Oncology and Palliative Flashcards
Name some mechanisms that chemotherapy works?
DNA cross links - platinum Damage tubulin - vinca alkaloids Topoisomerase 1 and 2 inhibitors Antimetabolites Free radical generator
what is chemotherapy?
cytotoxic drugs used to kill cancer cells
SE of chemotherapy?
myelosuppression, alopecia, infertility, fatigue
How do we work to prevent anaphylaxis with chemotherapy?
give steroids/antihistamines
slower infusion rates
specialist nurses on sight
Name some oncological emergencies
extravasation
coronary artery spasm
neutropenic sepsis
Name some late effects of chemotherapy
Infertility early menopause atherosclerosis HF/lung damage chemo brain secondary cancers
what is extravasation during chemotherapy?
if chemotherapy cannula accidently moves SC and is administered it can cause necrosis of large patches of skin
what is coronary artery spasm during chemotherapy?
typically occurs with 5FU
looks like ACS on ECG
stop infusion and involve cardiology
give NITRATES
what anti-emetics can you give to patients struggling with N&V during chemo?
metoclopromide, domperidone
why is there an increased risk of haemorrhage in cancer patients?
chemo + disease = reduced platelets
cancer can erode vessels
low numbers of clotting factors
How do you manage SCC in a cancer patient?
IV dexamethasone
how do you manage constipation/diarrhoea in a cancer patient?
loperamide, laxative
how does BM suppression present?
THROMBOCYTOPENIA - easy bruising and bleeding
ANAEMIA - fatigue and pallor
NEUTROPENIA - neutropenic sepsis
what is the definition of neutropenic sepsis?
neutrophil count <1.0 and a fever >37.5 in a patient undergoing chemotherapy (increased Rx due to myelosuppression)
what do you give to a patient with suspected neutropenic sepsis?
Tazocin
Ix for a patient with suspected neutropenic sepsis?
FBC/UE/LFT/Cr/CRP/lactate/blood cultures/urine cultures/swab central line
how do we try and increase appetite of cancer patients?
steroids
how do we manage painful spinal mets?
analgesia, bisphosphonates, palliative radiotherapy, vertebroplasty
how can we manage stomatitis?
difflam mouthwash
name some types of immunotherapy?
MAbs, interferons, interleukins, oncolytic virus therapy, cancer vaccines
name some side effects of immunotherapy treatment?
hepatitis - deranged LFTs/jaundice
colitis - perforation, pain and blood in stools
pneumonitis - cough/SoB
name some cancer functional assessments? why are they important
ECOG performance status (0 = fully active –> 5 = dead)
clinical frailty score
important because it strongly correlates to outcome
what can we use to dictate outcome predictions for cancer patients
cancer functional assessments
exercise tolerance
daily housework
Albumin/Cr/Hb/liver and renal function/pulm function/TNM staging
Indications for radiotherapy
medically unfit for surgery, anatomically unrescectable, close to vital structures, adjuvent to reduce recurrence
what is radiotherapy?
high dose X rays to destroy cells (cancer cells can’t repair themselves very well but normal cells can.)
name some different modalities for radiotherapy?
external beam, electrons, brachytherapy
acute SE of radiotherapy?
local sunburn effect fatigue reduced taste pneumonitis erythema irritation
late effects of radiotherapy?
scarring infertility lymphodoema delayed healing reduced salivary flow hypothyroid
what are the features of a benign tumour?
localised, non invasive, resembles normal tissue and encapsulated
what are the features of a malignant tumour?
invasive, metastatic, rapid growth, poorly defined border, necrosis
mechanism of hypercalcaemia of malignancy? 3 mechanisms
- secretion of PTH by tumour
- local realease of factors increasing osteoclast proliferation
- autonymous production of calcitriol by lymphoma
Mx of hypercalcaemia of malignancy?
IV normal saline
Bisphosphonates
Furosemide
What is SVC obstruction? and what is the commonest cause?
venous return for the head/thorax/upper extremities is obstructed, which increases venous pressure
commonest cause: cancer (lung cancer and lymphoma)
Symptoms of SVC obstruction?
oedema of face and upper extremities, facial plethora, dysponea and cough, distended chest and neck veins, , raised JVP
Ix for SVC obstruction?
CXR, CT thorax and contrast, USS upper extremities
what is tumour lysis syndrome?
combination of metabolic and electrolyte abnormalities occuring spontaneously in cytotoxic treatment due to excessive cell lysis.
What are the metabolic abnormalities in tumour lysis syndrome and what do these cause?
HYPERURICAEMIA - increased uric acid crystals –> AKI
HYPERPHOSPHATAEMIA - urinary obstruction
HYPERKALAEMIA - arrhythmia
HYPOCALCAEMIA - cramps/tetany
presentation of tumour lysis syndrome?
syncope, chest pain, dyspnoea, N&V, abdo urinary colic, muscle weakness, tetany
what causes carcinoid syndrome? what are the features?
increased serotonin from neuroendocrine tumours
flushing/diarrhoea, wheeze palpitations, abdo pain
what does palliative medicine focus on?
physical, psychological and spiritual - supportive care/EoL/terminal care/bereavement support
name some antiemetics and where they act?
bowels - domperidone
bowels and brain - ondasetron
biochem and brain - haloperidol
brain - cyclizine
Name some simple analgesics and their side effects?
paracetamol - liver impairment and cachexia
NSAIDS - renal impairment, GI bleeds, asthma
Name 3 weak opioids
codeine, dihydrocodeine, tramadol
name some strong opioids?
morphine, diamorphine, oxycodone, buprenorphine, fentanyl
Common SE of opioids?
constipation, sedation, nausea, dry mouth, resp depression
which opiods are best for renal impairment?
fentanyl, buprenorphine
name some alternative adjuvant analgesics?
antidepressants e.g TCAs pregabalin antispasmodics e.g. baclofen steroids benzos bisphosphonates
signs that a patient is dying?
weight loss and reduced appetite fatigue reduced mobility social withdrawan pulse changes, mottled, cool peripheries noisy secretions and laboured breathing
Name some symptoms in the dying patient and how you would manage them?
PAIN - PRN morphine syringe driver and patch BREATHLESSNESS - PRN opioid SECRETIONS - PRN buscopan N&V - Haloperidol AGITATION - midazolam
