Oncology & Palliative Care Flashcards
What is the commonest site of acute spinal cord compression?
Thoracic
What are some common cancers causing acute spinal cord compression?
Lung, breast, prostate, renal, myeloma
What are the 3 mechanisms of acute spinal cord compression?
Extradural metastases
Direct tumour extension
Crush fracture
What is the initial investigation you should do for acute spinal cord compression?
Urgent MRI whole spine
What is the management of acute spinal cord compression?
Dexamethasone 16mg IV then 8mg BD orally
Urgent radiotherapy +/- surgery
What is superior vena cava compression?
Obstruction of the vena cava that can also cause airway compression
What malignancies commonly cause superior vena cava compression?
NSCLC, lymphoma, metastaic seminomas, Kaposis sarcoma, breast cancer
What are some signs and symptoms of SVC compression?
Breathlessness, swelling of face/neck/arms, lethargy, puffy neck, non-collapsable/distended neck veins. Pemberton’s sign
What are the two mechanisms by which SVC compression occurs?
Blockage within the SVC (e.g. DVT, foreign body, tumour)
Blockage outwith the SVC (e.g. extrinsic compression from mass)
What investigations are important in SVC compression?
CXR, venogram, CT chest
What is the treatment of SVC?
Clot - thrombolysis
Extrinsic compression - steroids, stenting, radio/chemotherapy
What are the pathological causes of malignant hypercalcaemia?
Ectopic PTHrP production
Lytic bone destruction
Vit D analogue production
What are symptoms of malignant hypercalcaemia?
Lethargy, anorexia, thirst, confusion, weakness
What investigations should be done in malignant hypercalcaemia?
FBC, U&Es, calcium, phosphate, albumin, myeloma screen
How is malignant hypercalcaemia managed?
Rehydration then bisphosphonates
What is neutropenic sepsis a common complication of?
Chemotherapy
When does neutropenic sepsis usually occur?
7-14 days following chemotherapy
What is neutropenic sepsis defined as?
Neutrophil count less than 0.5 or less than 1 in chemotherapy patients PLUS
temperature >38 or other signs assoc with sepsis
What investigations do you do for neutropenic sepsis?
Basically everything - full infection screen, full blood screen, blood gases, ECG, CXR, AXR
If a patient is septic and has had chemo in the last 3 weeks, how should you manage them?
Assume neutropenic sepsis and treat them before blood results return
What is the treatment of neutropenic sepsis?
SEPSIS 6
Antibiotic - Pipercillin, Tazobactam +/- gentamicin if NEWS over 7
What organisms are most likely to cause sepsis?
Mostly gram negative (E.coli, Pseudomonas, Klebsiella)
What is tumour lysis syndrome?
Breakdown of tumour cells and subsequent release of chemicals from the cell
What cancers is tumour lysis syndrome related to?
Lymphomas and leukaemias
What may trigger tumour lysis syndrome?
Chemotherapy
What electrolyte imbalance do you see in tumour lysis syndrome?
High potassium, high phosphate
Low calcium
How is tumour lysis syndrome prevented?
IV allopurinol if at risk
What other oncological emergencies are there?
SIADH, brain mets, malignant pericardial effusion, PE, DIC
What are the main troublesome symptoms in end of life?
Pain, breathlessness, agitation, secretions and nausea
What should be used for pain in palliative care?
WHO analgesic ladder
What is important to start if using an opioid?
Laxative and anti-emetic
What is used for background pain?
MST
What drug is used for breakthrough pain?
Oramorph
What is the breakthrough dose of oramorph?
1/6th of the background dose
What are the symptoms of morphine toxicity?
Grogginess, feeling wiped out, hallucinations, myoclonic jerks
What opioid should be used in poor renal function?
Oxycodone, buprenorphine or alfentanil
What is the subcut dose of oramorph compared to the oral dose of oramorph?
HALF
How do you convert an oral codeine dose to an oral morphine dose?
Divide dose by `10
How do you convert an oral tramadol dose to an oral morphine dose?
Divide dose by 10
How do you convert an oral morphine dose to an oral oxycodone dose?
Divide by 2
How do you convert an oral morphine dose to a subcut morphine dose?
Divide by 2
How do you covert an oral oxycodone dose to a subcut oxycodone dose?
Divide by 2
How do you convert an oral morphine dose to a subcut diamorphine dose?
Divide by 3
What dose of oral morphine is equivalent to 1mg of subcut alfentanil?
30g
What drug is used for agitation in palliative care?
Midazolam
What drug is used for secretions in palliative care?
Hyoscine butylbromide (Buscopan)
What drug is used for nausea and vomiting in palliative care?
Levomopromazine
What drug is used for breathlessness in palliative care?
Opioids help with breathlessness
What do syringe drivers allow for?
A continuous sub cut infusion of fluids and drugs
What does a PET scan measure?
Glucose uptake
What tumour marker is used in breast cancer?
CA 15-3
Why is dexamethasone used for brain metastases?
Reduces brain oedema to cause reduction in symptoms of raised ICP
How are incontrollable hiccups in palliative care treated?
Chlorpromazine
What is the tumour marker for pancreatic cancer?
CA 19-9
What unit is radiotherapy prescribed in?
Grey
How is a chemotherapy dose calculated?
Patients calculated surface area
