Oncology Flashcards by Sheryl O'Hare

WHO Performance status has a number range from __ to __ ?

0 to 5

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What would the WHO performance status be: dead

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What would the WHO performance status be: fully active, no restrictions

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What would the WHO performance status be: completely disabled, totally confined to a bed/chair

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What would the WHO performance status be: unable to do any self care

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What would the WHO performance status be: unable to do strenuous activities but able to carry out light work duties

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What would the WHO performance status be: confined to a bed/chair for more than 50% of waking hours. Ambulant for less than 50% of the day

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What would the WHO performance status be: out of bed more than 50% of waking hours. Ambulant for over 50% of the day.

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What is the usual WHO performance status cut off score for chemotherapy?

Usually 2 is the highest

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What is the purpose of the WHO performance status?

Gives the dr an overall impression of the patient’s fitness so that they can have an idea of the likelihood of running into problems with treatment

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What is an oncological emergency

A complication related to cancer or anti-cancer therapy that requires immediate intervention otherwise it could be life threatening

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Name 6 examples of oncological emergencies

SVC obstruction
Spinal cord compression
Neutropenic sepsis 
Cardiac tamponade 
Hypercalcaemia 
Pulmonary embolism

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Define neutropenic sepsis

- including the neutrophil levels

Signs of sepsis + neutrophils < 1.0 (if chemotherapy given in past 21 days)

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If a patient has neutropenia (neutrophils <1.0) but no signs of infection, what should you do?

Nothing, no need for treatment if patient doesn’t possess any signs of infection

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If a patient on chemotherapy develops neutropenic sepsis, what should you find out about their chemotherapy?

Date of last chemotherapy
Type of chemotherapy
Were blood products administered?

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If patient has neutropenia (neutrophils <1.0) a temperature of over 37.5 degrees but no other signs of infection, what should you do?

Treat immediately

initiate sepsis 6
give antibiotics immediately

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Once you find out a patient has neutropenic sepsis, what is the first thing you should do?

Give antibiotics URGENTLY

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Management of neutropenic sepsis?

SEPSIS 6

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Which antibiotics are used in neutropenic sepsis?

IV Tazocin 4.5g QDS + gentamicin

- want a broad cover

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Spinal cord compression is most commonly seen in which 4 cancers

Breast
Lung
Prostate
Bladder

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What is usually the first symptom in a spinal cord compression

Pain

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Describe the pain experienced in spinal cord compression?

Radicular pain (band like, burning) 
Worse when coughing/straining

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Spinal cord compression signs and symptoms

Pain (radicular)
Weakness
Sensory alteration - numbness, foot drop
Urinary retention

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In spinal cord compression, which symptoms come first: sensory symptoms or motor symptoms?
- why is this

Motor symptoms come first
- cancer usually comes from the vertebral body (remember the vertebral body is positioned anterior to the SC) and the cancer works posteriorly so it hits the ventral horn first (motor) before the dorsal horn (sensory)

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What is the first line urgent investigation in a patient with spinal cord compression?

Urgent MRI scan

Management options in spinal cord compression

Dexamethasone - to reduce vasogenic oedema Surgery - if confined and patient able to go under GA Radiotherapy

Causes of SVC obstruction can be split into 2 categories. what are these?

Causes within the SVC - clot - foreign body - cancer Causes outwith the SVC (and compressing it from the outside) - cancer

SVC obstruction - which type of lung tumour is most likely to cause extrinsic compression on the SVC? SCLC or NSCLC

SCLC

SVC obstruction - clinical presentation

Swelling of the face, neck, arms distended veins shortness of breath headache

SVC obstruction - initial investigation

CXR - look for tracheal deviation - look for evidence of tumour

SVC obstruction - management if the cause is a clot

thrombolysis | anti-coagulation

SVC obstruction - management if the cause is compression from a mass

Dexamethasone Stent Chemotherapy Radiotherapy

Cancer patients are more/less likely to clot

More likely

What is the link between hypercalcaemia and cancer?

Most calcium is stored in the bone so if there is bone destruction (which can happen in cancer) then this can cause hypercalcaemia

What are the 2 most common causes of hypercalcaemia?

Malignancy | Hyperparathyroidism

Hypercalcaemia is when the corrected calcium level is over which value?

> 2.55mmol/l

Malignant hypercalcaemia - presentation

``` Pain Thirst Polyuria Confusion Anorexia Constipation Poor concentration Itch ```

If you suspect malignant hypercalcaemia, which investigations should you carry out?

``` Calcium Corrected calcium PTH - if raised, suspect primary hyperparathyroidism U+E - look for dehydration Myeloma screen ```

Malignant hypercalcaemia - what is the most important test to guide management?

U+E

What is the first step in the management of malignant hypercalcaemia?

REHYDRATION - 3-4L 0.9% saline in 24 hours - monitor urine output

What is the maangemetn of malignant hypercalcaemia?

Rehydration first then | bisphosphinates

What is a bisphosphinate used in the treatment of malignant hypercalcaemia ?

Pamidronate IV 60-90mg over 2 hours

What is the function of bisphosphinates

They adsorb to bone and block osteoclast-mediated bone resorption

How many days do bisphosphinates take to work?

3-5 days

If a patient has bisphosphinates but the next day there is no improvement in the symptoms, should you continue to give bisphosphinates?

No ??? | wait for a few days to see the effect of the bisphosphinates

Buzzword for tumour lysis syndrome

Abnormal electrolytes

Name 2 cancers which are most likely to cause tumour lysis syndrome?

Lymphoma | Germ cell tumours (testicular tumours)

What are the abnormal electrolytes in tumour lysis syndrome

Raised potassium Raised phosphates Low calcium

Management of tumour lysis syndrome

Prevention | Uric acid reduction (allopurinol or rasburicase)

Tumour lysis syndrome - how can you correct electrolytes immediately

Dialysis

Which cardiac protection should you consider for hyperkalaemia?

calcium gluconate

Cardiac tamponade - pathophysiology

pericardial effusion develops and compresses the ventricle, reducing the cardiac output. This increases venous back pressure

Cardiac tamponade results in

Diastolic heart failure | muffled heart sounds on auscultation

Causes of cardiac tamponade

Trauma Malignancy Infection Post MI

Clinical presentation of cardiac tamponade

Shortness of breath Fatigue Palpitations Symptoms of pericarditis

Clinical signs of cardiac tamponade

Muffled heart sounds Pulsus paradoxus Pericardial rub

Management of cardiac tamponade

Pericardiocentesis - done by a cardiologist

PE - clinical features

Acute deterioration in shortness of breath Pleuritic chest pain Unilateral leg swelling Tachycardia

SIADH is most commonly associated with which tumour

SCLC

Management of SIADH

Fluid restriction

Ras is - oncogene - tumour suppressor gene

Oncogene

p53 is - oncogene - tumour suppressor gene

Tumour suppressor gene

Which lung cancer is most common - SCLC - NSCLC

NSCLC

What is NSCLC further divided into

Adenocarcinoma Squamouc cell large cell

What is the most common lung cancer seen in non smokers?

Adenocarcinoma

What is the explanation of hoarse voice symptom of lung cancer?

Due to the tumour invading the recurrent laryngeal nerve branch of CN X

Which sign might you elicit when looking for SVC obstruction, and what is it?

Pemberton's sign | Get patient to put hands above head and this causes facial congestion and cyanosis

SIADH is often associated with which type of lung cancer?

SCLC | -Ectopic release of ADH by the small cell lung cancer can result in hyponatraemia.

What is the first line treatment of squamouc cell carcinoma of the oesophagus

Radical chemotherapy with radiotherapy

What is Virchow's node and which cancer is it associated with

Enlargement of left supraclavicular node | Associated with gastric cancer

Main risk factor for developing cholangiocarinoma

PSC

Which syndrome can cause neuroendocrine pancreatic cancer

Von Hippel Lindeau syndrome

Painless Jaundice Weight loss Back pain Lethargy Steatorrhea Diarrhoea Make you think

Pancreatic cancer

What is the name of the surgical procedure for pancreatic cancer

Whipple's procedure

Where does an insulinoma arise?

Beta cells of the pancrease which secrete insulin

Clinical features of insulinoma

``` Episodic hypoglycaemia Mood changes Lethargy Hunger Sweating ```

Excessive thirst and hunger Unintentional weight loss High blood sugar These symptoms may be present with which tumour

Glucagonoma

HNPCC (lynch syndrome) is associated with which other cancer?

Endometrial cancer (gynae)

What is the biggest risk for developing anal cnacer?

HPV

Neutropenic sepsis is defined as sepsis in a cancer patient with a neutrophil count

less than 0.5

pericardial tamponade can lead to SYSTOLIC/DIASTOLIC heart failure

diastolic

In terms of pagets disease of the nipple, how is this related to breast cancer

It is high grade DCIS involving the nipple skin

Which biopsy method is used for ?breast cancer - FNA - core needle biopsy - vaccum biopsy

Core needle biopsy

If a breast cancer is ER +ve what does this mean

Breast cancer contains oestrogen receptors, meaning they depend on oestrogen for growth

If a breast cancer is HR +ve what does this mean

Breast cancer is hormone receptor positive, it contains BOTH oestrogen and progesterone

If a breast cancer is HER-2 +ve, what does this mean

These are breast cancers which over express the HER2 protein, meaning that they tend to grow and spread faster than other types of breast cancer but can be treated with drugs that target the HER2 protein.

If the breast cancer is ER+ve, what hormone therapy is given

Tamoxifen | - this is an oestrogen receptor antagonist

If the breast cancer is HER-2 +ve, what hormone therapy is given?

Trastuzumab (Herceptin)

In relation to CIN (cervical intraepithelial neoplasia), what is koilocytosis?

The presence of structurally abnormal squamous cells

In relation to CIN (cervical intraepithelial neoplasia), what is dyskaryosis

Abnormal nucleus

What is the surgical treatment for endometrial cancer

Hysterectomy with bilateral salpingo-oophrectomy

Young woman with ovarian cancer - what type could it likely be

Germ cell tumour

For germ cell ovarian tumour, which three tumour markers should you be aware of

AFP b-hCG lactate dehydrogenase

What is the most common malignant primitive germ cell tumour

dysgerminoma

triad of right pleural effusion, ascites or raised CA125 suggests

Meig's syndrome

Lower gynaecological cancers use which staging

FIGO

Which lymph nodes does vulval cancer typically spread to?

Inguinal lymph nodes

When may oophrectomy be an option in the management of breast cancer?

Pre-menopausal women

Smoking is linked in the aetiology of which 1 of the following cancers - prostate cancer - melanoma - hepatocellular carcinoma - bladder cancer

Bladder cancer

What is the mechanism of tamoxifen

It is an oestrogen receptor antagonist

Alcohol induced pain makes you think

Hodgkins lymphoma

Infection with EBV increases your risk of which cancer (haematological)

Hodgkin's lymphoma

Reed sternberg cells suggest

Hodgkin's lymphoma

Which is more common: B cell or T cell lymphoma

B cell

What is the key diagnostic test in lymphoma

Lymph node biopsy | - look for reed sternberg cells - this indicated Hodgkin's

MALT lymphoma is associated with

H. Pylori infection

Which type of antibody is most common with myeloma

IgG

Management of bone lesions in myeloma

Bisphosphonates

Which type of nephropathy do you get with myeloma

Cast nephropathy

What may be found in the urine in a patient with myeloma

Bence Jones protein

In myeloma, there is raised / reduced plasma viscosity?

Raised (blood is thicker)

``` Elevated calcium Renal failure Anaemia Bone pain Makes you think ```

Myeloma

Initial investigations for ?myeloma

``` FBC (reduced WCC) Plasma viscosity (raised) Calcium (raised) ESR (raised) ```

If bloods come back suggestive of myeloma, which investigations are done

Serum protein electrophoresis Bence jones proteins in urine (urine electrophoresis)

Which investigation is used to confirm the diagnosis of myeloma

Bone marrow biopsy

Raindrop skull on Xray makes you think

Myeloma