Oncology Specific Knowledge

Question 1

What causes tumour lysis syndrome?

Answer 1

Caused by abrupt release of cellular components into the blood following rapid lysis of malignant cells (after chemo)
There is the release of potassium, phosphorus and nucleic acids which are metabolised to uric acid

Question 2

What cancers are tumour lysis syndrome mainly associated with?

Answer 2

cancers with rapid turnover e.g. haem malignancies and germ cell tumours in the testes

Question 3

Presentation of tumour lysis syndrome?

Answer 3

typically 1-5 days after starting chemo
oliguria/ AKI, cardiac arrhythmias, seizures

Question 4

What is high in tumour lysis syndrome?

Answer 4

potassium
phosphate
urate

and calcium is low

Question 5

Management of tumour lysis syndrome?

Answer 5

acutely resus, treat hyperkalaemia may need dialysis

best thing is prevention, those starting chemo should be risk assessed if needed they can get fluids and allopurinol to help prevent

Question 6

What 2 cancers is SVCO most common in ?

Answer 6

lung cancer (pan coast tumours particularly small cell) and non hodgkins lymphoma

Question 7

Presentation of SVCO?

Answer 7

SOB
flushed
swollen neck and chest veins, oedema, headache and CNS signs if causes cerebral oedema
Pembertons sign, raising hands above head causes facial plethora

Question 8

Diagnosis of SVCO?

Answer 8

can be clinical but may do CXR or CT to confirm

Question 9

Management of SVCO?

Answer 9

depends on patient factors
loose clothing, pillows to make comfortable
steroids can be helpful
in some consider RXT, stenting or thrombolysis

Question 10

Most common cancers to cause metastatic spinal compression?

Answer 10

lung, breast, prostate, melanoma, lymphoma, multiple myeloma

Question 11

Earliest and most common symptom of spinal cord compression?

Answer 11

back pain

Question 12

Presentation of spinal cord compression?

Answer 12

back pain worse on coughing, straining and sneezing, worse on lying down and relieved by sitting
bowel changes, urinary changes, sensory changes

Question 13

Mx of patient with suspected spinal cord compression?

Answer 13

dexamethasone should be given prior to imaging to prevent oedema
MRI whole spin
overall management will depend on patient factors

Question 14

Management of hypercalcaemia of malignancy?

Answer 14

can give IV fluids and bisphosphonates but to fully normalise calcium need to manage underlying malignancy

Question 15

Management of raised ICP due to cancer?

Answer 15

acutely should give mannitol with dexamethasone to reduce symptoms and likelihood of herniation
then need neurosurgery/ oncology opinion - surgery, RXT etc
high dose dexamethasone alone may be appropriate in palliative situation

Question 16

Explain how chemotherapy works?

Answer 16

targets rapidly dividing cell
given in cycles to try and maximise tumour cell death whilst minimising normal cell death (normal cells are better at recovering)

Question 17

Chemotherapy induced nausea and vomiting is treated with?

Answer 17

ondansetron and dexamethasone

Question 18

Side effects of chemotherapy?

Answer 18

alopecia, malaise, fatigue, lethargy, diarrhoea, mucositis, altered taste, neutropenia, thrombocytopenia, renal and liver dysfunction

Question 19

Criteria for neutropenic sepsis?

Answer 19

patient on chemo with neutrophils < 0.5 x10 ^9, plus temperature > 38 degrees or signs/ symptoms of sepsis
note: fever may be only sign of neutropenic sepsis

Question 20

Management of neutropenic sepsis?

Answer 20

sepsis 6 protocol
tazocin (tazobactam/ piperacillin) is the antibiotic of choice

Question 21

How does radiotherapy work?

Answer 21

ionises DNA, breaks double strand killing cells, damages normal cells too so has to be given to a very specific area

Question 22

Radiotherapy is most effective at killing cells at what stage of the cycle?

Answer 22

m phase

Question 23

4Rs of radiotherapy?

Answer 23

repair - fractionation gives normal cells (which heal better than cancer cells) time to repair between
Reassortment- fractionation allows reassortment so there is a greater chance of hitting a tumour cell in the m phase
repopulation - if cells are incompletely damaged they will repopulate so need to damage more each fraction
reoxygenation - fractionation allows hypoxic cells to deoxygenate so they are more susceptible to damage

Question 24

What is radiation measured in ?

Answer 24

Grays
you will receive a certain number of grays over several treatments (fractions)

Question 25

Side effects of radiotherapy?

Answer 25

acute: skin desquamation, fatigue, head and neck pain
chronic: pneumonitis, menopause, infertility, skin fibrosis, incontinence, secondary cancers, dysphagia, bowel dysfunction