Oncology + Palliative Flashcards
Briefly describe the genetics of cancer ? what causes it ?
mutations (acquired of inherited) => failure of control mechanisms
what is an oncogene ?
mutated gene that has potential to cause cancer: gain of function (behave in dominant manner)
what is tumour suppressor gene ?
loss of canton: no longer act s inhibitor of promalignant process
name some non-specific signs of cancer ? (3)
- unexplained weight loss
- decreased appetite
- DVT
what is the most common cancer staging ? explain it
TNM
- Tumour + any spread of cancer to nearby tissue (T1-4, Tis (in situ))
- Nodes: spread of cancer to nearby lymph nodes (N1-3, number + location)
- Metastasis: Spread of cancer to other parts of body (M0, M1)
How does. PET-CT scan work ?
highlights areas of increased metabolism, cell proliferation, hypoxia
PET shows functional and CT shows anatomical
What is chemotherapy ?
use of chemical substance to treat disease. usually cytotoxic drugs
why is chemo done in cycles ?
cytotoxic drugs given in cycles to allow recovery of normal tissue
What are the different chemotherapy approaches ? (4) how does each kinda work ?
- Combination
- adjuvant (after other initial treatment)
- neo-adjuvant (shrink tumours prior to surgical/radiological tx)
- palliative (no curative aim)
chemotherapy SE ? where are the greatest SE seen ? why is this ?
greatest SE seen on dividing cells: gut, hair, bone marrow, gametes
- vomiting, alopciea, neutropenia
how does chemo effect fertility ?
chemo/radiotherpy may damage spermatogonia (=> impaired spermatogenesis), hasten oocyte depletion (=> premature ovarian failure)
What are some of the aim of surgery in cancer care ? (6)
- prevention
- screening
- diagnosis/staging
- treatment
- reconstruction
- palliation
how does radiotherapy work ?
ionising radiation causes damage to DNA => prevent cell division => cells death
name some oncological emergencies ?
- neutropenic sepsis
- spinal cord compression
- Superior vena caval (SVC syndrome)
- malignancy associated hypercalcaemia
- Brain mets
- Tumour lysis syndrome
what is neutropenic sepsis ?
(oncological emergency)
- T>38 + low neutrophils (suspect in unwell patient within 6 weeks of chemo)
What causes spinal cord compression ? usually associated with which cancers ?
(oncological emergency)
- caused my collapse or compression of vertebral body due to metastases of direct extension of tumour (rare)
- usually lung, prostate, breast, myeloma
spinal cord compression mx ?
(oncological emergency)
- urgent MRI, give dexamethasone, radiotherapy
what causes SVC syndrome ?
(oncological emergency)
- reduced venous return from head due to extrinsic compression (or VTE)
SVC syndrome Px ?
- sob, stridor, cyanosis, cough, headache, engorged neck veins
SVC syndorme Mx ?
(oncological emergency)
- sit up, give oxy, dexamethasone, CT to assess anatomy, SVC stunting, radiotherapy
Malignancy associated hypercalcaemia Mx ?
(oncological emergency)
- aggressive rehydration, bisphosphonates, control underlying malignancy
what cancers are brain mets usually secondary to ? (4)
- Lung
- Breast
- Colorectal
- Melanoma
What is tumour lysis syndrome ? Cause ?
cancer tx => tumour cells killed off => release contents in bloodstream => metabolic abnormalities
what metabolic abnormalities are associated with Tumour lysis syndrome ? (4) what can this cause ?
- high urate, high K, high phosphate, low calcium
- can lead to arrhythmias and renal failure
Tumour lysis syndrome prevention ?
prevent with hydration + uricolytics (allopurinol)
What are paraneoplasic syndromes ?
a syndrome that is the consequence of a tumour in the body
- sometimes tumours release substances (electrolytes, hormones) that cause abnormal function of body systems
what are tumour markers ?
- specific molecules found in increased cones in serum/tissue/urine in cancer patients
- not diagnostic in isolation
What aspects does palliative care take into account ?
considers physical, psychological , spiritual, social
What is a syringe driver ? by which route are the drugs administered ?
allows for continuous SC inion of drugs
anticipatory end of life meds:
Name the med used for end of life pain ?
morhpine
anticipatory end of life meds:
Name the med used for end of life agitation + N&V ?
haloperidol
anticipatory end of life meds:
Name the med used for end of life agitation + anxiety ?
midazolam
anticipatory end of life meds:
Name the med used for end of life N&V ?
levomepromazine
anticipatory end of life meds:
Name the med used for end of life resp secretions ?
hyoscine butylbromide
What are the 6 things required to verify patient death ? which is the official time of death
1) Identify patient by their wrist band
2) Feel for carotid pulse to confirm absence
3) assess pain response (squeeze trapezius muscle) to confirm absence
4) use pen torch to assess pupillary light response + confirm absence (i.e, fixed, dilated)
5) Auscultate for heart sounds for full minute to confirm absence
6) ausculate for breath sounds for full minute to confirm absence
(after this all is done, is the official time of death)
Who are medical examiners ?
- senior doctors who review deaths occurring in hospitals to assist determine cause of death
what do medical examiners do ? (3)
1) Review patient med records
2) Discuss with doctor completing the MCCD (to agree cause of death)
3) give opportunity for family to ask questions
who issues MCCD ?
Doctor only issues MCCD if cause of death confirmed, if not then coroner does
When is an inquest held for a death ?
inquests are held if the death was violent or unnatural
how long does next of kin have to register death
next of kin only have 5 days to register death
- so death certificate must be written in a timely manner
what is 1a, 1b and 1c on death certificate ?
1a) primary cause of death (stroke)
1b) what may have led to 1a (basilar artery thrombosis)
1c) what may have led to 1b (cerebrovascular atherosclerosis)
What ist he general palliative approach to opioids
back ground opioids + rescue doses for breakthrough pain
How do you calculate the breakthrough dose for opioids ?
for brekthrough pain: 1/6 of total background 24 hr dose
- if patient required regular rescue doses then increase background (plus rescue pain)
10mg oral morphine is equal to how much oral codeine ?
10mg oral morphine = 100mg oral codeine
10mg oral morphine is equal to how much oral tramadol ?
10mg oral morphine = 100mg oral tramadol
10mg oral morphine is equal to how much IV/IM/SC morphine ?
10mg oral morphine = 5mg IV/IM/SC morphine
opioid SE ? sings of toxicity ?
- drowsiness, N&V, constipaation, dry mouth, pruritis
- toxicity: sedation, resp depression, visual hallucinations, myoclonic jerks, delirium
why do you need to take into account renal function when considering opioids ? which do you give to a patient with poor renal function ?
if eGFR<30: accumulation of renal excreted opioid + metabolites
- fentanyl + buprenorphine are mainly hepatic ally metabolised
What are the causes of N&V in palliative care ? (6)
- Chemo
- Constipation
- Hypercalcaemia
- Severe pain
- Infection
- Renal failure
name different antiemetic classes of drugs ? (4)
- 5-HT3 receptor antagonist
- Dopamine antagonists
- H1 antihistamines
- Glucocorticoids
How do 5-HT3 receptor antagonists work ? give an example ? used for what nausea ?
ondansetron
- work on central serotonin receptors
- used in acute gastroenteritis, PON&V, chemo/radiotherpy induced N&V
How do dopamine antagonists work ? give an example ? used for what nausea ?
Metoclopramide, domperidone
- pro kinetic agents (promote gastric emptying)
- PON&V, motion sickness
How do H1 antihistamines work ? give an example ? used for what nausea ?
cyclizine, hyoscine
- vertigo, motion sickness
How do glucocorticoids work ? give an example ? used for what nausea ?
antiemetics against chemo-induced emesis
causes of constipation in palliative patients ? mx ?
- opioids (v common)
- hypercalcaemia
mx: good fluid intake, stimulant (Senna), somatic laxative (macrogol)
causes of breathlessness in palliative care ? (4)
- Infection
- effusion
- thromboembolism
- SVC syndrome
cause of pruritus in palliative care ? (3) mx ?
opioids, systemic disease (renal failure, hepatitis), primary skin disease
- Mx: treat underlying cause, topical emollient as soap substitute
palliativ breathlessness mx ?
- treat underlying cuase
- consider resp sedatives (morphine) to reduce resp drive
