Oncology + Palliative Flashcards
What level do your neutrophils need to be below to be classed as having neutropenic sepsis?
Below 1 x 10^9
When should neutropenic sepsis be suspected?
Anyone who has had chemo in the past 6w
High Temperature
Infective presentation
What are 2 RF for neutropenic sepsis?
Central Venous Line
Poor nutrition
What does BUFALO say you need to do in Sepsis
Bloods: culture
Urine output
Fluids
Broad spec abx
Lactate
Oxygen
How would you treat neutropenic sepsis?
High dose broad spectrum antibiotics:
Piptazocin and Tazobactam
If you suspect that a patient will be a high risk of getting neutropenic sepsis. What should you give?
- Prophylaxis with anti bacterial and anti-fungal
2. Consider reducing their chemo dose.
What are 3 causes of malignant hypercalcaemia
- Lytic Lesions Bone mets
- Too high PTH
- Dehydration
What value is classed as a severely high calcium ?
A value of over 3.4
What is the management of malignant hypercalciaemia?
IV fluids
IV bisphosphonates
Why do you need to do a corrected level of calcium?
This is because 40% of calcium is bound to albumin.
It is only the unbound calcium that is important for us.
Hence why we need a corrected calcium value
How does malignant hypercalcaemia present?
- Moans
- Groans
- Stones
- Bones
Give two urinary symptoms of malignant hypercalcaemia?
- Poly dipsia
2. Polyuria
What is the most common cause of spinal cord compression?
Give a few examples
Secondary bone mets
Breast
Lung
Prostate
How does malignant spinal cord compression normally present?
It presents with a picture of worsening back pain.
Numbness and lower limb weakness
Bowel or bladder dysfunction
Abnormal nerve signs: including LMN signs below the compression
If you have a patient with nausea caused by gastric stasis.
What anti-emetic should you use?
Domperidone
Metoclopramide
If you have a patient with nausea caused by drug induced. What anti-emetic should you use?
Metoclopramide
What is the most common anti-emetic used in intra cranial caused nausea and vomiting?
Cyclizine
What two types of cancer are common cause of Superior Vena Cava Obstruction (SVCO)?
Small cell lung cancer
Lymphoma
How does SVCO normally present?
Flushed face
Visible dilated veins on face and neck
Oedema of the neck and face
Respiratory distress SOB, chest pain
What investigations would you want to do in someone with suspected SVCO?
- CT
2. CXR (will show widened mediastinum)
How do you acutely manage SVCO?
- Sit the patient up
- High Flow oxygen
- High dose Dex
- Endo vascular stent
When does bowel cancer screening in the UK start?
What does it involve?
It starts at the age of 55 and you get a one off endoscopy
60-74 you get home testing every 2 years
What does it mean when you describe a cancer as a grade?
It means how similar the tissue resembles the original cells.
For example a benign cancer will have a lower grade (as resembles more) than a malignant cancer.
Give 3 examples of screening in the UK?
Bowel cancer
Breast cancer
Cervical Cancer
Foetal heel prick test
Triple AAA
What are 3 characteristics that cancer cells have?
Evading apoptosis
Evading the immune system
Genome instability.
Where do most chemo drugs work at in the cell cycle?
They work at the level of mitosis
What is a neo-adjuvant?
What is an adjuvant?
When you give a drug pre surgery
When you give a drug post surgery
How does radiotherapy work?
It uses high power radiation to produce free radicals and ROS that damages cells and DNA so that they can no longer replicate.
How does the chemo dose in a curative vs palliative patient?
Why are the regimes different?
In a curative patient you would have: lower dose chemo but give it more times. This is supposed to reduce SE
If a palliative patient: give it at a higher dose and a one off
What are 5 SE of Radiotherapy?
Nausea and Vomiting
Fatigue
Anorexia
Oesphagitis
What period of time post radiotherapy are SE the worse?
Normally worse at around 2 w post radiotherapy
What are 3 SE of Chemotherapy?
Heart Failure
Nausea and Vomiting
Bowel upset
Alopecia
Peripheral Neuropathy
What are two ways to scale a patient’s performance status?
ECOG
WHO’s performance status
What are 3 complications of chemotherapy?
- Alopecia: this is reduced by sitting them underneath a cold cap
- Nausea and Vomiting: give anti-emetics like ondansetron
- Anaphylaxisis: prevented by taking steroids the day before
- Extra vascularisation: this is when you give SC injections and it causes necrosis of large patches of skin. Prevented by using smaller ‘yellow’ needles.
How do we prevent anaphylactic reactions in patients who are given chemotherapy?
You start them on steroids the day before
What complication is related to the use of 5- FU creams?
Coronary Artery Spasm
Who are 5-FU creams contraindicated in?
They are contraindicated in people with ACS
If you had a patient older than 30 with suspected MSK malignancy. What are your first two thoughts?
Myeloma
Bone mets
What would the zone of transition look like in a patient with
A. Benign bone disease
B. Malignant bone disease
Benign you would have a narrow zone of transition
Malignant you would have a wide zone of transition
What does a periosteal reaction signify?
A bone reaction
What is codman’s triangle sign seen on x-rays?
What cancer is it associated with?
This is when you get elevated periosteum
Associated with osteosarcoma
What bone cancer is associated with onion skinning?
Ewings Sarcoma
What criteria classifies kidney cancers?
Bosniak
What is a syringe driver?
This is a machine that gives multiple medications to a patient over a 24 hr period.
What are 4 cancer types that are associated with major haemorrhage?
- Head Cancer
- Neck Cancer
- Bowel Cancer
- Lung Cancer
If you had a palliative patient with a haemorrhage how would you respond?
- Give midazolam
2. Use dark coloured towels
Describe what the following abbreviations mean:
A. Planning target volume (PTV)
B. Clinical Target Volume (CTV)
C. Gross Target Volume (GTV)
A. Planning target volume (PTV): degree of movement
B. Clinical Target Volume (CTV): area of micro spread
C. Gross Target Volume (GTV): size on CT
What unit is radiotherapy prescribed under?
Gray dose
What is fractionation in terms of radiotherapy?
The total amount of radiotherapy given which is then split into dosages
What type of cell makes up a sarcoma?
Mesenchymal cells
What scoring system is used to grade a sarcoma?
FNCLCC
