Treatments and complications Flashcards

Question

Malignant hypercalcaemia ix

Answer 1

Bloods - bone profile, myeloma screen CT C/A/P

Answer 2

IV hydration - normal saline Calcitonin - can be given to a patient with moderate/severe hypercalcaemia → promotes urinary calcium excretion Bisphosphonates - provide calcium-lowering effects over a prolonged period

Answer 3

Build up of fluid within the peritoneal cavity in the abdomen due to underlying malignancy

Answer 4

Ovarian cancer Breast cancer Bowel cancer Stomach cancer Pancreatic cancer Lung cancer Liver cancer

Answer 5

Tumour cells irritate the peritoneum and cause it to produce too much fluid Lymph glands in the abdomen get blocked & can’t drain fluid properly Cancer has spread to the liver → raises pressure in blood vessels → forces fluid out Liver can’t produce enough albumin → fluid leaks out of veins into the cavity

Answer 6

Abdominal distension Abdominal pain Back pain Loss of appetite Indigestion Breathlessness

Answer 7

Bloods - FBC, U&Es, LFTs, clotting, bone profile, CRP Abdominal ultrasound Ascitic tap - fluid sent to lab & tested

Answer 8

Abdominal paracentesis - reduces swelling & makes patient more comfortable Long term drain may be required if fluid builds up again Drugs - diuretics, chemotherapy into abdomen

Answer 9

Build up of fluid in the pleural cavity with underlying malignancy

Answer 10

Shortness of breath Dru cough Pain Feeling of chest heaviness/tightness Inability to lie flat Inability to exercise Generally feeling unwell

Answer 11

Cancer - breast cancer, lung cancer, lymphoma, mesothelioma, ovarian cancer Cancer treatments - radiotherapy, chemotherapy, lung surgery

Answer 12

CXR CT scan Ultrasound Thoracentesis - needle that removes fluid from pleural space for cytology

Answer 13

Most common treatment is to drain the malignant pleural fluid Thoracentesis - needle is inserted to remove the fluid Tube thoracostomy - tube inserted to drain the fluid, typically stays in for a day or longer until enough of the fluid has drained; after this pleurodesis is done → stick the edge of the lung to the chest wall which decreases the chance that the fluid will return Tunneled pleural catheter - can be left in long term for ongoing draining Shunt - inserted during surgery, and used to bypass and divert excess fluid from one place to another Chemotherapy

Answer 14

defined by radiological evidence of indentation of the thecal sac

Answer 15

Usually occurs secondary to metastatic deposits within the spinal column Lung, breast, kidney, prostate and thyroid cancers are associated with cord compression secondary to metastatic disease Primary malignancies → primary bone tumours, CNS malignancies Other causes → trauma, intervertebral disc prolapse, haematoma, epidural abscess, cervical spondylitic myelopathy

Answer 16

A tumour invades into the epidural space and compresses the thecal sac More extensive the compression of the thecal sac & thus the spinal cord → more likely there will be significant neurological symptoms Most cases occur secondary to metastatic extension from the vertebral bodies → pressure on the thecal sac occurs anteriorly

Answer 17

Pain - usually precedes the development of neurological symptoms by several weeks Weakness, typically, symmetrical → progressive with development of disturbed gait & eventually paralysis UMN lesions → increased tone → positive Babinski Cauda equina symptoms

Answer 18

MRI scan - investigation of choice in suspected MSCC Other possible ix: myelography, CT, bone scan & plain radiographs

Answer 19

Surgical emergencies requiring prompt recognition and treatment General measures - receive adequate analgesia utilising WHO ladder, TED stockings & prophylactic LMWH Glucocorticoids - normally high dose dexamethasone Definitive procedures - **external bean radiotherapy** may be used as an adjuvant to surgery/a definitive stand-alone therapy in those unable to undergo surgical intervention - surgical management options include **surgical decompression** and reconstruction, vertebroplasty & kyphoplasty

Answer 20

Obstruction to the flow of blood through the superior vena cava secondary to a cancer SVC = provides venous drainage for the upper limbs, head and beck

Answer 21

Lung cancer (70-80%) - NSCLC NHL (10%) - may occur due to mediastinal nodes Other - thymic, breast, mediastinal germ cell tumours

Answer 22

Symptoms - dyspnoea - facial swelling - head ‘fullness’ - symptoms exacerbated by bending forwards/lying down - cough - dysphagia Signs - facial swelling - distended neck and chest wall veins - upper limb oedema - facial plethora - cyanosis - cognitive dysfunction - coma - Pemberton’s sign - patient is asked to elevate both arms above the head for 1-2 minutes - positive = congestion, cyanosis or respiratory distress - occurs due to increased venous return from the upper extremities exacerbating any obstruction

Answer 23

CXR - mediastinal widening & pleural effusion CT chest with contrast Duplex US Histology if malignant cause is suspected

Answer 24

Relieving the obstruction & treatment of the underlying cause Elevation of the head and neck & oxygen titrated to saturations Medical therapy - radiotherapy & chemotherapy Surgical therapy - endovenous stent

Answer 25

Average life expectancy of six months → reflects the extent of tumour or lymphadenopathy necessary to develop obstruction of the SVC

Answer 26

a fever > 38 or features or sepsis in a patient with a neutrophil count of < 0.5 x 10^9

Answer 27

Bacteria most commonly isolated organisms in neutropenic sepsis - gram negative: - E. coli - Klebsiella spp - Pseudomonas aeruginosa - gram positive: - coagulase-negative staphylococci - staph aureus - strep pneumoniae - other: - c. difficile Viral - more common in high-risk patients - usually part of the human herpes family Fungal - more common in high-risk patients - candida & aspergillus typically

Answer 28

Date of last chemo and which agent Symptoms of infection Ask about lines Drugs and allergies

Answer 29

May present with signs of symptoms of a specific infection Should be considered in any patient at risk of neutropenia presenting with clinical features of infection → patient receiving or having recently received chemotherapy

Answer 30

Looking for source of infection Bedside - observations, blood sugar, pregnancy test Bloods - VBG/ABG, FBC (urgent), CRP, U&Es, LFTs, bone profile, clotting, fungal assays, blood borne virus screen - don’t wait for results of FBC to start the abx Cultures - blood cultures, line cultures, sputum MC&S, urine cultures, stool MC&S, c. diff toxin, viral PCR, wound swabs Imaging - CXR, LP, echo (infective endocarditis)

Answer 31

Require antibiotics < 1 hour Sepsis 6 bundle should be completed in all patients Additional efforts should be made to identify the source of infection

Answer 32

- metabolic disturbances arising from the breakdown of malignant cells following the initiation of treatment for malignancy - rapid cellular breakdown leads to the release of intracellular components resulting in a series of electrolyte abnormalites: - hyperkalaemia - hyperphosphataemia - hypocalcaemia - hyperuricaemia - AKI, arrhythmias & sudden death can occur as a consequence

Answer 33

Cytotoxic-mediated lysis of tumour cells lead to the release of intracellular components → potassium, phosphate and nucleic acids Hypocalcaemia develops secondary to hyperphosphataemia with the precipitation of calcium in soft tissues Development of hyperuricaemia and hyperpsophataemia can lead to an AKI through the precipitation of uric acid and calcium phosphate within the renal tubules

Answer 34

Tend to develop within the first 72 hours following the initiation of treatment but can occur up to 7 days post-treatment Generally related to the metabolic abnormalities that occur Symptoms - lethargy - N&V - diarrhoea - anorexia - muscle cramps - syncope - pruritus - arthritis Signs - fluid overload - haematuria - tetany & paraesthesia - bronchospasm

Answer 35

U&Es, serum urate (serum urate levels taking in patients treated with rasburicase should be sent to lab on ice to prevent falsely low levels) Urine dip Urine microscopy Serum lactate LDH ECG Cardiac monitoring

Answer 36

Cairo-Bishop definition, clinical and laboratory Laboratory - presence of two or more abnormal serum values that occur three days prior to or seven days after beginning treatment (25% increase in everything except calcium which is 25% decrease) Clinical - patient who meets the lab diagnosis with the presence of one or more of the following features: - serum creatinine > 1.5 ULN - cardiac arrhythmia/sudden death - seizure

Answer 37

Centres around the treatment of hyperphosphataemia, hyperkalaemia, hypocalcaemia & renal impairment Calcium gluconate, insulin/dextrose Hypouricaemic agents - allopurinol, rasburicase Phosphate binders IV hydration