oncology Flashcards

1
Q

NEUTROPENIC SEPSIS
how many days post chemo?
Diagnosis?

Treatment
1.
2.
3

A
  • 7-14 DAYS POST CHEMO
  • neutrophils under 0.5 X10^9
    + single reading fever >38.5 or two above 38 for an hour

treatment:
IV BROAD SPECTRUM WITHIN 1 HOUR + BUFALO
- Granulocyte colony stimulating factor (GCSF)
- haematopoietic growth factors sub cut

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2
Q

METASTATIC SPINAL CORD COMPRESSION

sign?

IVX:

Treatment
1.
2.
.3.

A
  • Seen in lung, prostate, breast

SYX:

  • back pain, motor weakness, sensory disturbance
  • bladder/bowel dysfunction

SIGN
- spin tenderness, reflexes increased below compression

IVX: urgent MRI of whole spine !!

TX

  • DEXAMETHASONE 16MG + PPI
  • surgery to reverse collapse
  • radiotherapy to shrink
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3
Q

SUPERIOR VENA CAVA OBSTRUCTION
syx

Treatment
1.
2.
3

A
  • common in lung cancer, lymphoma, germ cell tumours
  • distension of veins superior to obstruction
    syx-
  • neck and faical swelling
    headache/ fullness in head
  • DYSPNOEA
  • cough
  • horase voice + nasal congestion
  • syncope+ worse when bending forwards

SIGN-

  • raised JVP + venous collaterals
  • stridor (emergency)

TX

  • high hose steroids DEXAMETHASONE 16mg + ppi cover
  • vascular SVC stent radiological
  • urgent chemo in some cancers
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4
Q

HYPERCALCAEMIA

syz

ivx

management
how long does it take bisphosphonates to work?

A
  • breast cancer, prostate lung cancer, renal cell carcinoma andn myeloma
  • ## cancer 2nd most common cause after 1 hyperparathyroidSYX
  • Lethargy, malaise, anorexia, polyuria, thirst !!!
  • later: confusion, drowsiness, fits, coma
    “boans, stoans, abdo moans and psych groans”

IVX: Calcium, albumin, u+es

management:
- saline
- diuresis- furosemide
- bisphosphonates zolendronic acid = takes 6-11 days to work

if arrhythmias: calcitonin or corticosteroids

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5
Q

CEA

A

Colorectal cancer

elevated in smokers / IBS / pancreatitis

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6
Q

CA125

A

OVARIAN carcinoma markers

related to pancreatic, lung, colorectal and breast

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7
Q

alpha fetaprotein

  • memory aid?
A

HEPATACELLULAR CARCINOMA
teratoma

“alpha feta hepata terata”

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8
Q

human chorionic Gonadotrophin HcG

A
  • raised in pregnancy
  • non-seminomous testicular cancer
  • seminoma
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9
Q

PSA - prostate specific antigen

A
  • prostate cancer
  • benign prostate hypertrophy
    (elevated by rectal exam, uti and prostatitis)
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10
Q

Immunoglobulins

A
  • myeloma

- non-hodgkins

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11
Q

CHEMO COMPLICATIONS

A
  • Nausea and vomiting: Pre chemo treat with ondansetron + dexamethasone, post chemo metoclopramide and exa
  • GI: MUCOSITIS, DIARRHOEA, CONSITPATION AND paralytic ileus.
  • Alopecia
  • skin and soft tissue toxicity- extravasation, hand-foot syndrome, photosensitivity, pigmentation, bowers lines on nails
  • ototoxicity
  • nephrotoxic (platinums)
    arrhythmias
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12
Q

Major haemorrhage

A

treatment: GREEN TOWELS

IM / SC midazolam as a sedative

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13
Q

lung cancer: non small cell

A
  • adenocarcinoma = outside
    NON SMOKERS! “Adeno why - i didnt smoke!!!!
  • EGFR + alk mutations = treat with tyrosine kinase inhibitors
  • Squamous cell
  • central
  • associated with smoking

Large cell: peripherally

TX:
surigcal resection +

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14
Q

lung cancer: small cell

A

ALWAYS IN SMOKERS
associated with paraneoplastic sydnromes
metastasises early therefore usually all over

  • TP53 and RB1 tumour supressor gene mutations

TX: radiotherapy
usually systemic and mets early
extensive chemo

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15
Q

breast cancer

factors for treatment:
ER status
- pre menopause tx
- post menopause tx

HER 2 staus
- +Ve then

A

BRACA 2 = breast only
BRACA 1 - ovarian and breast

IDCIS = 80%, lobar 10%

TRIPLE ASSESSMENT: clinical, imaging, biopsy

  • ER Status= oestrogen receptor positive
    pre menopause: tamoxifen to blockIFEN oestrogen
    post menopause: aromatase inhibitors
  • HER-2 status = if +ve, Herceptin = Traztuzumab - monoclonal ab.
  • nodal involement, tumour size + grade
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16
Q

Prostate cancer

ivx

treament

A

adenocarcinoma 95%
RF: african, BRACA 2, brother/fater fox

ivx: PSA, transrectal uss biopsy, bone scan

Gleason score

TX:
SURGERY
RADIOTHERPAY
LHRH agonists - decrease testosterone or oestrogen to inhibit LHRD in hypothalamus 
chemo
17
Q

COLORECTAL CANCER

screening age

Tumour marker

staging?

manamagement

A

90% ADENOcarcinoma

Screening >55 one off screening
60-74 home testing kit every 2 years home kit

CEA TUMOUR MARKER

dukes staging

management
colon: surgery

REctal: radiotherapy + high risk chemo

18
Q

Radiotherpay

A

given in fractions
radical/curative = high hose in many small fractions
palliative- low dose in smaller number eg 8 Grey in 1 fraction

Treatment volume is greater then clinical target volume which is bigger than gross tumour volume

SE:
ST: ITIS, dermatitis, inflammation
LTL: osis e.g. fibrosis, scarring

19
Q

brachytherapy

A

radiotherpay when source of radiation placed within/ closr to tumour
- prostate, gynaen, oesophageal, head and neck

20
Q

stereotatic

ARC therapy

A

type of external beam
for small, well defined tumours large dose small margin

continuously delivered as unit moves through arc around patient
fast delivery and complex tumour shapes

21
Q

Tumour lysis syndrome
syx

ivx

Management

A

syx: abdo pain, vomiting, cramps
ivx: U+E, Ca, uric acid, phosphate

management:

  1. IV hydration
  2. cardiac monitoring
  3. allopurinol to reduce uric acid
22
Q

Kaposi’s Sarcoma?

A

Seen in HIV patients commonly
Caused by Human Herpes Virus 8 (HHV-8)
Purple lesions in mouth and on torso

23
Q

What does Squamous cell cancer of the lung often release?

A

Often leads to an ectopic release of parathyroid hormone related peptide (PTHrP).

24
Q

Sarcoidosis?

How would you differentiate from lung cancer?

A

Enlarged parotid glands!
Skin signs: erythema nodosum and lupus pernio
Biopsy: non-caseating granuloma

25
Q

1st line treatment for patients with chronic myeloid leukaemia?
CML chromasome?

A

tyrosine kinase inhibitors such as imatinib

Philadelphia chromosome