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Phase 3b > ONCOLOGY > Flashcards

ONCOLOGY Flashcards

1
Q

What are the big and serious side effects of chemotherapy

A

Neutropenic sepsis

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2
Q

What is radical treatment

A

Curative treatment (usually)

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3
Q

What is neo adjuvant treatment

A

Things you do before giving curative treatment to optimise this working (eg to reduce burden of metastatic disease)
Aim is to improve longer term survival before having curative treatment (eg surgery, radiotherapy etc)

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4
Q

What is adjuvant treatment

A

Treatment you give after your curative intent treatment
Intent is to reduce the risk of cancer coming back in the future - eg to kill little cancer cells floating around that you dont see on scans etc - would give chemo for this

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5
Q

What are palliative treatments

A

Shrink and control (not get rid of it)
Improve QOL
Improve symptom control

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6
Q

What is radiotherapy

A

Use of high energy x rays to destroy cancer cells

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7
Q

What is brachytherapy

A

internal radiation therapy - directed at a specific place

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8
Q

Difference between chemo and radiotherapy

A

Radiotherapy - local therapy

Chemo - systemic therapy

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9
Q

Difference between chemo and radiotherapy

A

Radiotherapy - local therapy

Chemo - systemic therapy (deals with micro-metastatic disease)

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10
Q

Time frame for neutropenic sepsis in chemo

A

In a 3 weeks cycle of chemo

7-10 days lowest for neutrophils

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11
Q

Risk factors for breast cancer

A 
Atypical ductal hyperplasia
Lobular carcinoma in situ 
Age
Alcohol - even moderate intake 
Obesity (post menopaural) 
HRT (5 years plus)
COCP 
Late first child (>35 years), no breastfeeding 
Early menarche
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12
Q

Red flags for breast cancer

A 
Hard painless lump 
Irregular 
Tethered
Skin tethering - pathognomic 
Lump and enlarged node - pathognomic 
Positive family hx, breast, prostate, pancreas (ductal)
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13
Q

Breast lump differentials

A

Fibroadenoma - younger pts (puberty - 30), breast tissue proliferation - benign and leave unless very large. Breast mouse - feels smooth and moveable.
Cyst - most similar to cancer as can feel hard if dense and irregular - 35-55
Papilloma
Benign breast changes - cyclical, tender, rubbery, nodules
Mastitis
Sarcoma

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14
Q

Nipple discharge differentials

A

Physiological - colour - yellow/ creamy
Hormonal - pregnancy/ hormone profile - milky large volume
Duct ectasia (dilation) - green/ brown, multi duct (can get blood sometimes)
Papilloma - blood, uniduct
DCIS - clear or bloody, uniduct

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15
Q

Red flags for nipple discharge

A

Red - blood
Uniduct
If these, probably papiloma or DCIS

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16
Q

Breast pain differentials

A

Hormonal (pre meno and post on HRT)

MSK (non cyclical)

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17
Q

Outline the management of breast lumps

A

> 40 - mammography then US and biopsy
25-40 - US and biopsy
<25 - free hand biopsy

Positive result - sentinal node biopsy

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18
Q

what is the inheritance pattern of lynch syndrome

A

autosomal dominant

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19
Q

what is the criteria for 2 week wait referral for ?breast cancer

A

age (>30), unexplained lump in breast
age (>50),
no lump but nipple discharge or retraction
consider urgent referral for unexplained lump in axilla
<30 unexplained lump - non urgent referral

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20
Q

what 2 clinical features in over 50s require 2 week wait referral for suspected breast cancer
(regardless of breast lump or pain)

A

nipple discharge

nipple retraction

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21
Q

what are the common gene syndromes associated with breast cancer

A

brca 1 and 2 (2 associated with other ductal cancers - prostate and pancreatic)
tp53 - li-fraumeni (brain, gastric)
cowdens - thyroid, endocrine

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22
Q

what should you ask about in a ?cancer hx to identify any possible gene penetrance/ syndromes

A

family hx of ANY cancers

any fhx of cancers <50 years

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23
Q

what age of women are screened for breast cancer, how, what are pros and cons

A

47-73, every 3 years, mammogram
pros picks up dcis, lcis
cons - lead time bias about whether improvement in survival is real or artifact

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24
Q

how are pts with cancer penetrance genes monitored for breast cancer

A

mri from >30 years - more sensitive than mammogram

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25
Q

what investigations are done for suspected breast cancer

A

> 40 years - mammogram then uss and biopsy
25 - 40 - uss and biospy
<25 - free hand biopsy

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26
Q

What are the main imaging tools for breast cancer

A

mammography (xr)
ultrasound
mri (if young and dense breasts, or discrepancy between clinical findings and other imaging)

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27
Q

what are the indications for mri in breast cancer

A

dense breasts <30 years and cancer genes in family
discrepancy in other imaging used and clinical findings
if needed to quantify tumour size in breast conserving surgery (i.e. need to know more precise detail of tumour size)

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28
Q

which breast cancer has the worst prognosis

A

her 2 positive

50% will get brain mets vs 20% in her 2 negative

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29
Q

what are patients with lynch syndrome recommended to take for prevention of colorectal cancer

A

aspirin

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30
Q

what is difference between men and women re follow up anaemia

A

men should not be anaemic - always needs investigating

women can be anaemia due to menstruation - once post menopausal would investigate as a man

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31
Q

indications for transfusion

A

depends on symptoms - not based on hb

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32
Q

how do you give iron for iron deficiency anaemia

A

oral
if cant tolerate this iv
give for 3 months to replace iron stores

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33
Q

how often would you prescribe iron for iron deficiency anaemia

A

od - 200mg od

tds - get less iron absorption because of symptoms

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34
Q

causes of thrombocytosis

A

inflammation, bleeding, cancer

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35
Q

what exam do you for constipation

A

rectal and abdo

to see where constipated

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36
Q

what exam do you need to do for confusion

A

neurological, gcs

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37
Q

what is a blood disorder than increases dvt risk

A

factor v leiden

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38
Q

what is factor v leiden

A

mutation of one of the clotting factors in the blood. This mutation can increase your chance of developing abnormal blood clots, most commonly in your legs or lungs.

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39
Q

first line for pe in cancer patients

A

dalteparin

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40
Q

what should you co prescribe with dexamethasone

A

ppi, antiemetic

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41
Q

what is first line treatment for neutropaenic sepsis

A

piperacillin/ tazobactam

42
Q

what days are greatest risk for neutropenic sepsis

A

7-14

43
Q

dexamethasone dose in spinal cord compression

A

8mg dex bd

44
Q

outline current bowel cancer screening in uk

A

> 55 - one off scope (flexisig) in some areas
60-74 - fit test every 2 years - faecal immunochemical test
looks for small amounts of blood with antibodies for human blood (eg dont get false positive by detection of ingested blood from meat)

45
Q

what is curative treatment

A

definitive treatment

usually surgery or radiotherapy

46
Q

what is palliative treatment

A

treatment aimed at reducing symptom burden

47
Q

what is concurrent treatment

A

treatment given at same time as definitive treatment

48
Q

how does chemotherapy work

A

mechanisms that damage rapidly dividing cells and cause them to die.
Works mainly on cancer cells rather than healthy tissue as cancer cells are less developed cells and so have less defences. Health tissue has better mechanisms/ defences to deal with damage from chemo, although damage still happens.

49
Q

How is toxicity graded with chemotherapy, and what levels of serious/ life-threatening

A 
1-5 (5 is death)
1 = mild
2 = moderate 
3,4 = serious, hospital admission, life threatening, need change in chemo regime 
5 = death 
Graded based on speed of toxicity
50
Q

Management of anaphylaxis

A 
Stop drug infusion 
High flow oxygen (12-15L, bag valve mask)
IV adrenalin (0.5 ml of 1:1000 IM)
IV fluids 
IV antihistamine (eg chlorphenamine) 
IV steroid (eg hydrocortisone) 
Continuous monitoring
51
Q

What dose and route of adrenalin should you give in anaphylaxis

A

0.5 mls of 1:1000 adrenaline IM

52
Q

What blood test do you need to do before starting gentamicin

A

UandE - can cause renal failure

53
Q

List some of the common side effects of chemotherapy

A 
Anaphylaxis 
Neutropenic sepsis / neutropenia 
Extravasation 
Coronary spasm 
Nausea/ vomiting 
Constipation/ diarrhoea 
Bone marrow suppression
Fatigue
Alopecia 
Stomatitis 
Skin toxicity (rash, itching etc) 
Cognitive impairment 
Lung toxicity 
Peripheral neuropathy 
Late effects
54
Q

Difference between chemotherapy and immunotherapy

A

Chemo - drugs that kill cancer cells by toxic mechanisms

Immunotherapy - antibodies that help to activate (upregulate) immune system to respond to cancer

55
Q

Commonest side effects of immunotherapy

A

Autoimmune damage to liver (derranged LFTs), lungs (SOB, cough, chest pain), colon (diarrhoea, constipation), thyroid

56
Q

Currently, what are immunotherapies used for

A

Palliative treatment only

57
Q

When should you suspect neutropenic sepsis and how would you proceed with assessment / management

A

Neutrophils <1.0 and any symptoms of infection (does not have to be fever)
Consider it in ANY patient on chemo with temp of >37.5
CLINICAL DIAGNOSIS AND MANAGEMENT
Do not wait to for blood results to confirm
Any infection symptom - treat as per sepsis protocol, stat IV broadspectrum antibiotics
Check hx for blood cultures and any known resistant organisms - may mean you need to speak to microbiology about this
Contact oncall oncologist

58
Q

How is anaphylaxis prevented when starting a new chemotherapy

A

High dose steroids day before
IV/ PO antihistamines day before
Slow infusion

59
Q

What is extravasation, what are the complications and how is it prevented

A

When cannula tissues - cytotoxic drug accumulates into tissue and can cause necrosis
Prevent by small cannula and insert away from joints to reduce serious damage if tissues
Management - stop infusion and seek help
Of bad, ?plastics

60
Q

What chemotherapy can cause coronary artery spasm and what is the management

A

Flurouracil
Capecitabine
Management is nitrates

61
Q

What antiemetics are prescribed for nausea and vomitting

A

Metoclopramide - D2 antagonist
Ondansetron - 5HT
Aprepitant - only licenced for chemo
Cyclizine - antihistamine

62
Q

What is the management of diarrhoea and constipation in patients on chemotherapy

A

Loperamide (diarrhoea)

Laxatives (constipation)

63
Q

What should you always consider when a patient on chemotherapy presents with constipation

A

Bowel obstruction

64
Q

What are the features of bone marrow suppression in a patient on chemotherapy

A

Anaemia
Thrombocytopenia
Neutropenia

65
Q

What is dose limiting toxicity determined by with chemotherapy

A

Bone marrow suppression

So basically - toxicity level acceptable is when marrow is still functioning

66
Q

What is pancytopenia, what does it represent

A

Low red cells
Low white cells
Low platelets
Represents aplastic anaemia, which is the term used for bone marrow failure

67
Q

What is the management of aplastic anaemia in chemotherapy patients

A

Lower threshold for transfusion, want a Hb target of 100-120 - discuss with oncologist
Platelet transfusion when <10

68
Q

What would make you suspicious of bone marrow suppression in a patient undergoing chemotherapy

A

Signs of anaemia
Pallor
Fatigue

69
Q

When should you suspect neutropenic sepsis and how should it be managed

A

Suspect and treat based on clinic symptoms and very low threshold
Fever (>37.5) OR any infection symptom - cough, feeling unwell, dysuria, abdo pain, diarrhoea - ANYTHING
CHECK ALLERGIES then:
IV broadspectrum antibiotics - tazobactam / pipercillin
Speak to on call oncologist
Bloods and monitor
Neutrophils <1
Do not treat based on neutrophils
TREAT BASED ON SYMPTOMS

70
Q

Presentation and management of stomatitis

A 
Sore, dry, red, inflamed oral mucosa 
Ask about oral intake (if preventing this need to consider dehydration) 
Supportive: 
Oral anti-inflammatory gels/ mouthwash/ toothpaste
Difflam mouthwash (numbs mouth)
Antacid ozetocaine
Aspirin gargle/ mouthwash
Last resort: systemic analgesia 
ALCOHOL free oramorph
71
Q

What can you give for the management of fatigue in cancer patients

A

steroids - although only if end of life/ poor prognosis as not good long term

72
Q

What can you give for management of dry skin/ itch in cancer patients

A

emollients

antihistamines

73
Q

What should you include in differential of SOB in patients on chemotherapy

A

Lung toxicity - rare but potentially life threatening remember in differential
Bleomycin

74
Q

What neurological symptoms are common with chemotherapy

A

Peripheral neuropathy

Platinum in chemo is cause

75
Q

What are the late effects associated with chemotherapy

A 
Infertility 
Early menopause 
Atherosclerosis
Heart failure / lung damage 
Chemo brain 
secondary cancers
76
Q

What should you always check on examination when suspecting cancer

A

lymph nodes

77
Q

what is the 2 ww referral guidelines for breast cancer

A

> 30 unexplained breast lump

>50 nipple retraction, discharge or lump in axilla

78
Q

what is the 2 ww referral guidelines for bowel cancer

A

> 40 unexplained weight loss + abdo pain
50 unexplained rectal bleeding
60 iron deficiency anaemia or change in bowel habit

79
Q

what is the 2 ww referral guidelines for lung cancer

A

> 40 unexplained haemoptysis

CXR changes suggestive of cancer

80
Q

what is the 2 ww referral guidelines for prostate cancer

A

> 50 and PSA >3

Hard craggy mass on DRE

81
Q

List some red flags for bowel cancer

A 
Change in bowel habit 
Anaemia 
Abdominal mass
Abdominal pain 
Blood in stool 
Weight loss 
Change in appetite 
Anal mass/ ulceration 
DVT
82
Q

What should you include in differential for an unprovoked DVT

A

Cancer

83
Q

How long should a patient who has had a PE and who has cancer be anticoagulated for (as a minimum)

A

3-6 months

usually 6 months

84
Q

List red flags for lung cancer

A 
Haemoptysis 
Cough, chest pain + smoker
Dysphagia 
Hoarse voice 
SOB
Head, neck, arm swelling (SVCO obstruction)
85
Q

Most common symptoms of lung cancer

A

Cough
Chest pain
Haemoptysis

86
Q

Site of lung cancer mets

A 
lymph glands
bone
brain
liver
adrenal glands
87
Q

Symptoms of lung cancer metastatic disease

A 
bone pain
headache 
seizures
neurological deficit
hepatic pain
abdominal pain
88
Q

What are paraneoplastic syndromes

Which cancers most commonly have paraneoplastic syndromes

A

Symptoms caused by the effects of a tumour rather than tumour itself (eg secreting high ACTH - Pituitary tumour/ lung tumour, or tumour acts as antigen that causes immune system to produce antibody that cross reacts eg Eaton Lambert syndrome, or tumour secretes protein that interacts with normal physiology eg parathyroid hormone related protein and hypercalcaemia)
Lung, breast, ovarian, pancreas, stomach, kidney, lymphoma, leukaemia

89
Q

Investigations for lung cancer

A 
CXR 
CT thorax
Bronchoscopy +/- US guided biopsy
Percutaneous (CT guided) needle biopsy
US guided aspirate or biopsy
Surgical biopsy
90
Q

List the common paraneoplastic syndromes and their symptoms/ presentations

A

Eaton Lambert - weakness, fatigue, similar to MG
SIADH - hyponatraemia - headache, lethargy, weakness, confusion
Hypercalcaemia - parathyroid related protein (check PTH (high in primary HPT), phosphate (low in primary HPT), protein (normal to low in cancer), ALP (bone turnover)
Hypertropic osteoarthropathy - joint pain, bone pain
Clubbing
Weight los

91
Q

What questions should you ask about in cancer hx to probe for paraneoplastic syndromes

A 
Weakness
Balance/ stumbling 
Bone/ joint pain 
Thirst / polyuria 
Nausea/ sickness / vomitting
92
Q

presentation of paraneoplastic ACTH producing lung tumour

A

Cushing’s symptoms

93
Q

what are carcinoid tumours

A

Tumours of neuroendocrine cells (enterochromaffin in gut that releases serotonin and histamine; and PNEC - pulmonary neuroendocrine cells that release serotonin)

94
Q

how do carcinoid tumours present

A

Features of high plasma serotonin and bradykinin
Flushing
Low BP
Palpitation
Diarrhoea
Bronchospasm
Can get symptoms of R sided heart disease bc of metastatic spread from gut to liver to heart. Get tricuspid valve regurge, endocardial fibrosis
Can get retroperitoneal fibrosis from retroperitoneal spread - eg hydro nephrosis
Peyronies

95
Q

how would you investigate carcinoid tumours

A

Plasma chromaffin A - screening test
24 hour urinary excretion of 5HIAA
Bloods for tumour marks including FBC, LFTs, TFTs, parathyroid hormone, calcium, calcitonin, prolactin. alpha-fetoprotein, carcinoembryonic antigen (CEA) and beta-hCG.

96
Q

What radiation is used in radiotherapy and why

A

Gamma waves

Higher energy, more ionising, affect nucleus of cell

97
Q

What is the difference between a bone scan and a DEXA scan

A

DEXA is X rays - looks at density

Bone scan is nuclear medicine - uses a radioisotope to look as bone activity

98
Q

How does a bone scan work

A

Uses a radioactive tracer - usually technetium 99 - attaches it to a compound that is metabolically active with bone (medronic acid - is taken up by blasts). The tracer is then taken up more in areas of bone clast activity and turn over, eg mets or fractures and generates ‘hot spots’

99
Q

What is the difference between X-rays/CT and nuclear medicine scans

A

XRays/ CT - anatomical scans

Nuclear medicine - functional - have a tracer that gives some index of physiology

100
Q

What is the difference between PET and SPECT vs Bone scan (gamma camera)

A

Bone scan - 2D image

PET and SPECT - 3D image (combined with CT for anatomy)

Phase 3b (13 decks)

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