Oncology Questions Flashcards
Patient has been coughing more than 3 weeks and there is no reason for it what is the next step
go to the GP and check for lung cancer
If someone has suspected lung cancer what is the next imaging modality
Staging CT Scan - includes chest abdomen and pelvis
TNM staging
What is the are of the body where the lung cancer is least likely to spread
kidneys
malignant plural effusion investigation
Do an US guided aspirate
biopsy for lung cancer locations
bronchoscopy in proximal of airway
Endobronchial US - further down in airway in centre of chest from lymph
medical bronchoscopy - pleural effusion
lump in neck - US guided biopsy
lining of lung - medical thorascopy
small nodule - robotic bronchoscopy
what is the purpose of palliative treatment
to help people increase their quality of life, helps people in their last 24 months of life
good for symptom control and allows their family support too
when suspecting cancer of the brain what imaging do you need
MRI brain and spine with contrast
long term side effects of radiotherapy
fatigue - especially if its brain
dysphagia, sore throat, oral mucositis - can be seen in any,
dysphagia more common in head and neck cancer
erythema - radiotherapy dermatitis
sterility - pelvic area
lymphedema - breast! refer to clinic
why do people experience dry mouth years after having chemo/radio
mouth is dry years after chemo as all he glands have been fried off and so they can produce saliva
how to prevent bad diode effects or radiotherapy
young, fit and healthy as they will have the ability to produce new healthy cells fast
if they smoke, then that’s bad as they will slow down new cell regeneration
depends on where you’re treating and at what dose, higher dose means more side effects
if someone on radiotherapy who is usually an outpatient has to become an in patient because they are unwell what does this mean
it mean they are not tolerating their radiation dose and you’re doing something wrong
before starting immunotherapy what are some baseline levels you need to check
check adrenal function (cortisol)
thyroid function
in colon cancer if patient has rectal bleeding and you suspect colorectal cancer what are the next steps
can skip the fit testing and just move onto the examination and colonoscopy as fit testing will be positive by default
what are the key investigations needed for tumour lysis syndrome
ECG, U&E, calcium, uric acid
Pernicious anaemia presentation
tongue is noted to be large and smooth in appearence
is patient’s macrocytic anaemia, smooth tongue (glossitis), and other symptoms are suggestive of pernicious anaemia. Pernicious anaemia is a form of megaloblastic anaemia typically caused by the inability to absorb vitamin B12 due to autoimmune destruction of gastric parietal cells.
what is the most common cause of an ovarian tumour
epithelial cell tumour
which anti emetic is used when a patient has raised intercranial pressure, and vestibular sickness (sickness with movement) and physical bowel obstruction
cyclizine
what antiemetic can you give if someone is struggling with gastric statis and functional bowel obstruction (stasis)
metoclopramide
can cause extrapyrimdal symptoms
if there is medication relation nausea and vomiting then what is the best antiemetic
cyclizine
when to give dexamethasone in nausea and vomiting in palliative care
if there are liver or Brain mets or there is bowel obstruction
found melanoma what do you do
- excisional biopsy
CONFIRMED - WLE of melanoma and radiological investigation CT scan to rule out metastases
- discuss in an MDT coordinator, radiologist, histopathologist, surgeon based on location, dermatologist, medical and clinical oncologist. Core 8 members
- offer adjuvant therapy if high stage (melanoma is not chemo or radio sensitive, only offer radio if too much bleeding or pain) - give immunotherapy
- surveillance -> 5 year programme, the programme starts from the first excisional biopsy date for 5 years
differentials for auxiliary lump
- breast cancer
- infection related
- lymphoma
- recent tattoo, recent vaccination
unexplained auxiliary lump that seems suspicious
- request an US
- refer them to breast surgery for a biopsy
- given a triple assessment
- biopsy reported as a melanoma - to do referral to dermatology to a through skin check and refer to MDT
- do a full body CT scan as its spread (comes back clear and they also cant find the primary lesion)
- do a blocked section of lymph node OR immunotherapy
if patients refuse curative surgery and they accept immunotherapy, is this neoadjuvant, adjuvant or palliative
this is palliative treatment as she has refused curative surgery
before starting immunotherapy what conditions should you check for
AVOID in autoimmune conditions
if they have any viral conditions like hiv, hepatitis
kidney transplant as it will cause the transplants to be rejected as you are bumping up the immune system
if a patient has death rattles and reduced consciousness what does this suggest
they will die in the next 24 - 73 hours
in Catholics what do they need before they die
they need to be seen by a priest, otherwise they wont go the heaven
similar with other religions
rational for PE in cancer for osce
cancer makes blood more thick and sticky so more likely to clot
if patient has cancer that is not curable how log will they need apixaban for
lifelong
how does apixaban work
it will prevent new blood clots forming, it will not break down any clots
the body will break down the clots
which medications actually break down blood clots? relevant for stroke too
alteplase
struggle to swallow ppl what Is an alternative medication
fast tabs
what is a another form of citalopram
drops form
if someone has MSCC what is the management
- IMMOBILISE THE PATIENT - dont want to cause further damage - VTE prophylaxis
- request whole spine MRI within 24 hours
- should offer radiotherapy within 24hrs / surgery
- offer high dose dex 16 mg STAT (check bms first) then next day give 8mg BD (8am, 12pm)
- analgesia
- can consider surgery if they have a high performance status, not much cancer spread. bones above and below need to be healthy
if complains of bladder retention can ask for a bladder scan
ECG, full blood and clot
what are some signs seen on MSCC
UMN signs below the level of the lesion, due to damaged in the descending pathway between the brain and spinal cord
Hypertonia
Hyperreflexia (although reflexes may be absent at the level compressed)
Clonus
Upgoing plantars
Sensory loss (a “sensory level”)
how does a PET CT work and indentift cancer spread
rate of glucose uptake
Cancer cells, being more metabolically active, consume more glucose than normal cells and hence light up on PET scans. This allows for the detection and localisation of cancerous growths in the body.
what are the two most common symptoms of hypercalcemia in a cancer patient
- nausea and vomiting
- reduced consciousness
features of hypocalcemia
numbness, tingling arounds hand feet and mouth, muscle cramps and seizures
what does hyperkalemia look like on an ecg
tall tented t waves and broad QRS, flattened p wave and prolonged PR interval
