TCD Case Notes Flashcards
What is the top cancer amongst men?
Lung Cancer
(quickly followed by Prostate Cancer)
What is the top cancer amongst women?
Breast Cancer
What is Radiotherapy?
This is therapy with high intensity x-ray treatment. It works by dmaging the DNA of the cancer cells, which leads to apoptosis.
It is a curative method of treatment and is more curative than chemotherapy, so it is more widely received.
How is Radiotherapy given?
In courses of treatment, because if it is given in too high a dose, it can cause more harm than it helps.
What “fractions” are radiotherapy treatments given between?
1 and 34 fractions - the higher the fractions, the more curative it is.
What is most important for patient to understand in terms of radiotherapy treatment?
They have to be in the same position, place etc EVERY single time they go fro treatment if they want to minimise the damage to other cells around the affected site.
What are the early side effects of radiotherapy?
Fatigue,
Early Flare,
Oesophagitis (depending on where the therapy is),
Pneumonitis,
Skin reaction,
diarrhoea,
nausea,
cystitis,
raised intracranial pressure
hair loss
What are the late side effects of Radiotherapy?
Fibrosis,
Osteonecrosis,
Strictures,
Rib Fracture
Possible second malignancy
What is Brachytherapy?
A type of internal radiation therapy in which seeds, ribbons, or capsules that contain a radiation source are placed in your body, in or near the tumor. Brachytherapy is a local treatment and treats only a specific part of your body.
What is the most common use for Chemotherapy?
Chemotherapy is usually used as a Adjuvant therapy (which means it is used alongside something else).
And also as a treatment of metastasis.
What is an Adjuvant therapy?
This is treatment that is given after definitive treatment (surgery or radiotherapy) with the aim to increase the chance of cure.
What is a Neoadjuvant?
Given before the main treatment to shrink it/improve chances of cure. Example: neo-adjuvant chemotherapy can be given in Lung cancer, breast or oesophageal cancer to enable definitive surgery or radiotherapy to be performed
How is Chemotherapy usually administered?
In cycles every 2-3 weeks, for a couple hours.
Why is Chemotherapy given in cycles?
To allow the patient and their organs to recover from the chemotherapy.
What is Nadir?
In medical terms, nadir could mean the lowest concentration of a drug in the body.
With regard to chemotherapy specifically, it describes the point at which blood cell counts are at their lowest after a chemotherapy treatment. This is usually 5-12 days after treatment.
What are three major side effects of Chemotherapy which can cause Oncological Emergencies?
Neutropenic Sepsis
Thrombocytopenia Haemorrhage
Tumour Lysis Syndrome
What is Tumur Lysis Syndrome?
This refers to the number of different metabolic disturbances that occurs when large numbers of neoplastic cells are killed rapidly. It is a consequence of good treatment.
What is Immunotherapy?
These are drugs that are used to treat cancer using immune cells.
Name 2 immunotherapy drugs that are used commonly in the treatment of cancer.
HINT: they are monoclonal antibodies.
Rituximab and Trastuzumab
What is the ECOG Performance Status?
This is a criteria/grading scale for determining how mobile and capable of living a person is.
What is ECOG score 0?
The person is fully active and able to carry out all pre-disease performance without restriction.
What is ECOG score 1?
The person restricted in physically strenuous activity but they are ambulatory and able to carry out light work.
What is ECOG score 2?
The person is ambulatory and capable of all selfcare, but they are unable to carry out any work activities. They are up and about >50% of their waking hours.
What is ECOG score 3?
The patient is capable of only limited parts to their selfcare. They are confined to a bed or chair and they are up and about <50% of waking hours.
What is ECOG score 4?
The patient is completely disabled and confined to their bed/chair. They cannot carry out any self care.
What is ECOG score 5?
Deceased
What are 6 main oncological emergencies?
Neutropenic sepsis
Superior Vena Cava Obstriction (SVCO)
Metastatic Spinal Cord Compression (MSCC)
Hypercalcaemia
Tumour Lysis Syndrome
Brain Metastases
What is Neutropenic Sepsis?
This is sepsis that happens when a person has critically low amounts of neutrophils.
Any patient that is known to be receiving chemotherapy, presenting with symptoms of infections should be assumed to have neutropenic sepsis until proven otherwise.
How is Neutropenic Sepsis managed?
A-E assessment - cannulate during assesment to enable venous access
IV antibiotics - Tazosin or Meropenem
Culture everything and investigate all avenues of infection entry - e.g.throat swab, sputum culture, blood culture, skin culture, urine dipstick, MSU, line culture etc.
Imaging etc
How quickly should antibiotics be given to a patient who is presenting with Neutropenic Sepsis?
within 1 hour of them arriving at hospital.
What is Metastatic Spinal Cord Compression?
This is spinal nerve compression chracterised by metastasis from other remitting tumours within the body.
What are the RED FLAGS of Metastatic Spinal Cord Compression?
Referred pain (multi-segmental or band -like)
Escalating pain (poorly responsive to treatment)
Different chracter or site to previous symptoms
Funny feelings, odd sensations or heavy legs - basically neuro problems
Lying flat increases pain (or pain worse on coughing)
Agonising pain
Gait disturbances
Sleep greatly disturbed (due to pain worse at night/lying down)
How is Metastatic Spinal Cord Compression managed?
High dose steroids - dexamethasone (to reduce inflammation around the compression)
Flat bed rest
Whole Spine MR
Based on the what the MR spine shows, develop a definitive treatment for it.
What is Superior Vena Cava Obstruction?
This is when there is an obstruction in the superior vena cava, as a result of a tumour in mediastinal lymph nodes or lung cancer.
What are the clinical features of Superior Vena Cava Obstruction?
Breathlessness (because of swelling around the windpipe)
Headaches (Raised ICP)
Facial Swelling
Changes in your eyesight (papilloedema)
A swollen neck
Feeling dizzy
How is SVCO managed?
A-E
High dose such as Dexamethasone
Stenting and possible chemotherapy or radiotherapy
(surgery is less likely because of all the important vessels around this area)
Why is hypercalcaemia more likely in cancer?
Many cancers, with or without bone metastases, secrete cytokines and/or PTH-related protein/peptide (PTHrP) that mimic the action of PTH on the osteoclasts and kidneys.
Parathyroid hormone causes osteoclasts to resorb bone which allows for the build up of calcium in the blood.
How is Hypercalcaemia managed?
IV fluid rehydration - litres of fluids
Bisphosphonates - but only after rehydration
Denosumab
Treat malignancy!
What are the red flags for Lung Cancer?
Cough
Haemoptysis
Dyspnoea
Hoarse voice
Chest pain
Fatigue
Appetite loss
Weight loss
What should you check before someone has a CT contrast imaging test?
Have they had a previous contrast reaction - make sure there isn’t an anaphylactic reaction
Renal Function test - if eGFR <40mL/min then there is an increased risk of contrast-induced acute kidney injury
Do they have diabetes mellitus? - if they are taking metformin then they may need to stop this
What are the main types of lung cancer?
Small Cell Lung Cancer
Squamous Cell Carinoma
Adenocarcinoma
What percentage of Lung Cancers are Small Cell Lung Cancers?
15%
What percentage of Lung Cancer are Squamous Cell Carcinoma?
30%
What percentage of Lung Cnacers are Adenocarcinomas?
30-40%
Where in the lungs are small cell lung cancers seen?
Typically centrally located and infiltrative on CT
Where in the lungs are squamous cell carcinomas found?
Centrally located and symptoms start early
Where in the lungs are adenocarcinomas usually located?
Peripherally located and slower growth
Which lung cancers are smoking related?
Small cell lung cancer
Squamous cell carcinoma
What are some really important questions to ask for back pain symptoms?
Weight loss, fever, night sweats, malaise and lymphadenopathy - cancer suspecting
CIBH - this may add to either a cancer dx or cauda equina dx
LUTS - this supports a dx of cauda equinae syndrome or spinal cord compression
Neuro syx - difficulty walking, reduced power in the limbs, loss of sensation (particularly in the perineum)
Why should you do a full body CT on someone presenting with Back Pain?
Because most of the time, the metastasis isn’t just to the back, it is also likely that it goes to other parts of the body.
Name two types of bisphosponates
Zoledronic Acid and Alendronic Acid
When and why is hormonal therapy useful?
Hormonal therapy may be used in breast cancer treatment and it is used because it allows the cancer to be targetted directly, in a way that is not as specific with chemotherapy.
Name two types of hormonal therapy drugs?
Tamoxifen and Fulvestrant
What is the mechanism of action of Tamoxifen?
Selective Oestrogen Receptor Modulator (SORM/SERM)
What do Aromatase Inhibitors do (hormonal therapy for breast cancer)?
They prevent the conversion of androgens to oestrogen and effectively reduce the oestrogen levels in the blood to undetectable levels.
Name one drugs that can be used for HER2 therapy?
Trastuzumab
What is Denosumab?
It is a monoclonal antibody which is a RANK (receptor activator of nuclear factor).
It works on the bone remodelling process. It is a medicine that is used for the treatment of metastatic cancers or osteoporosis.
What happens during Phase 0 of a clinical trial?
Testing a low dose of the treatment to check it isn’t harmful.
This is done for lots of cancer groups
Usually its done with a small group of individuals.
What happens during Phase 1 of a clinical trial?
Finding out about side effects, and what happens to the treatment in the body.
This is done with a small group.
What happens in Phase 2 of a clinical trial?
Finding out more about side effects and looking at how well the treatment works
This is done with a group about 100 people.
What happens in Phase 3 of a clinical trial?
Comparing the new treatment to the standard treatment - is it better than what is already available?
What happens in Phase 4 of a clinical trial?
Finding out more about long term benefits andside effects.
