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Year 4 CCC > Oncology > Flashcards

Oncology Flashcards

1
Q

4 most common cancers?

Top 4 cancers with highest mortality?

A

Breast- Lung- CRC- Prostate

Lung- CRC- Breast- Prostate

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2
Q

Examples of uninterrupted oestrogen exposure increasing breast cancer risk

A

Late childbearing, Nullparity, Early menarche, Late menopause, Obesity, HRT

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3
Q

2 week referral guidelines for ?breast cancer

A 
30+= Unexplained lump
50+= unilateral discharge/retraction/nipple sign

Consider if skin changes/ Axilla lump

If <30 + unexplained lumo then non-urgent referral

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4
Q

Describe breast cancer screening in the UK

A

50-70 years

Mammogram every 3 years

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5
Q

What is the breast cancer triple assessment?

What is added if there is a discrepancy?

A

1- Clinical Dx
2- Bilateral mammography
3- Targeted US biopsy (FNAC)

MRI
Isotopic bone scan or CT if ?Disseminated disease

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6
Q

What is triple -ve breast cancer?

A

ER -ve HER2 -ve and PR-ve

HARDER TO TREAT

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7
Q

When does BRCA1/2 status impact treatment?

A

if <50 and triple -ve

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8
Q

Broad indication for surgery in breast cancer?

Wen is neo-adjuvant chemo given?

A

Number one choice if localised

+/- Post op RT
+/- Neo-adjuvant Chemo if HER-2 +VE or Triple -ve or need to reduce size to enable surgery

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9
Q

How does ER/PR status impact prognosis in breast cancer?

A

Better if +ve

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10
Q

How does HER2 status impact prognosis in breast cancer?

A

Worse if +ve

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11
Q

In what breast cancer group is chemotherapy most effective in?

A

<50

+ Oncotype Dx can help predict extent of benefit

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12
Q

Tumour marker used in breast cancer?

A

CA15.3

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13
Q

When is RT required to treat breast cancer?

A

Following conservative surgery by all residual tissue to decrease recurrence
Post-mastectomy if high recurrence risk (mets or >4cm or deep resection margin)

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14
Q

When is endocrine therapy the primary treatment in breast cancer?

A

ER/PR +ve and slowly progressive

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15
Q

Indications for tamoxifen in breast cancer?

A

ER/PR +VE
PRE-MENOPAUSAL
taken for 5 years as adjuvant

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16
Q

Indications for Herceptin (Trastuzamab) in breast cancer?

A

HER2 +VE

12 months but need regular cardiac testing

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17
Q

Indications for Aromatase inhibitors (Anastrazole) in breast cancer?
What are the complications?

A

POST-MENOPAUSAL and ER/PR +VE

Osteoporotic events therefore do DEXA baseline

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18
Q

Median response to endocrine therapy if breast cancer with metastatic disease?

A

1-2 years

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19
Q

What factors are considered during management of metastatic breast cancer?
What is not part of the treatments for the above?

A

Extent, hormone status, HER2 status, symptoms, preferences, performance status

If mets or S4 post-assessment then surgery only has a palliative role. Metastatic solid breast cancer tumour= Wholly palliative.

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20
Q

Information and support available to breast cancer patients

A

Breast cancer nurse specialist
Psychological support
Lymphedema risk
Early menopause (iartrogenic)

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21
Q

What factors impact the response to endocrine therapy in breast cancer?

A

Dominant site of the disease- greater response if soft tissue; much reduced if bony or visc mets

An objective response to prior endocrine therapy

Greater duration of previous disease free interval

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22
Q

Most common type of prostate cancer?

Where in the prostate is cancer likely to be?

A

95% Adenocarcinoma

Peripheral or posterior (BPH likely centric)

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23
Q

Gold standard imaging of choice in ?Prostate cancer

A

MRI

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24
Q

What do patients with an abnormal PR usually get if ?Prostate cancer?

A

Transrectal biopsy under US guidance

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25
Q

Side effects of Transrectal biopsy under US guidance?

A

Blood in urine/semen, infection, discomfort

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26
Q

Ideal imaging method to detect bone mets from prostate cancer?

A

Radionucleotide bone scan

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27
Q

Describe the The Gleason System of Grading

A

Sample from the two most predominant areas of prostate neoplasm
Histological grading ranging 2-10
“4+3” Main area is graded as 4 and second area 3
Higher number= Less differentiation= More aggressive

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28
Q 
What are the following scores on the Gleason System of Grading:
6
7
8
10
What ISUP grade is high risk?
A

6- Low (LOWEST POSSIBLE)
7- Intermediate
8- Aggressive
10- Highest

ISUP 4/5 is high risk

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29
Q

Advantages of ISUP score over other Gleason classification scores?

A

The classification simplified the number of grading categories from Gleason scores 2 to 10, with even more permutations based on different pattern combinations, to Grade Groups 1 to 5

The lowest grade is 1 not 6 as in Gleason, with the potential to reduce overtreatment of indolent cancer

Many classification systems consider Gleason score 7 as a single score without distinguishing 3+4 versus 4+3, despite studies showing significantly worse prognosis for the latter

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30
Q

Cancers commonly causing Bony mets?

A

Prostate, Kidneys, Lung, Thyroid, Breast (All midline)

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31
Q

Where does prostate cancer commonly metastasise to?

A

Spine +/- Pelvis

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32
Q

Classic appearance of prostate cancer related bony mets?

A

Sclerotic

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33
Q

Important discussion points with a patient who has ?Prostate cancer

A 
Sexual function
Urinary function
Fertility
Asymptomatic
Comorbidities
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34
Q

When is surgery considered for treatment of prostate cancer?

What iatrogenic side effects can this have?

A

Radical prostatectomy with curative content if T2 (confined to prostate) or less

Impotence

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35
Q

What is the intent of Transurethral resection of the prostate?

A

Palliative

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36
Q

Side effects of Radiotherapy treatment in prostate cancer?

A

Dysuria, rectal bleeds, diarrhoea, impotence, incontinence

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37
Q

General role of radiotherapy in prostate cancer treatment?

A

Can be alternative to surgery if T1/T2
Adjuvant
Palliative if persistent bone pain

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38
Q

What is brachytherapy?

When should this be avoided in prostate cancer?

A

Interstitial implantation of radioisotopes (form of radiotherapy)
Best if fewer comorbidities as less risk of impotence
Avoid if significant urinary symptoms (can exacerbate)

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39
Q

Indications for hormone therapy to treat Prostate cancer?

A

Advanced disease (or with radiotherapy if localised)

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40
Q

General side effects of using hormone therapy to treat Prostate cancer?

A

Reduced muscle bulk
Wx gain
Sexual dysfunction
Increased risk of DM

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41
Q

How do LHRH and GnRH antagonists work to treat prostate cancer?
Side effects?

A

Reduce testosterone
Medical castration
Can exacerbate symptoms if there is a tumour flare

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42
Q

What hormone therapy is rarely the best option to treat prostate cancer?

A

Oestrogen induced LHRH inhibition

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43
Q

Prognosis of prostate cancer if:

1) Local
2) Radical surgery/RT
3) Metastatic

A

1) Local- 4.5 years
2) Radical surgery/RT- 85% live 10 years if treated
3) Metastatic- 3.5 years

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44
Q

Role of chemotherapy in prostate cancer treatment?

Example regimen?

A 
Adjuvant to increase QoL and Survival 
Cytotoxic Docetaxel (+prednisolone)
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45
Q

Is small cell or non-small cell the most common type of lung cancer?

A

Non-small cell 82%

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46
Q

Most common types of NSCLC?

A

Squamous cell -> Adenocarcinoma -> Large cell -> Other (Carcinoid, mesothelioma, sarcoma etc)

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47
Q

General features to differentiate between squamous cell and adenocarcinoma lung neoplasms?

A

SCC- Central, close to bronchi, SMOKERS GET THIS, Secrete PTHpp therefore hypercalcaemia

Adeno- Peripheral, EGFR and ALK mutations (drug targets!), non-smokers, women, asbestos

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48
Q

General features of small cell lung cancer?

How responsive are they to chemo/RT?

A

Aggressive, rapid growth, mets likely before Dx, neuroendocrine cells (SIADH, ACTH-Cushing’s, Lambert-Eaton), marker= Bombesin

Good response to Chemo/RT but relapse quickly

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49
Q

Indications for a 2 week lung cancer referral

A

Unexplained haemoptysis in >40

CXR suggesting cancer

> 40 + 2 of cough/fatigue/SOB/Chest pain/Wx loss/Smoker

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50
Q

Role of bronchoscopy in lung cancer Dx?

A

Biopsy

End brachial US to biopsy lymph nodes in the mediastinum

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51
Q

What investigation is essential for lung cancer staging?

A

CT as allows an assessment of disease extent

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52
Q

When is PET indicated in ?Lung cancer?

A

If thought to be operable

Usually after CT to make sure distant mets arent missed

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53
Q

Role of pulmonary function tests in assessing lung cancer

A

Important in deciding whether an individual is fit for lung cancer surgery (alongside cardiopulmonary exercise training)

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54
Q

Role of sputum cytology in assessing lung cancer

A

Malignant cells in ~80%

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55
Q

In terms of TMN staging, when is trimodality treatment indicated in lung cancer?

A

Ipsilat bronchopul and hilar nodes (N1)

Ipsilateral mediastinal or subcranial (N2)

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56
Q

What Nodal involvement would usually indicate inoperable lung cancer?

A

Contralateral mediastinal/hilar/supraclavicular

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57
Q

S4 lung cancer prognosis

A

6 months

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58
Q

Role of Chemotherapy in treating SCLC

A

Good response. Usually palliative though as relapse is v common within 12 months

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59
Q

Common mets in SCLC? What is done to ameliorate this?

A

Brain mets therefore receive prophylactic cranial irradiation

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60
Q

Role of RT in treating SCLC

A

Treat primary tumour
Prophylactic cranial irradiation to prevent brain mets following good chemo response
Palliative id advanced

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61
Q

Role of surgery in treating SCLC

A

Inappropriate in vast majority.

Needs adjuvant CT/RT if used.

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62
Q

Role of surgery in NSCLC

A

S1 or S2
Adjuvant RT if +ve surgical markings
Adjuvant CT if nodal/larger

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63
Q

General CI for surgery in NSCLC

A

Mediastinal involvement

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64
Q

When is RT a good choice for NSCLC?

A

If not suitable for surgery or palliative

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65
Q

What is Continuous hyperfractionated accelerated RT?

What is Stereotactic ablative RT?

A

CHART- 3X a day for 12 days

SABR v large doses to a small area; good if peripheral and not suitable for surgery

66
Q

Examples of when to use palliative RT in Lung cancer

A

SC compression, Painful mets, central disease symptoms (blood, cough)

67
Q

Role of chemotherapy in NSCLC

A

Mainstay if metastatic or locally advanced

Also palliative role

68
Q

Example of an EGFR inhibitor used to treat NSCLC

A

Gefitinib

69
Q

Example of an ALK inhibitor used to treat NSCLC

A

Crizotinib

70
Q

What is Pembrolizumab?

A

Immunotherapy used to treat NSCLC with high PDL1 expression

71
Q

SE of prophylactic intracranial irradiation?

A

Memory loss
Functional deficit
Dementia

72
Q

What is the 1/3rd rule for CRC?

A

1/3rd rectum, 1/3rd left side, 1/3rd rest of colon

73
Q

Most common type of CRC?

A

Adenocarcinoma= 90%

74
Q

CRC screening- what blood test is used? Who for?

A

Faecal occult blood test
60-74 every 2 years
3X separate samples

75
Q

When is sigmoidoscopy screening done for CRC?

A

55

if normal then bowel screening at 60

76
Q

What is Faecal Immunological Blood testing for CRC? Any advantages?

A

One sample
Home test kit
60-74 yrs

77
Q

What age is a RF for CRC?

A

95% in >50s

Dont forget IBD and acromegaly

78
Q

What imaging is used for CRC staging?

A

CT scan

79
Q

Essential bed side investigation for CRC?

A

Rectal exam! 3/4 felt on this

80
Q

What is Carcinoembryonic antigen (CEA)?

A

Tumour marker for CRC

Role in monitoring treatment response/disease progression

81
Q

Describe Duke’s staging for CRC

A 
A- Bowel wall only
B- Invasion through wall 
C1- Apical/high tide node clear but other nodal involvement 
C2- Apical node involved
D- Distant mets
82
Q

What treatment can be curative in CRC?

A

Surgery- radical CR resection

83
Q

Indications for palliative surgery in CRC?

A

Stenting etc to manage or prevent obstruction

84
Q

Role of RT in:

  • Rectal carcinomas
  • Colonic cancers
  • Palliation in CRC
A
  • Rectal carcinomas= Pre-op or adj in high risk before resection
  • Colonic cancers= NOT USUALLY INDICATED DUE TO RADIATION RISK TO OTHER ORGANS
  • Palliation- Bone mets
85
Q

When is adj chemotherapy accepted practice in CRC?

A

High risk CRC

More effective in DUKES C THAN B in increasing survial

86
Q

Example of genetic factors that impose ‘high risk’ status on individuals with CRC?

A

HNPCC (lynch), Gardener’s (APC gene), P53, DCC, RAS mutation

87
Q

What is the most active chemotherapy agent in CRC with the highest response rate?

A

5-FU with a response rate of 25%

88
Q

Standard screening process for CRC?

A

Faecal occult blood test followed by endoscopic intervention if +ve

89
Q

General principles of CRC follow up

A

CT 18 months/3 yrs/5yrs
Endoscopic intervention at 12 months and 3 years
CEA tumour marker
Specialist nurse led

90
Q

When does RT generally have curative potential?

A

No mets

Especially useful if H+N cancer

91
Q

Units of RT?

A

Grays

Smaller doses= Fractions

92
Q

How many RT fractions are usually given?

A

1 fraction a day for Mon-Fri

If radical then large doses over many fractions

93
Q

How does concurrent chemotherapy impact the efficacy of RT?

A

Acts as a radiosensitiser so increases effectiveness

BUT ALSO INCREASES TOXICITY

94
Q

What is Gross tumour volume?

A

What you see on the scan

95
Q

What does the Clinical target volume include?

A

Microscopic parts not seen on the scan so you add margins for ?spread

96
Q

What is the planning target volume?

A

Add margins for variation in pt and tumour position whilst also considering other organs at risk of RT-related damage

97
Q

When are the acute RT side effects usually seen?

What are the common acute SE?

A

After first 5-10 fractions (usually 2 weeks)
Reversible TRANSIENT damage to normal tissue

Localised hyperpigmentation/skin reaction/Dermatitis
Oral mucositis
Diarrhoea
‘‘-itis’’

98
Q

Late often irreversible SE of RT?

A

3 months to years after
Infertility, blood vessel damage, fibrosis, dry mouth, urethral/oesophageal strictures, skin atrophy, telangectasia, secondary malignancy, teratogenic!

99
Q

What is brachytherapy?

A

Interstitial/cavity based radioactive source near tumour
used in prostate/H&N/Gyane/Oesophageal
Localised dose to small volume! But pt is radioactive…

100
Q

What is stereotactic RT? When can it be used?

A

Delivers a large dose to a small margin, small Number of large fractions, minimal SE

Used if well defined & small tumour

101
Q

When are Radioisotopes used to treat cancer?

A

Cancerous tissue takes up decaying isotope, useful if thyroid cancer, must stay isolated for 4 days though

102
Q

What does a ‘course’ of chemotherapy mean?

A

A planned number of cycles

103
Q

Immediate adverse effects of chemotherapy

A 
N&amp;V
Myelosuppression- Thrombocytopenia/Leucopenia/Neutropenia
Oral mucositis 
Diarrhoea/Constipation 
Alopecia
Nephrotoxicity
Peripheral neuropathy
Skin Extravasation /Erythema /Pigmentation/Photosensitivity 
Myalgia
Lethargy
Clots
deafness
104
Q

Long term consequences of chemotherapy

A 
Secondary malignancy (via DNA damage)
Infertility 
Pulmonary fibrosis
Cardiac fibrosis
Osteoporosis
Psychosocial
Toxicity to major organ systems- important to consider PMHx
105
Q

What is the nadir in relation to chemotherapy?

A

The most profound point of haemopoetic stem cell deficit

106
Q

Signs of chemotherapy related thrombocytopenia?

A

Petechial haemorrhage, Spontaneous nose bleeds, corneal haemorrhage, haematuria

107
Q

When is a platelet transfusion indicated in thrombocytoepenia?

A

Platelet count <10 X 10^9

consider if 10-20, but need evidence of spont bleeding

108
Q

Definition of neutropenic sepsis?

A

Absolute neutro count <1X 10^9

plus single temp >38.5 or sustained temp of >38 for 1 hour

109
Q

What investigations are indicated if ? Neutropenic sepsis

A

2X peripheral cultures
2x line cultures (Both within 30 mins)

BUFALO

Site of infection? Lines? Catheters?

110
Q

Key Q if ? Neutropenic sepsis

A

Chemotherapy timeline and drugs
Previous episodes
Localising symptoms

111
Q

Most common causes of neutropenic sepsis?

A

70% G+ve S.Aureus, Staph Epidermis/Haemolyticus, strep pyogenes

30% G-ve like E.coli/Klebsiella/Pseudomonas

Also consider candida and aspergillosis

112
Q

Key management principles for neutropenic sepsis

A

Start IV broad spec Abx immediately (E.G Tazocin or meropenem)
Continue if ANC<1 +Fever/Hypotension/Tachycardia
Review past microbiology
Fluid resus

113
Q

What is s MASCC score?

A

Risk of neutropenic sepsis complications

114
Q

If penicillin allergic what initial Abx would you try in neutropenic sepsis

A

Vancomycin or Aztreonam

115
Q

When would you consider changing the intial Abx in neutropenic sepsis

A

If Microbiology results come back

or if no response in 48 hours try a second broad spec and then if no response after another 48 hours ?Antifungal or antiviral

116
Q

How can you prevent neutropenic sepsis?

A

Prophylactic Abx if high risk e.g COPD

Dose modification; although may need to keep this high if radical therapy

117
Q

What are the top 3 cancers most likely to metastasise to the vertebral bodies/spine

A

Prostate -> Breast -> Lung

Also consider Myeloma and lymphoma

118
Q

Most common sign of MSCC?

A

90% Back pain
Aggravated by coughing/moving/Lying
Can be worst at night

119
Q

Minus pain what are other signs of MSCC?

A 
Motor change- weakness/parapesis
Gait change
Sensory loss
Incontinence 
saddle anaesthesia 
Hyperreflexia 
UMN signs- Inc tone inc reflexes, up going plantars
120
Q

If you ?MSCC what do you do?

A 
Whole spine MRI within 24 hours 
16mg Dex with PPI cover 
Lay flat
RT (Think about treatment goals)
Neurosurgery if limited/good prognosis/structural failure
121
Q

When is presentation of MSCC with complete paralysis almost never reversible?

A

> 48 hours from onset

57% reversibility if treated within 24 hours

122
Q

Signs of SVCO

A 
SOB exacerbated by lying 
Headache worse on coughing 
Upper body swelling
Venous distension in the neck 
Cyanosis 
Visual disturbance
123
Q

Investigations for SVCO

A

First do CXR- LOOK FOR WIDE MEDIASTINUM
If above is +ve thenarrange a CT to confirm
+/- Tumour markers, Bronchoscopy, Biopsy, Mediastinoscopy

124
Q

When would you start treating SVCO?

How would you do this?

A

If the SVCO is obvious on the CXR then treat with 16mg Dex + PPI cover

The next step is cause dependent- Stenting/Chemo/RT/LWMH if thrombus

+/- Morphine if severe SOB

125
Q

Brief outline of calcium homeostasis

A

low Ca2+= Inc PTH release= Osteoclast bone resorption= inc ca2+

Kidneys also activate Vit D

126
Q

What are PTH related peptides?

What is transforming growth factor alpha?

A

PTHrp- Mimic PTH to stimulate osteoclast bone resorption

TGFA- Produced by tumour cells, act directly to stimulate osteoclasts

127
Q

Normal calcium levels?

Severely high calcium?

A

2.1-2.6 mmol/L

> 3.4 (Mod if >3)

128
Q

Most common cancers to cause hypercalcaemia

A

Myeloma,SCLC, NSCLC, Renal cell, lymphoma, H&N

129
Q 
Hypercalcaemia...
General symptoms?
CNS?
GI?
GU?
CV?
Late?
A

General symptoms- Dehydration (Ca is a diuretic), Weakness, Fatigue
CNS- Confusion, Seizure, Hyporeflexia, coma, neuropathy
GI- Wx loss, N&V, Constipation, Pain
GU- Polyuria
CV- Bradycardia, ECG changes, Arrest, Arrhythmia
Late- Coma

130
Q

Hypercalcaemia ECG changes

A 
Bradycardia
Short QT
Wide T wave
Prolonged PR
BBB

J WAVES
(Extra little wave on S wave)

131
Q

How do you rehydrate someone with hypercalcaemia?

A

Saline 1L 4 hourly for 24 hours
Then 1L 6 hourly for 48-72 hours
Make sure K+ is adequate

132
Q

How do bisphosphonates work in hypercalcaemia?

Examples of drugs used?

A

Inhibit osteoclastic bone resorption

IV Zolendronic acid or IV Pamidronate
N/B Repeat many times before intensifying

133
Q

If someone with hypercalcaemia has an arrhythmia/Seizure what do you intervene with?

A

SC or IM Salmon calcitonin with oral prednisolone

134
Q

Tumour markers- HCG

A

Oncofetal protein

Seminoma/Non-seminomatous testicular cancers, pregnancy

135
Q

PSA

A

Prostate pathology

Good for monitoring

136
Q

Ca19.9

A

Pancreatic cancer

137
Q

Ca15.3

A

Breast cancer

138
Q

Immunoglobulins are tumour markers in what?

A

Myelomas, NHL

139
Q

AFP tumour marker

A

Oncofetal protein

Hepatocellular carcinoma
Teratoma
Hepatitis

(High levels= Poor prognosis)

140
Q

Cell surface glycoproteins (CEA)

A

Colorectal cancer
Pancreatic/Breast/Gastric lung cancer

Also raised in: Smokers, pancreatitis, IBD, hepatitis, Gastritis

141
Q

CA-125

A

Ovarian cancer +/- Panc/lung/CRC/Breast

Not v sens/spec

142
Q

Performance status

Explain 0-5

A 
0- Normal
1- Symptomatic but self-care
2- Ambulatory >50% time
3- Ambulatory <50% time needs nursing care
4- Bed ridden
143
Q

SE of prostatic RT

A

Cystitis, prostatitis, Proctitis (Diarrhoea, Haematemesis)

Haematuria, Abd pain, nausea

144
Q

SE of pulmonary RT

A

Pneumonitis (6-8 weeks post RT) Therefore always make sure there is good residual lung function before
Progressive SOB
Cough
Oesophagitis

145
Q

When is mammography not viable for Breast cancer screening?
How can USS be used?

When is MRI good?

A

Dense breast tissue in pre-menopausal breast

USS good if confirmed lump

MRI good if V young and V high risk. Not very specific so wont tell you if it is malignant

146
Q

Tamoxifen SE

A

Vasomotor, mood changes, reduced libido, vag discharge, VTE risk

USED PRE OR POST-MENOPAUSAL

147
Q

Aromastase inhibitors SE

A

Vag dryness, vasomotor, mood, reduced libido, arthralgia, Reduced bone density

POST-MENO ONLY

148
Q

Benefits of PSA testing

A

Catch cancer early
If left than cancer can present too late
Reassurance

149
Q

Disadvantages of PSA testing

A

75% of abnormal PSAs arent cancer so uncecessary worry
80% OF abnormal ones will go and have TRUS

15% of normal tests still have prostate cancer

150
Q

How is prostate cancer diagnosed

A

Pre-biopsy MRI followed by TRUS

151
Q

what will you do if the PSA is

> 20
10-20
Low risk

A

> 20= HIGH RISK ALWAYS TREAT
10-20= ?Radical treatment
Low risk= Monitor

152
Q

Indications for androgen deprivation therapy in prostate cancer?

Any side effects?

A

Advanced disease/spread/recurrence

Hot flushes, sexual dysfunction, loss of muscle, mood disturbance, Wx inc, DM, osteoprosis

153
Q

What treatments would you give for CRC if…
Low risk?
Mod risk?
High risk?

A

Low risk- Anterior resection/other surgery
Mod risk- RT then surgery
High risk- RT + Chemotherapy + Surgery

N.B If higher risk (T3, N2, V1, M0) then more benefit from the triple therapy

154
Q

Side effects of immunotherapy drugs

A

Autoimmune disease and endocrinopathies
Thryoid, Glomerulonephritis, Vasculitis, Pneumonitis, Hepatitis, Cystitis, Encephalitis, Addisons, Cushings, Arthralgia

PEAK 6-8 WEEKS POST TREATMENT

155
Q

How do you manage immunotherapy SE?

A

Steroids

Lifelong hormone replacement if endocrinopathies

156
Q

When prescribing controlled drugs what do you always have to write?

A

THE SUPPLY

“MORPHINE SULPHATE 10mg/5ml TWICE A DAY. SUPPLY: ONE HUNDERED MILIMETRES”

157
Q

2 week referral for ? Oesophageal cancer if

A

Dysphagia
or
Wx loss + > 55 + Pain/Reflux/dyspepsia

(Urgent endoscopy)

158
Q

2 week referral for ? Pancreatic cancer if

A

> 40 + Jaundice
or
60 + Wx loss + Back pain/N&V/Bowel habit change/New DM

159
Q

2 week referral for ? Gastric cancer if

A 
Upper abd mass
or
Dysphagia 
or
Wx loss + > 55 + Pain/Reflux/dyspepsia

(Urgent endoscopy)

160
Q

2 week referral for ? Anal cancer

A

Unexplained anal mass or ulceration

161
Q

2 week referral for ? CRC

What can you do if the 2 week referral criteria aren’t met but you are still suspicious?

A

> 40 + Wx loss + Abd pain
50 + rectal bleeding
60 + Fe deificency anaemia/Change in bowel habit
Occult blood in faeces + mass
<50 + rectal bleeding + Pain/Change in bowel habit/Wx loss/Fe deficiency anaemia

If above not met but still suspicious then offer faecal occult blood testing

Year 4 CCC (3 decks)

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