increased uric acid

increased K+ and phosphorus

decreased calcium

28
Q

Tumour lysis syndrome prophylaxis

A

hydration
low risk: allopurinol 7 days before chemo
high risk: Rasburicase stat dose

29
Q

Neutropenic sepsis prophylaxis

A

Ciprofloxacin (fluroquinolone) during expected period of neutropenia

30
Q

Hypercalaemia causes

A

lytic bone mets

myeloma

tumour producing osteoclast activating factor or PTH like hormones

31
Q

hypercalaemia presentation

A
  • bones
  • stones
  • abdo groans (and constipation)
  • fatigue
  • N&V
32
Q

Investigations and management of hypercalaemia

A

Ix: high serum calcium >2.6

Mx: rehydrate IV bisphosphonate

33
Q

Patho behind non-hodgkins lymphoma

A

Genetic mutation causes B/T cells to divide uncontrollably producing a neoplastic cell.

This can be

1) nodal lymphoma

2) extranodal lymphoma
- GI tract
- Bone Marrow
- Spinal cord

34
Q

What types of B cell lymphoma are there?

A

Indolent e.g. follicular lymphoma and marginal zone lymphoma

aggressive e.g. Diffuse large B cell lymphoma
mantle cell lymphoma

highly aggressive e.g. Burkitts lymphoma (chromosomal translocation 8->14) associated with EBV

35
Q

Types of T cell lymphoma

A

adult T cell lymphoma

mycosis fungoides

36
Q

Non-Hodgkins lymphoma symptoms

A

gastric MALT: GORD + constitutional symptoms

Burkitts: abdo swelling, nausea and diarrhoea

37
Q

NHL investigations

A

Lymph node biopsy

CT - staging

38
Q

NHL Management

A

localised - Radiotherapy

High grade - R-CHOP

Rituximab
Cyclophosphamide
Hydroxydaunomycin
Vincristine
Prednisolone

39
Q

Which cancer is associated with coeliac disease?

A

small bowel T cell lymphoma

40
Q

What is bacteria is assoicated with Burkitts lymphoma?

A

H. pylori

41
Q

how do you treat h.pylori?

A

PPI

clarithromycin

metronidazole or amoxicillin

42
Q

What are the possible causes of a mediastial tumour?

A

Terrible lymphoma (Hodgkins)

Teratoma

Thymoma

Thyroid Mass

43
Q

Tumour Lysis Management

A
  • Hydration, 10mls 10% calcium gluconate (lowers potassium, protects the heart)
  • 10 units rapid acting insulin and 50mls 50% glucose
  • Calcium polystyrene sulfonate (reduces K+ )
  • ±furosemide
  • Rasburicase (reduces Uric acid)
  • Aluminium hydroxide (reduces phosphate)
  • Haemodialysis
44
Q

Causes of SIADH

A
  • Produced by SCLC
  • Brain: Meningitis
  • Lung: Pneumonia, TB
  • Alcohol withdrawal
  • Drugs: opiates, carbamazepine, vincristine, cyclophosphamide
45
Q

Presentation of SIADH

A

Mild – nausea, vomiting, headache, anorexia, lethargy

Moderate – muscle cramps, weakness, confusion

Severe – drowsiness, seizures, coma

46
Q

Signs of SIADH

A

Signs: hyporeflexia, ataxia, tremour

47
Q

Investigations of SIADH

A
  • High ADH
  • Urine: Hyperosmolar and hypernatraemic
  • Plasma: Hypo-osmolar and hyponatraemic, low uric acid
  • Normal BP, thyroid and adrenal function

Test: give saline - Na depletion responds, SIADH doesn’t

48
Q

SIADH management

A

Treat cause

Fluid restriction - maybe lifelong

Tolvaptan - V2 receptor antagonist which stops aquaporins

49
Q

What is anaphylaxis?

A

Type 1 hypersensitivity reaction

IgE mediated

50
Q

How do you manage anaphylaxis?

A
  • ABCDE
  • High flow 02
  • IM adrenaline 0.5MG (1in 1000)
  • Repeat after 5 mins X3 then switch to IV
  • IV fluid - 500ml bolus in 5/10 mins
  • Chlorphenamine 10mg IM
  • Hydrocortisone 200mg IM

phase 3b (15 decks)

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