Oncology Flashcards
What neutrophil count is considered neutropenic sepsis?
<1.0, but always suspect if a fever and immunocompromised
What antibiotics do you give in neutropenic sepsis according to NICE guidelines?
Piperacillin with tazobactam (tazocin), some hospital guidelines add gentamycin
What is your acute management of spinal cord compression?
Dexamethasone 16mg PO BD
What are features of malignant spinal cord compression?
Back pain
Lower limb weakness
Sensory changes
Bowel/bladder incontinence
A patient undergoing chemotherapy is suffering from nausea and vomiting. What antiemetic do you give them?
Metoclopromide/Domperidone
Then add in ondansetron with dexamethasone if not effective
What are some symptoms of SVC obstruction?
SOB Blurring of vision, headache Bulging Forehead vein Pemberton Sign - bilateral arm elevation causes facial plethora Conjuctival and periorbital oedema
What is calcitonin a tumour marker for?
Medullary Thyroid
What is Ca 15-3 a tumour marker for?
Breast cancer
What is the most common cause of SVC obstruction?
SCLL
Lung Cancer
In a metastatic disease of unknown primary, what are the investigations that should be done in every patient?
What should be done in specific patients?
FBC, U&E, LFT, Ca2+, urinalysis, LDH
CXR
CT chest, abdo, pelvis
AFP and hCG
Myeloma screen (if lytic bone lesions)
Endoscopy (directed towards symptoms)
PSA (men)
CA 125 (women with peritoneal malignancy or ascites)
Testicular US (in men with germ cell tumours)
Mammography (in women with clinical or pathological features compatible with breast cancer)
Which is the most common kind of lung cancer in non-smokers?
Adenocarcinoma
What are the different stages in WHO Performance Status?
0 - full active, able to carry on activities as normal
1 - restricted in physical activity but able to carry out light work
2 - unable to work, >50% time up and about
3 - limited self-care, >50% bed or chair
4 - disabled, cannot carry out self-care, confined to bed or chair
What symptoms require immediate referral to a 2WW?
Frank haematuria
Breast changes
PR bleed in over 50 years old
Post-menopausal bleed
What tumour markers are commonly checked on a workup for a metastases of unknown origin?
PSA
Ca125
AFP
bhCG
What is the difference between adjuvant and neo-adjuvant?
Adjuvant - chemo given after definitive treatment
Neo-adjuvant - chemo given before definitive treatment - reduces risk of relapse, reduce micrometasases and allow for better excision margins
What are 5 side effects of chemotherapy? Which one of these should you counsel patients on prior to treatment?
Infertility - consider egg or sperm freezing
Nausea and vomiting Alopecia Peripheral neuropathy Diarrhoea Low WCC, immunocompromised
What are some side effects of radiotherapy?
Fatigue Dry skin, erythema, mucositis N+V Diarrhoea Dysphagia Cystitis
What kind of endocrine treatments are used in cancer management and which cancers are they used for?
Tamoxifen - breast cancer
Aromatase inhibitors - breast cancer
GnRH analogues - prostate cancer
Give the name of 5 different complementary therapies and describe what they do
Reiki - moving your hand above the body to channel energy
Healing - spiritual or religion, redirecting energy flows
Homeopathy - treating like with like, dilutions
Acupuncture - use of fine sterile needles into parts of the body
Chiropractic - state licences, identifies strain and stiffness, stretching and manipulation of muscle and tissue
How would a patient with raised ICP present and what is your management?
Headache (worse on coughing or bending forwards)
Urgent CT/MRI head
Dexamethasone 8-16mg
Mannitol for symptoms
What is your immediate management in someone presenting with confusion, polydipsia, lethargy and a high calcium on blood tests?
IV Fluids
Then bisphosphonates
Which types of cancer have a genetic component?
Colorectal
Breast
Endometrial
Ovarian
What anti-emetic is used with intracranial tumours?
Dexamethasone
How do you manage an SVC obstruction?
PO Dexamethason 8-16mg/24 hours
Balloon venoplasty/stenting
Tissue biopsy
