oncology Flashcards
NEUTROPENIC SEPSIS
how many days post chemo?
Diagnosis?
Treatment
1.
2.
3
- 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
METASTATIC SPINAL CORD COMPRESSION
sign?
IVX:
Treatment
1.
2.
.3.
- 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
SUPERIOR VENA CAVA OBSTRUCTION
syx
Treatment
1.
2.
3
- 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
HYPERCALCAEMIA
syz
ivx
management
how long does it take bisphosphonates to work?
- 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
CEA
Colorectal cancer
elevated in smokers / IBS / pancreatitis
CA125
OVARIAN carcinoma markers
related to pancreatic, lung, colorectal and breast
alpha fetaprotein
- memory aid?
HEPATACELLULAR CARCINOMA
teratoma
“alpha feta hepata terata”
human chorionic Gonadotrophin HcG
- raised in pregnancy
- non-seminomous testicular cancer
- seminoma
PSA - prostate specific antigen
- prostate cancer
- benign prostate hypertrophy
(elevated by rectal exam, uti and prostatitis)
Immunoglobulins
- myeloma
- non-hodgkins
CHEMO COMPLICATIONS
- 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
Major haemorrhage
treatment: GREEN TOWELS
IM / SC midazolam as a sedative
lung cancer: non small cell
- 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 +
lung cancer: small cell
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
breast cancer
factors for treatment:
ER status
- pre menopause tx
- post menopause tx
HER 2 staus
- +Ve then
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
Prostate cancer
ivx
treament
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
COLORECTAL CANCER
screening age
Tumour marker
staging?
manamagement
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
Radiotherpay
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
brachytherapy
radiotherpay when source of radiation placed within/ closr to tumour
- prostate, gynaen, oesophageal, head and neck
stereotatic
ARC therapy
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
Tumour lysis syndrome
syx
ivx
Management
syx: abdo pain, vomiting, cramps
ivx: U+E, Ca, uric acid, phosphate
management:
- IV hydration
- cardiac monitoring
- allopurinol to reduce uric acid
Kaposi’s Sarcoma?
Seen in HIV patients commonly
Caused by Human Herpes Virus 8 (HHV-8)
Purple lesions in mouth and on torso
What does Squamous cell cancer of the lung often release?
Often leads to an ectopic release of parathyroid hormone related peptide (PTHrP).
Sarcoidosis?
How would you differentiate from lung cancer?
Enlarged parotid glands!
Skin signs: erythema nodosum and lupus pernio
Biopsy: non-caseating granuloma
1st line treatment for patients with chronic myeloid leukaemia?
CML chromasome?
tyrosine kinase inhibitors such as imatinib
Philadelphia chromosome
