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