Oncology Flashcards
WHO Performance status has a number range from __ to __ ?
0 to 5
What would the WHO performance status be: dead
5
What would the WHO performance status be: fully active, no restrictions
0
What would the WHO performance status be: completely disabled, totally confined to a bed/chair
4
What would the WHO performance status be: unable to do any self care
4
What would the WHO performance status be: unable to do strenuous activities but able to carry out light work duties
1
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
3
What would the WHO performance status be: out of bed more than 50% of waking hours. Ambulant for over 50% of the day.
2
What is the usual WHO performance status cut off score for chemotherapy?
Usually 2 is the highest
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
What is an oncological emergency
A complication related to cancer or anti-cancer therapy that requires immediate intervention otherwise it could be life threatening
Name 6 examples of oncological emergencies
SVC obstruction Spinal cord compression Neutropenic sepsis Cardiac tamponade Hypercalcaemia Pulmonary embolism
Define neutropenic sepsis
- including the neutrophil levels
Signs of sepsis + neutrophils < 1.0 (if chemotherapy given in past 21 days)
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
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?
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
Once you find out a patient has neutropenic sepsis, what is the first thing you should do?
Give antibiotics URGENTLY
Management of neutropenic sepsis?
SEPSIS 6
Which antibiotics are used in neutropenic sepsis?
IV Tazocin 4.5g QDS + gentamicin
- want a broad cover
Spinal cord compression is most commonly seen in which 4 cancers
Breast
Lung
Prostate
Bladder
What is usually the first symptom in a spinal cord compression
Pain
Describe the pain experienced in spinal cord compression?
Radicular pain (band like, burning) Worse when coughing/straining
Spinal cord compression signs and symptoms
Pain (radicular)
Weakness
Sensory alteration - numbness, foot drop
Urinary retention
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)
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
