Oncology/palliative: General Flashcards
Most commonly causing death
Lung > colorectal > breast > prostate
Most likely to metastasise to bone
Prostate > breast > lung
Treatment of SCLC
Chemo (usually systemic at presentation
Radiotherapy
Rarely surgery
Treatment of NSCLC
Surgery 30%
Radiotherapy
Chemo
Tyrosine kinase inhibitors
Management of bone pain
NSAIDs, bisphosphonates, radiotherapy
Most common cancers
Breast > lung > colorectal > prostate
Terminal drug for bowel colic
Hycosine butylbromide
Terminal drug for respirator secretions
Hycosine hydrobromide
Terminal drug for nausea and vomiting
Cyclizine
Levopromazine
Haloperidol
Metoclopramide
Terminal drug for agitation/restlessness/confusion
Midazolam
Also haloperidol, levopromazine
Terminal drug for pain
Diamorphine
Best antiemetic for:
GI cause
Toxic cause
Cerebral cause
GI cause - domperidone, metaclopramide, but not in Parkinson’s
Toxic cause - haloperidol
Cerebral cause - antihistamine
Ondansetron - also good for chemo/GI
Benzos - good adjuncts for chemo nausea
Para neoplastic syndrones SCLC
Hyponatraemia
Cushing’s (raised cortisol)
Lambert-Eaton syndrome (myasthenia)
Laxatives: Bulk-forming Softeners Stimulants Combination
Bulk forming: fybogel
Softeners: lactulose, docusate
Stimulants: senna
Combination: movicol, co-danthramer
Four essential PRN medications all dying patients should be prescribed
- Anti-emetic - haloperidol/levomepromazine
- Analgesic - diamorphine
- Anti-secretory - hycosine hydrobormide
- Sedative - midazolam
If >2 SC PRN injections required, put in syringe driver and keep PRN
Converting oral morphine to SC diamorphine
Divide by 3
Neutropenic sepsis management: ABx If MRSA positive/line infection If penicillin allergy If C.diff suspected Additional management
Tazocin
MRSA/line infection - add vancomycin
Pen allergy - vancomycin + aztreonam
If C.diff - add metronidazole
O2, IV fluids, caution with antipyretics (mask pyrexia), early senior involvement
Colorectal cancer: risk factors (6)
Lots of meat, little fibre Inflammatory disease (UC, Crohn's) HNPCC, FAP Diabetes, obesity Increasing age Smoking, alcohol
Colorectal cancer - commonest site for mets
Liver
Management of colorectal cancer
Surgery - definitive treatment for localised disease
Radiotherapy - rectal only (brachytherapy)
Chemo - adjuvant for high risk
Prostate cancer histological type
Adenocarcinoma (95%)
Prostate cancer: risk factors (5)
Increasing age BRCA2 Developed countries Family history Afro-caribbean
Gleason score
Prostate cancer grading based on 2 most predominant areas of tumour
Prostate cancer: prognostic factors (2)
High BPH - poor prognosis
Extent of disease
Management of prostate cancer (4)
Surgery for localised disease
Radiotherapy/brachytherapy if early
Hormonal therapy in advanced disease (LHRH agonists, oestrogen, anti androgens)
Chemo (docetaxel
Breast cancer: risk factors (4) including in males (2)
Increasing age Oestrogen exposure BRCA1/2 Family history In males: gynaecomastia, Kleinfelter's
Types of breast cancer
Invasive ductal carcinoma (develops from DCIS) 70-80%
Invasive lobular carcinoma (devlops from LCIS) 10%
Paget’s disease = infiltrating carcinoma of nipple epithelium (1%)
Investigation of breast cancer
Triple testing
- Clinical examination
- Diagnostic radiography (USS/mammogram)
- Biopsy (core/open/FNA)
Also ER+PR status (+ve good because will respond to hormonal treatment)
HER2 status (+ve bad)
Ca15-3
Search for mets
Management of breast cancer
Surgery - initial treatment of choice (mastectomy/WLE)
Radiotherapy - post-surgery
Chemotherapy - adjuvant
Hormone therapy if ER/PR+ (aromatase inhibitors, anti-oestrogens, ovarian ablation)
Types of lung cancer
Bronchial carcinoma (95%) - SCLC, NSCLC (squamous, adenocarcinoma, large cell, other) Lung mets from: prostate kidney, breast, bone, GI
Urgent CXR if (6)
Hoarseness >3wk Cough >3wk Dyspnoea >3wk Weight loss Chest pain Bone pain/met signs
Lung cancer: prognostic factors (1 positive, 5 negative)
Positive: stopping smoking
Negative: advanced, mets, respiratory complications, weight loss, biochemical abnormalities
Diagnosing dying patient
Irreversible life-threatening illness Stepwise change Day to day change Bed bound/profound weakness Drowsy Sips/no oral intake No easily reversible cause
Certifying death (5)
Absence of central pulse Absence of pupillary light response Absence of corneal reflex No motor response to supra-orbital pressure Asystole on ACG
Observe for 5 minutes
When to refer to coroner’s office (9)
No doctor attended during last illness Not seen by a doctor in last 14 days of life Unknown cause Death udring op/anaesthetic Occupational Medical mistake Suicide/accident In prison custody Suspicious circumstances
Courvoiser’s sign
Painless jaundice and enlarged gall bladder - upper GI cancer
Virchov’s node
L supraclavicular node - gastric cancer
