Oncology Flashcards

1
Q

What 2 hormones control calcium?

A

PTH

Calcitonin

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2
Q

How is serum calcium increased?

A

thyroid gland releases calcitonin

  • this causes reduced calcium uptake in the kidneys
  • stimulates calcium deposition in bones
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3
Q

how is serum calcium decreased?

A

parathyroid gland releases PTH

  • calcium release from bones
  • calcium uptake in kidneys increased (via active Vit D causes increase in ca uptake in intestines as well)
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4
Q

causes of hypercalcaemia?

A

Normal PTH:
direct bone destruction i.e. cancer
PTHrP- released by some cancers e.g. breast, kidney, lung, head and neck

High PTH:

  • primary hyperparathyroidism
  • sarcoidosis
  • vit D intoxication
  • lithium
  • dehydration
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5
Q

features of hypercalcaemia?

A

bones, stones, groans and moans
GI groans-pain, constipation, N&V, weight loss, dehydration
Moans- depression, fatigue, weakness, confusion

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6
Q

Ix of hypercalcaemia?

A
corrected calcium levels
ECG- shortened QT interval
U&Es
Bone profile
CXR- sarcoidosis
Isotope bone scan
24hr urinary Ca excretion
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7
Q

what blood features should make you think of malignancy with hypercalcaemia?

A

low albomin, Cl and K
high phosphate, alk phos
alkalosis
PTH normal

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8
Q

tx of hypercalcaemia?

A

treat cause
correct dehydration- IV 0.9% saline, 3L over 24 hours
bisphosphonates- inhibits osteoclasts e.g. pamidronate, zoledronic acid (monthly via IV)
chemotherapy
steroids in sarcoidosis
denosumab- inhibits osteoclast maturation

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9
Q

SEs of bisphosphonates?

A

flu, oesophagitis, osteonecrosis of the jaw, bone pain, myalgia, reduced phosphate levels, N&V

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10
Q

what levels does the spinal cord end?

A

L1

forms cauda equina

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11
Q

what spinal nerves cause knee jerk reflex?

A

l3/l4

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12
Q

what spinal nerve causes ankle jerk reflex?

A

S1

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13
Q

causes of spinal cord compression?

A
malignancy- primary or secondary
trauma
disc prolapse
inflammatory disease e.g. RA
spinal infection
epidural or subdural haematoma
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14
Q

presentation of SCC?

A
back pain
radicular pain
leg or arm weakness
sensory level
bladder and bowel dysfunction
ED
abnormal neuro exam
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15
Q

Ix of SCC?

A

MRI whole spine

bloods- FBC, U&E, LFTs (could indicate lever mets)

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16
Q

tx of SCC?

A
Analgesia
dexamethasone 8mg BD
PPI
surgery
radiotherapy
chemo
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17
Q

cause of superior vena cava obstruction?

A

90% due to small cell lung cancer
non-SCLC
lymphoma

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18
Q

features of SVCO?

A

Dyspnoea, chest pain, cough, neck arm and face swelling, dizziness, headache, blurred vision
visual compensatory collaterals
Pemberton’s sign= raising arms up to face worsen SOB, cyanosis and facial congestion

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19
Q

Ix of SVCO?

A
clinical diagnosis
CXR- widened mediastinum or mass on RHS of heart
CT scan
biopsy of any masses
doppler studies
invasive studies- venography
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20
Q

mx of SVCO?

A
elevation of the head and oxygen therapy may provide symptomatic relief
High dose- dexamethasone
endovascular stenting
radiotherapy
chemo
diuretics for breathlessness
anticoagulation
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21
Q

what is neutropenic sepsis?

A

oral temp >38 degrees or 2 consecutive readings of >37.5 degrees AND
an absolute neutrophil count <1x 10^9/L or expected to fall below 1x10^9/L

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22
Q

presentation of neutropenic sepsis?

A

any infective symptoms
asymptomatic yet febrile
can follow cytotoxic chemotherapy

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23
Q

Ix of neutropenic sepsis?

A

as per local guidelines
IV Piperacillin with Tazobactam (tazocin) (don’t wait for results of blood tests)
Assess risk of septic complications- AKI, DIC, organ failure
Oral abx for low risk patients

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24
Q

prophylaxis of neutropenic sepsis?

A

fluoroquinolone while undergoing chemotherapy

G-CSF (granulocyte colony- stimulating factor)

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25
Q

Side effects of radiotherapy?

A

N&V, anorexia, mucositis, oesophagitis, diarrhoea, skin rashes

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26
Q

types of chemotherapy?

A

1) cytotoxic:
- alkylating agents e.g. cisplastin
- anti-metabolites- e.g. methotrexate
- natural products e.g. bleomycin
2) hormonal therapy
3) molecular targeted therapy

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27
Q

SEs of chemotherapy?

A

HF, nausea, taste change, hepatic impairment, immune suppression, peripheral neuropathy, constipation, hair loss, skin rashes, renal impairment, infertility

28
Q

palliative care drug for resp secretions?

A

hyoscine hydrobromide

29
Q

palliative care drug for bowel colic?

A

hyoscine butylbromide

30
Q

pain relief for palliative care?

A

regular oral (MR) morphine with immediate release (MR) morphine for breakthrough pain- should be 1/6th dose of maintenance dose

  • laxatives should be co-prescribed
  • anti-emetic if nausea persists
31
Q

alternatives to morphine for pain relief?

A
diamorphine
oxycodone
alfentanil
buprenorphine
fentanyl
32
Q
conversion between:
oral codeine/tramadol-> oral morphine
oral morphine -> oral oxycodone
oral morphine -> sub cut morphine
oral morphine -> sub cut diamorphine
oral oxycodone -> sub cut diamorphine
A

oral codeine/tramadol-> oral morphine (divided by 10)
oral morphine -> oral oxycodone (divided by 1.5-2)
oral morphine -> sub cut morphine (divided by 2)
oral morphine -> sub cut diamorphine (divided by 3)
oral oxycodone -> sub cut diamorphine (divided by 1.5)

33
Q

what pain relief is used for palliative care if oral treatments aren’t suitable?

A

transdermal opioid patch

34
Q

SE morphine?

A
constipation
nausea
sedation
dry mouth
psychomimetic effects
confusion
myoclonus
allergy
resp depression
pruritis
35
Q

what are the different neurotransmitters causing in N&V?

A

5HT3- serotonin
H2
D2

36
Q

what factors influence vomiting centre in the brain?

A

fear pain -> cerebral cortex -> VC
motion sickness/cerebral tumours -> vestibular apparatus-> VC
gastric irritation/GI distension -> vagus/ splanchnic nerves -> VC
GI tract-> VC
drugs/ metabolic -> chemoreceptor trigger zone -> VC

37
Q

what types of anti-emetic is a 5HT3 receptor antagonist?

A

e.g. ondansetron
acts at chemoreceptor trigger zone and GI tract
Useful in CTZ stimulation e.g. drugs, gut infection, radiotherapy

38
Q

SEs of 5HT3 receptor antagonist?

A

constipation, diarrhoea, headaches, prolonged QT interval

39
Q

what types of anti-emetic is a D2 receptor antagonist?

A

metoclopramide, domperidone
acts at CTZ and upper GIT
prokinetic: relaxes the pylorus, reduces lower oesophageal sphincter tone, increases gastric peristalsis
useful in long-term opioid use

40
Q

SE of D2 receptor antagonist?

A

diarrhoea, extrapyramidal side effects with metoclopramide- acute dystonia- more common in young females
(domperidone doesn’t cross BBB so doesn’t cause EPSE)
CI- GI obstruction, perforation

41
Q

what types of anti-emetic is a H2 receptor antagonist?

A

cyclizine, promethazine

acts at vomiting centre, vestibular system

42
Q

SE of H2 receptor antagonist?

A

drowsiness, dry mouth and blurred vision (anti-cholinergic side effects)
transient tachycardia after IV
useful in motion sickness and vertigo

43
Q

CI of H2 receptor antagonist?

A

prostatic hypertrophy as it can cause urinary retention

44
Q

what anti-emetics are best used for post op N&V?

A

ondansetron

cyclizine

45
Q

name some PONV risk factors?

A
female
prev PONV
history of travel sickness
non-smoker
surgeries- ENT, gynae, GI
peri-operative opioid use
gastric insufflation during intubation
duration of anaesthesia
46
Q

investigating metastatic disease of unknown primary?

A
FBC, U&amp;E, LFT, Ca, LDH
urinalysis
CXR
CT of chest, abdo, pelvis
AFP and hCG
47
Q

what are the human rights related to health?

A

2- the right to life
3- the prohibition of torture or inhumane or degrading treatment or punishment
8- the right to respect for private or family life

48
Q

what is the pain ladder?

A

simple analgesia- paracetamol and NSAIDs
weak opioids- codeine, dihydrocodeine, tramadol
strong opioids- morphine, oxycodone, fentanyl, buprenorphine, diamorphine

49
Q

how do NSAIDs work?

A

inhibits COX

need to monitor renal function and platelet count

50
Q

how does paracetamol work?

A

inhibits CNS prostaglandins

51
Q

5 drugs essential for palliative care?

A
pain- morphine 1.25-2.5mg SC or 2.5-5mg PO
breathlessness- morphine
secretions- hycosine butylbromide SC
agitation- midazolam
nausea- haloperidol
52
Q

signs and symptoms of opioid overdose?

A
sudden improvement in pain
reduced conscious level
reduced resp rate/SpO2
myoclonic jerks
pinpoint pupils
confusion
hallucinations
53
Q

mx of opioid overdose?

A

naloxone 400mg STAT if live threatening
close observation
review dosing

54
Q

what are the different types of breast cancer?

A
  1. invasive ductal carcinoma
  2. invasive lobular carcinoma
  3. ductal carcinoma-in-situ
  4. lobular carcinoma-in-situ
55
Q

what is paget’s disease of the nipple?

A

eczematoid change of the nipple associated with an underlying breast malignancy and it is present in 1-2% of patients with breast cancer

56
Q

what is inflammatory breast cancer?

A

where cancerous cells block the lymph drainage resulting in an inflamed appearance of the breast

57
Q

RFs for breast cancer?

A
BRCA1/BRCA2 genes- lifetime risk of breast/ovarian cancer
1st premenopausal relative with breast cancer
Nulliparity, 1st pregnancy, >30 years
Early menarche, late menopause
COCP, HRT
Not breastfeeding
Ionising radiation
p53 gene mutation
Obesity
58
Q

features of breast cancer?

A
lump
nipple inversion
nipple discharge
skin contour changes
peau d'orange
dimpling of the breast
59
Q

when to refer for 2ww?

A

age >30 and have an explained breast lump with or without pain OR
age >50 with any of the following symptoms in one nipple only: discharge, retraction or other changes of concern

60
Q

who is offered breast cancer screening?

A

women aged 47-73 years

women are offered a mammogram every 3 years

61
Q

diagnosis of breast cancer?

A

mammogram
USS
core needle biopsy/fine needle aspiration
examination

62
Q

staging of breast cancer?

63
Q

mx of breast cancer?

A

surgery- either wide local excision or mastectomy
radiotherapy
hormonal therapy
chemotherapy

64
Q

when to do a mastectomy for breast cancer?

A

Multifocal tumour
central tumour
large lesion in small breast
DCIS >4cm

65
Q

SEs of radiotherapy for breast cancer?

A
pneumonitis
rib fracture
pericarditis
lymphoedema
brachial plexus injury
66
Q

when is hormonal therapy used?

A

ER positive- tamoxifen (pre or peri-menopausal women)or aromatase inhibitors (post-menopausal women)

67
Q

when is biological therapy used?

A

HER2 positive disease e.g. Herceptin (transtuzumab)