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RACP > Oncology/Pall Care > Flashcards

Oncology/Pall Care Flashcards

1
Q

Oesophageal cancer Staging

A

Dx - Endoscopy
T - EUS
M - CT and PET
N - Surgery and PET

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2
Q

Clinical Trials

A

Phase 0 - Animal Trials
Phase 1 - Small Clinical trial in health people - Dose & SE
Phase 2 - Larger Clinical Trial vs placebo
Phase 3 - Response to new therapy vs standard
Phase 4 - Evaluation of clinical use

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3
Q

Colorectal Carcinoma surveillance

A

Post Operative Colonoscopy

  • Metasynchronis ca
  • Anastomotic Ca
  • Colonic polyps
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4
Q

Familial Adenomas Polyposis

A
  • 95% risk of CRC
  • Hundreds to thousands of polyps
  • Colectomy ~20’s
  • 25% has spontaneous mutation
  • Autosomal dominance
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5
Q

Extra Colonic Disease of FAP

A
  • Desmoid tumours - non metastatic (local symptoms)

- Duodenal polyps

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6
Q

NSCLC Stages

A 
Stage I
- Solitary tumour without regional or mediastinal lymph node involvement
Stage II 
- Tumour > 5cm
- Regional lymph node involement 
- Tumour with invasion into local structures (chest wall or unilateral) or located near the carina
Stage III 
- Mediastinal lymph node involvement 
Stage IV 
- Metastatic disease
- Ipsilateral malignant pleural effusion
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7
Q

Tumor lysis syndrome (TLS)

A

is an oncologic emergency that is caused by massive tumor cell lysis and the release of large amounts of potassium, phosphate, and uric acid into the systemic circulation.

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8
Q

Radiotherapy related lung ingury

A
  1. Pneumonitis
    - treated with steroids
    - CXR can look normal
    - Onset 4 to 12 weeks post radiation
  2. Radiation Fibrosis
    - Onset 6-12 months post radiation
    - Treatment unknown (steroids unlikely benefit)
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9
Q

Complications of Ovarian Ca

A
  • Malignant bowel obstruction

- Treatment of associated symptoms consider buscopan (Hyoscine), not motility agents

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10
Q

Chemotherapy induced nausea

A

1st - 5HT3 receptor antagonist (Ondansatron)
2nd - Glucorticiods (Dexamethazone)
3rd - Neurokinin-1 antagonists (Aprepitant)
4th - Olanzepine

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11
Q

Chemotherapy induced nausea types

A
  • Acute <24hrs
  • Delayed >24hrs
  • Anticipatory - Rx lorazapam and effectively Rx Acute
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12
Q

Metoclopromide SE

Dopamine Receptor Anagonists

A 
Movement - treated with benztropine
- Restlessness (akathisia)
- Focal dystonia 
- Extrapyramidal effects such as oculogyric crisis (rare)
Infrequent
- hypertension
- hypotension
- hyperprolactinaemia leading to galactorrhea
- Constipation
- depression
- headache
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13
Q

Treatment for malignant bone pain

A
  • 1st line - NSAIDs
  • 2nd line - bisphonates
  • 3rd line - Radiation therapy
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14
Q

ECOG scale- Key Points

A 
Prognostic of Survival
Stage 2
- Independent ADLs
- Out of bed >50% of day
- no higher for chemo
Stage 3
- Assisted ADLs
Stage 4
- >50% bed bound
Stage 5
- Dead
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15
Q

Opioid eqivalents

A

Morphine

  • oral 3:1 IV
  • Oxycodone 1:2 oral morphine
  • Hydromorphone 5:1 Morphine
  • Codeine 10:1 oral morphine
  • Tramadol 10:1 oral morphine

Hydromorphone
- Oral 3:1 IV

Fentanyl

  • Patch 12mcg = 36mg oral morphine per 24hrs (caution in niave pts)
  • Subling (Abstral) - rapid <10min (breakthrough)
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16
Q

Opioid Principles

A
  • in Ca never cap breakthrough
  • Never use fentanyl patch if titrating
  • Opioid rotation to decrease tolerance if breakthroughs are not working
17
Q

Preferred opioids in patients with renal impairment:

A

1) Fentanyl
2) Methadone
3) Tramadol (caution if on SSRI,TCA)
4) Oxycodone (use with caution-Prolonged elimination of oxycodone and its metabolites in renal impairment)

18
Q

Avoid these opioids in patients with renal impairment

A

1) Morphine
2) Codeine
3) Dihydrocodeine
4) Dextropropoxyphene

19
Q

Opioid Conversion

A

T 1 - Tramadol
O 2 - Oxycodone
M 3 - Morphine
H 5 - Hydromorphone

20
Q

Opioid and QT prolongation

A

Safe to use in renal failure.

But risk of QT prolongation.

21
Q

Which opioid increases the risk of convulsions

A

Pethidine is metabolized to norpethidine and therefore increases the risk of convulsions.

22
Q

The most effective treatment for opioid-induced painful constipation is

A
  • methylnaltrexone
  • Subcut
  • Fiber supplementation, polyethylene glycol, and docusate are rarely effective in cases of severe opioid-induced constipation
  • Note methylcellulose is a bulking agent
23
Q

Opioids in renal impairement

A 
- Morphine’s metabolite is renally cleared
Therefore use:
- Buprenorphine
- fentanyl
- methadone
24
Q

Breakthrough Opiods

A
  • 1/6 of regular dose

RACP (15 decks)

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