Oncology Flashcards
Neutropenic sepsis
Temp >38 and neutrophil count <0.5x109/L
Suspect in all patients and within 6w of receiving chemotherapy
Localising signs may be absent
Examine in dwelling catheter sites
Use local guidelines or treat empirically with piperacillin/tazobactam
Spinal cord compression
Most commonly associated with lung, prostate, breast, myeloma, melanoma
Cause- collapse or compression of vertebral body due to mets
Signs and symptoms- back pain. Worry if cervical/thoracic back pain. Limb weakness, difficulty walking, sensory loss, bowel/bladder dysfunction
Management- bed rest and urgent MRI. Dexamethasone 16mg/24h + prophylactic gastroprotection and blood glucose monitoring. Radiotherapy within 24h of MRI diagnosis
Patients with loss of motor function >48h unlikely to recover
Superior vena syndrome
Reduced venous return from head, neck and upper limbs. Due to extrinsic compression or venous thrombosis.
Most common cancers- lymphoma, metastatic, thymoma, germ cell
Signs- SOB, orthopnoea, strider, plethora/cyanosis, oedema of face and arm, cough, headache, engorged neck veins (non pulsatile raised JVP), engorged chest wall veins. Pembertons test
Management- oxygen if needed. Dexamethasone 16mg/24h. Balloon venoplasty and SVC stenting rapid relief of symptoms. Radiotherapy or chemotherapy depending on sensitivity of underlying cancer
Malignancy- associated hypercalcaemia
Poor prognostic sign: 75% mortality within 3 months
Cause- PTH related protein produced by tumour, local osteolysis e.g. myeloma, tumour production of calcitriol
Signs- weight loss, anorexia, nausea, polydipsia, polyuria, constipation, abdominal pain, dehydration, weakness, confusion, seizure, coma
Management- aggressive rehydration. Bisphosphonates e.g. zolendronic acid IV. Long term- control of underlying malignancy
Paraneoplastic syndromes
Hypercalcaemia SIADH Cushing’s syndrome Neuropathy Lambert-Eaton myasthenia syndrome Acanthosis nigricans Dermatomyositis + polymyositis
Brain metastases
Most commonly: lung, breast, colorectal, melanoma
Poor prognosis
Headache, focal neurological signs, ataxia, fits, nausea, vomiting and papilloedema
Urgent CT/MRI depending on underlying diagnosis. Dexamethasone 16mg/24h to reduce cerebral oedema .
AFP tumour marker
Relevant cancer: germ cell/testicular, hepatocellular
Other:Colorectal, gastric, HPB, lung cancer
Ca125 tumour marker
Relevant cancer: ovarian
Other: Breast, cervical, endometrial, hepatocellular, lung, non-Hodgkin’s lymphoma, pancreatic, medullary thyroid, peritoneal, uterine
Ca 19-9
Relevant cancer: pancreatic
Other: colorectal, gastric, hepatocellular, oesophageal, ovarian
Ca 15-3
Main: breast
Other: hepatocellular, pancreatic
Carcionembyonic antigen (CEA)
Main; colorectal
Other: breast, gastric, lung, mesothelioma, oesophageal, pancreatic
hCG tumour marker
Main: Germ cell/ testicular, Gestational trophoblastic
Other: lung
Opioid conversion
Oral Codeine- oral morphine (divide by 10)
Oral tramadol- oral morphine (divide by 10)
Oral morphine- sc morphine (divide by 2)
Oral morphine - sc diamorphine (divide by 3)
Investigation metastatic disease of unknown primary (general)
FBC, U&E, LFT, calcium, urinalysis, LDH
CXR
CT TAP
AFP and hCG
Investigation metastatic disease of unknown primary (specific)
Myeloma screen (lytic bone lesions)
Endoscopy (directed towards symptoms)
PSA (men)
CA125 (women with peritoneal malignancy or ascites)
Testicular USS (men with germ cell tumour)
Mammography (women with clinical or pathological features compatible with breast Ca)
