Oncology Blue Book Part 2

Question 1

what causes myelosuppression

Answer 1

can be a result of disease or chemotherapy due to siping out own body’s cells in bone marrow

Question 2

aetiology of myelosuppression

Answer 2

treatment related –> cytotoxic and biological agent, causes a transient fall of leukocytes and platelet count in conventional dose but worse in higher dose

bone marrow infiltration –> infiltration of malignant cells into the bone marrow and cause pancytopenia

para-neoplastic syndrome –> syndrome caused by the production of hormone/cytokines by tumour cells leading to an immune response by the body leading to depletion of leukocytes etc

other –> anaemia caused by a tumor and chemotherapy

Question 3

when does myelosuppression usually come on

Answer 3

10-12 days post inital engagement of chemotherapy

Question 4

which cancer more likely to cause bone marrow infiltration

Answer 4

lung breast prostate (those cancer in particular that invade bones)

haematological cancer –> leukomai, lymphoma etc

Question 5

which type of myelosuppression does carboplatin cause

Answer 5

thrombocytopenia

Question 6

which biological agents causes myelossuppression

Answer 6

interforon

interleukin-2

Question 7

Ix for myelosuppression

Answer 7

full evaluation incl blood film, measurement of haematinics, bone marrow aspirate and trephine (bone marrow test)

Question 8

treatment for myelosuppression due to anaemia

Answer 8

gold standard = transfusion but the loss of risks

recombinant erythropoietin –> stimulate EPO and so stimulate RBC production from bone marrow level

Question 9

what level of HB is considered to be impairing QOL

Answer 9

< 10 g/dl

Question 10

presentation of thrombocytopenia

Answer 10

petechial haemorrhage, spontaneous nose bleeds, corneal haemorrhage, haematuria

Question 11

what level of platlet is considered life-threatening

Answer 11

< 10x10(9)/L –> significant risk of spontaneous risk of bleeding eg intra-cerebral haemorrhage

Question 12

treatment of thrombocytopenia when platelet level of < 10x10 9

Answer 12

urgent platelet transfusion

Question 13

what platelet support is given when HB level between 10-20x10 (9)

Answer 13

frequent transfusion of platelet but not urgent

Question 14

treatment of thrombocytopenia when platelet is > 20x10 (9)

Answer 14

usually nothing unless spontanoues bleeding

Question 15

what can repeat platelet transfusion cause

Answer 15

specifice antibbodies produced by the body itself targeting the transfused platelet

using of a singler donor or a donor with HLA matched platelet

Question 16

what level of WBC is considered to be infection prone

Answer 16

< 1x10(9)/L

Question 17

management of a patient present with fever post chemo

Answer 17

medical emergency due to the possbility of neutropenic sepsis

board spectrum ABx - local Leeds guideline –> Tazosine

Question 18

what examination should be avoided in patients presentation consistent of neutropenic sepsis

Answer 18

PR or vaginal exam to avoid any breach to the mucosa leading to the infection risk

Question 19

management of persistent pyrexia despite correct Abx treatment

Answer 19

additional anti-fungal or anti-viral agents

Question 20

treatment of pneumocystis pneumonia

Answer 20

co-trimoxazole

Question 21

what are some of the prevention method of myelosuppression

Answer 21

prophylactic ABx –> only used in those pt with myelosuppression and other co-morbidity leading to inc infection risk eg COPD and risk of pneumonia

dose modifications –> red dose of chemo = dec severity of myelosuppression

colony stimulating factors –> current no evidence to prove the effectiveness of this treatment

Question 22

what are some of the novel discovery in recent biological therapy

Answer 22

1) further understanding of the biological process of tumour formation
2) pathway which tumour cells subverting the immune system of the body