Oncology Flashcards
List the main oncological emergencies
Spinal cord compression
Superior vena cava obstruction
Raised ICP
Hypercalcaemia
What are some causes of spinal cord compression?
Extra-cordal compression (tumour)
Vertebral body extension (osteophyte)
Osteoporotic crush fracture
List symptoms and signs of spinal cord compression
Back pain Radicular (band-like) pain Pain worse on cough/straining Bowel/urinary change Weakness Altered sensation
What investigations would you order for spinal cord compression?
Urgent MRI
Lumbar puncture if suspected meningeal involvement
How is spinal cord compression treated?
Acute: IV dexamethasone
Surgery
Radio/chemo therapy
List some causes of superior vena cava obstruction
Intrinsic: clot, foreign body, tumour
Extrinsic: mass/tumour, aneurysm, fibrosis
Thrombosis, ovarian hyper-stimulation
List symptoms and signs of superior vena cava obstruction
Dyspnoea Swollen face/neck/arms Distended veins Headache Organomegaly Non-collapsing veins
What is Pemberton’s test for superior vena cava obstruction?
Lift arms over head
If causes facial plethora/cyanosis and raised JVP, obstruction is likely
How is superior vena cava obstruction?
Clot - streptokinase, anticoagulation
Oral dexamethasone
Chemo/radio therapy
Stenting
List causes of hypercalcaemia in oncological patients
Lytic bone mets
Myeloma
PTH-producing tumour
List symptoms and signs of hypercalcaemia
Lethargy Anorexia Nausea Polydipsia Polyuria Constipation Confusion Weakness Moans, groans, aches and stones
How is hypercalcaemia treated?
Manage underlying malignancy
Bisphosphonates
Calcitonin
List symptoms and signs of raised ICP
Headache, worse in morning or straining Nausea Vomiting Papilloedema Fits Focal neurological deficit
What investigations would you order for raised ICP?
Urgent CT/MRI head
How is raised ICP treated?
Dexamethasone PO
Radiotherapy
Surgery
Mannitol may give symptomatic relief
What is meant by neoadjuvant chemotherapy?
Shrink tumour prior to surgery
Early control of metastasis
What is meant by primary chemotherapy?
Sole treatment for malignancy
What is meant by adjuvant chemotherapy?
Given post- surgery/radiotherapy to decrease risk of remission
What is meant by palliative chemotherapy?
Given for symptomatic relief and prolong survival, i.e. non-curative intent
What do antimetabolic chemotherapy agents do? Name some?
Inhibit processes that promote growth/synthesis
Methotrexate, 5-fluoroucil, azathioprine
What do anti-tumour antibody chemotherapy agents do? Name some?
Inhibit DNA transcription and replication via topiromase inhibitors
Doxorubicin, etoposide, actinomycin
What do antimicrotubule chemotherapy agents do? Name some?
Prevent separation of chromatids during replication
Vincristine, vinblastine, paclitaxel
What do alkylating chemotherapy agents do? Name some?
Alkylate functional groups to form covalent bonds
Cyclophosphamide, chlorambucil, cisplatin, busulfan
What do monoclonal antibody chemotherapy agents do? Name some?
Target tumour-specific antigens
Rituximab (CD20), cefuximab (EGFR1), bevacizumab (VEGF), imatinib (TK1)
List some side effects of chemotherapy
Vomiting Alopecia Neutropenia Infertility Rash
How does radiotherapy work?
Uses ionising radiation to produce free radicals that damage DNA
Why is radiotherapy delivered in fractions?
Gives normal cells time to recover
What is the difference between radical and palliative radiotherapy in terms of the doseage given?
Radical - 40-70Gy in 15-35 fractions
Palliative - 8-30Gy in 1-10 fractions
List some early side effects of radiotherapy
Tiredness Skin reactions Mucositis, oral thrush Nausea, vomiting Diarrhoea Dysphagia
List some late side effects radiotherapy
CNS: somnolence, weakness, reduced IQ, plexopathy
Lung: pneumonitis, cough, dyspnoea
GI: dry mouth, strictures, inflammation
GU: frequency, infertility, dyspareunia, vaginal stenosis
Erectile dysunction, endocrine disturbance
List palliative drugs used for nausea and vomiting
Cyclizine (anti-histamine) Domperidone (blocks CTZ) Metoclopramide (anti-dopaminergic, pro-kinetic) Haloperidol (dopamine antagonist) Odansetron (5-HT antagonist)
List palliative drugs used for constipation
Bisacodyl
Movicol
List palliative drugs used for breathlessness
Oxygen
Morphine (reduces resp drive)
BZD’s
Pleurodesis, thoracocentesis
List palliative drugs used for dry mouth
Chew ice or pineapple
Oral hygiene
Pilocarpine
List palliative drugs used for itch
Cholesyramine
Ursodeoxycholic acid
List palliative drugs used for agitation/hallucinations
Haloperidol
Quetiapine
Midazolam
List palliative drugs used for excessive secretions
Buscopan (hyoscine hydrobromide)
List palliative drugs used for pain
Non-opioid (paracetamol, aspirin, NSAID)
+ weak opioid (codeine, dihydrocodeine, tramadol)
+ strong opioid (morphine, diamorphone, oxycodone, fentanyl)
What tumours cause raised AFP?
Hepatocellular carcinoma
Germ cell tumour
Also hepatitis, cirrhosis, pregnancy
What tumours cause raised CA 125?
Ovarian cancer
Uterine cancer
Breast cancer
Hepatocellular carcinoma
What tumours cause raised CA 153?
Breast cancer
What tumours cause raised CA 199?
Colorectal cancer
Pancreatic cancer
Cholestasis
What tumours cause raised CA 2729?
Breast cancer
What tumours cause raised CEA?
GI cancer (esp colorectal) Also cirrhosis, pancreatitis, smoking
What tumours cause raised HER2?
Breast cancer
Ovarian cancer
Stomach cancer
Uterine cancer
What tumours cause raised B-HCG?
Germ cell cancer
Hydatiform mole
Choriocarcinoma
Also pregnancy
What tumours cause raised PSA?
Benign nodular hyperplasia of prostate
Prostate adenocarcinoma
