Oncology & Palliative care Flashcards
What are features of superior vena cava obstruction?
- Dyspnoea is the most common symptom
- Swelling of the face, neck and arms - Conjunctival and periorbital oedema may be seen
- Headache: often worse in the mornings
- Visual disturbance
- Pulseless jugular venous distension
What is the management of superior vena cava obstruction?
- Endovascular stenting for symptomatic relief
- Glucocorticoids are often given but evidence is weak
What are the following tumour markers associated with?
CA125
CA19-9
CA15-3
CA125: ovarian cancer
CA19-9: pancreatic cancer
CA15-3: breast cancer
What are the following tumour markers associated with?
PSA
AFP
CEA
S-100
Bombesin
PSA: prostatic carcinoma
AFP: hepatocellular carcinoma, teratoma
CEA: colorectal cancer
S-100: melanoma, schwannomas
Bombesin: small cell lung carcinoma, gastric cancer, neuroblastoma
What are the most common tumours causing bone metastases?
In descending order:
1. Prostate
2. Breast
3. Lung
Where are the most common sites of bone metastases
In descending order:
1. Spine
2. Pelvis
3. Ribs
4. Skull
5. Long bones
What can be given to reduce discomfort associated with a painful mouth in a palliative patient?
Benzydamine hydrochloride mouthwash or spray
What can be given to reduce uncomfortable secretions in a palliative patient?
Hyoscine hydrobromide or hyoscine butylbromide
What can be given to help with agitation and confusion in a palliative patient?
Underlying causes of confusion need to be looked for and treated as appropriate, for example hypercalcaemia, infection, urinary retention and medication. If specific treatments fail then the following may be tried:
* first choice: haloperidol
* other options: chlorpromazine, levomepromazine
In the terminal phase of the illness then agitation or restlessness is best treated with midazolam
What can be given to help with hiccups in a palliative patient?
- chlorpromazine is licensed for the treatment of intractable hiccups
- haloperidol, gabapentin are also used
- dexamethasone is also used, particularly if there are hepatic lesions
What electrolye imbalances are seen in tumour lysis syndrome?
Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
Name different types of laxatives
Osmotic agents - pull liquid into stool:
* Lactulose
* Movicol
Stimulant agents - increase intestinal motility:
* Senna
* Docusate - also a softener
Bulking agents - increase faecal mass, stimulate peristalsis:
* Isphagula husk
* Fybogel
What is the management of pressure sores?
Wound dressing
Analgesia
Nutritional assessment
*Abx only indicated if there is systemic sepsis, spreading cellulitis or underlying osteomyelitis
You can also consider referral to tissue viability nurse or surgeons for debridement
What pain relief is preferred in palliative care?
Morphine
However…
* oxycodone is preferred to morphine in palliative patients with mild-moderate renal impairment
* if renal impairment is more severe, alfentanil, buprenorphine and fentanyl are preferred
What is Pemberton sign?
When you ask a patient to raise their arms until they touch the side of their face. If they develop cyanosis or worsening of their shortness of breath or facial congestion, it is said to be positive
*This is seen in superior vena cava obstruction
