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Fifth Year Medicine > Oncology > Flashcards

Oncology Flashcards

1
Q

What is a-fetoprotein a tumour marker for?

A 
Hepatocellular carcinoma (liver)
Germ cell/testicular
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2
Q

What is b-HCG a tumour marker for?

A

testicular germ cell carcinoma

Gestational trophoblastic tumours

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3
Q

What is inhibin a tumour marker for?

A

Ovarian carcinoma

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4
Q

What is estridiol a tumour marker for?

A

Ovarian germ cell carcinoma

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5
Q

What is CA 19.9 a tumour marker for?

A

Pancreatic carcinoma

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6
Q

What is carcinoembryonic antigen (CEA) a tumour marker for?

A

Colorectal

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7
Q

What is Sex Hormone Binding Globulin a tumour marker for?

A

Breast carcinoma

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8
Q

What is Lactose Dehydrogenase a tumour marker for?

A

Testicular germ cell and gastric carcinoma

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9
Q

What is CA-125 a tumour marker for?

A

Ovarian carcinoma

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10
Q

Carrying BRCA1 or BRCA2 mutations confers what lifetime risk of cancers?

A

BRCA1-
65% risk of breast cancer
40% risk of ovarian cancer

BRCA2-
45% risk of breast cancer
11% for ovarian cancer

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11
Q

What kind of surveillance should women aged 30-50 with BRCA mutations be offered?

A

Yearly MRI (more sensitive than mammogram)

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12
Q

What prophylaxis can women with BRCA1/2 be offered to reduce risk of cancer?

A 
Bilateral mastectomy (decreases risk by 90%)
±oophrectomy
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13
Q

What mutation is associated with Familial Adenomatous Polyposis?
How can cancer be avoided?

A

APC gene in germline cells

Total colectomy (100% of those with the gene get cancer by 50)

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14
Q

What is Peutz Jeghers syndrome?

Inheritance, features?

A

Autosomal dominant mutation of STK11 (tumour supressor)

Dark freckles on lips, oral mucosa, palms + soles
GI cancer risk

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15
Q

Hereditary non-polyposis colorectal cancer- inheritance pattern? Type of genes involved?

A 
Autosomal dominant (but not everyone who has the mutation gets the cancer)
DNA mismatch repair genes
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16
Q

Investigation and treatment of oncology patient where spinal cord compression is suspected?

A

MRI whole spine

Dexamethasone 16mg OD

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17
Q

Harry has a diagnosis of prostate cancer and has noticed worsening back pain and ‘numbness’ in his lower leg. What diagnosis needs to be excluded?

A

Spinal cord compression

Do spine MRI

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18
Q

What test can you perform in suspected superior vena cava obstruction?

A

Pemberton’s test: lift arms over head for 1 minute = facial plethora/cyanosis, raised JVP and inspiratory stridor

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19
Q

Investigation of choice for suspected SVC obstruction?

A

Contrast enhanced CT (venogram)

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20
Q

Rx of superior vena cava obstruction?

A

Dexamethasone
Balloon venoplasty/SVC stenting

(More rapid relief of symptoms than chemo/radiotherapy)

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21
Q

Patient with multiple myeloma comes in confused and weak with polyuria and complaining of nausea, what needs to be ruled out?
Rx if positive?

A

Malignancy associated hypercalcaemia (occurs in 40% of myeloma patients)

Rehydration then IV bisphosphonate

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22
Q

Which cancer types may lead to tumour lysis syndrome when treated?

What electrolyte disturbance occurs?

A

Leukaemia, lymphoma or myeloma
Germ cell tumours

Rise in serum urate and potassium

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23
Q

What can be given prior to chemo to reduce the chance of getting tumour lysis syndrome?

A

Allopurinol 24 hours before (xanthine oxidase inhibitor)

Tumour lysis syndrome leads to raised urate- crystallisation in nephrons causes renal failure

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24
Q

How soon after chemo are patients at risk of neutropenia?

A

10-14 days later

Or 7 days later for taxanes

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25
Q

Which three types of cancers commonly use bone scans for staging?

A

Prostate
Breast
Lung

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26
Q

What scan can you use to demonstrate a cancer with somatostatin receptors?
Which types of cancer can have such receptors?

A

Octreotide scan

Pancreas
Medullary thyroid
Neuroblastoma (CNS)
Carcinoid

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27
Q

What cancer type are MIBG scans used for localising?

A

Phaeochromocytoma

Localise noradrenaline production

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28
Q

What are Beau’s lines?

A

Horizontal depressions in the nail plate from interruption to keratin synthesis due to infection, trauma, systemic illness or chemo

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29
Q

How many weeks does it take for palliative radiotherapy to exert it’s effect?

A

Around 3 weeks

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30
Q

Rx for cancer patients complaining of xerostomia during radiotherapy?

A

Xerostomia = dry mouth

Pilocarpine (ACh agonist)

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31
Q

When a patient is taking 5a-reductase inhibitors, how much should you adjust their PSA value?

A

Multiple by 2

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32
Q

What is the tumour marker for medullary thyroid cancers?

A

Calcitonin

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33
Q

For breast cancer what tumour marker can you use?

A

CA 15.3

CA 19-9 (=pancreatic)
CA 125 (=ovarian)
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34
Q

What is the tumour marker for thyroid cancers of follicular or papillary types?

A

Thyroglobulin

Calcitonin for medullary thyroid

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35
Q

Adjuvant chemo means?

A

After surgery if at risk of reoccurrence

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36
Q

When do you give patients granulocyte colony-stimulating factor?

A

May give it day 2 or 3 post chemo if white blood cell counts are low to try to stimulate the bone marrow, but the WBCs that are produced may not be good quality

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37
Q

Rx of neutropenic sepsis?

A

IV broad spectrum antibiotics (within 1 hour)

Not GCS-factor in the acute setting

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38
Q

Young patient with SVC obstruction due to cancer, what is the most likely type of cancer causing the problems?

A

Lymphoma

Lung cancer commoner in older patients

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39
Q

Cancers typically going to bone?

A 
Thyroid
Lung
Breast
Renal
Prostate
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40
Q

What needs to be considered for treating brain metastases?

A

Not chemo- may not be able to cross the blood brain barrier

Consider surgery if focal lesion (need MRI head to confirm)
Whole brain radiotherapy / Stereotactic radiotherapy (specific)
Palliative

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41
Q

Management of bowel obstruction in cancer patients?

Drugs?

A

Conservative:
Drip and suck

Steroids
Antiemetics SC
Motility agents (if subacute, like metoclopramide)
Antisecretory agent (octreotide)

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42
Q

When would you consider surgical management for someone with cancer and bowel obstruction?

A

If it hasn’t resolved after 48 hours of conservative management

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43
Q

Cancer patient on active treatment + VTE, what anticoagulant to use?

A

LMW heparin whilst on active treatment

Unstable INR with chemo makes management difficult.

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44
Q

Patient with liver mets from an unknown primary, what imaging modalities would be useful?

A

CT
PET scan to look for primary

Tend to give combination chemo if fit for it.

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45
Q

What proportion of those with benign prostatic hyperplasia have a PSA greater than 10?

A

1%

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46
Q

What are the three mechanisms for nausea and the chemicals mediating these?

A

Visceral stimulation: dopamine + serotonin
Vestibular + CNS: histamine + acetylcholine
Chemoreceptor trigger zone: dopamine + serotonin

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47
Q

Why does cyclizine (an antihistamine) work on motion sickness?

A

Histamine + ACh stimulate vestibular centres to cause nausea

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48
Q

What type of antiemetic is most effective for post-op or GI irritation?

A

Anti-serotonin (ondansetron)

As serotonin and dopamine trigger nausea via the stomach

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49
Q

Which antiemetics are dopamine antagonists and what is the risky SE?

A

Domperidone (peripheral so no dystonic SEs)
Metoclopramide (central and peripheral)
Chlorpromazine
Haloperidol

Not suitable for Parkinson’s, may cause extrapyramidal SEs or orthostatic hypotension

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50
Q

Name a serotonin antagonist antiemetic?

A

Ondansetron

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51
Q

Which antiemetic is good for gastric stasis (ie after surgery)?

A

Metoclopramide

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52
Q

Give an example for each of the common types of antiemetic

A

Antidopaminergics: domperidone, metoclopramide, haloperidol
Antiserotonin: Ondansetron
Antihistamine: Cyclizine

Vestibular pathway= ACh + histamine
Visceral stomach pathway = 5-HT + dopamine
Chemoreceptor trigger zone = 5-HT + dopamine

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53
Q

What are the four different types of laxative?

A

Bulking agents- increase faecal mass (bran, ispaghula husk)
Stimulant laxatives- increase intestinal motility (biascodyl, senna)
Stool softeners- for painful anal conditions
Osmotic laxatives- retain fluid (lactulose, macrogel)

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54
Q

Patient has constipation from intestinal obstruction, which type of laxatives should be avoided?

A

Stimulant laxatives as they increase intestinal motility, will just lead to further impaction of obstruction

Ie docusate, bisacodyl, senna, glycerol

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55
Q

Prolonged use of stimulant laxatives may cause…?

A

Colonic atony

or hypokalaemia

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56
Q

Which laxative type is best for use in constipation related to anal fissures? (Pre-surgery)

A

Stool softeners- le liquid paraffin (although not for long term use)

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57
Q

1st line for acute or opiate-related constipation?

A

Senna (stimulant laxative)

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58
Q

1st line for chronic constipation or elderly patients?

A

Ispaghula husk (bulk forming laxative)

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59
Q

Laxative used for faecal impaction?

A

Macrogol (osmotic laxative)

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60
Q

Palliative treatment for agitation near death?

A

Midazolam

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61
Q

What is the difference between hyoscine hydrobromide and hyoscine butylbromide?

A

Palliative:
Hyoscine hydrobromide- respiratory secretions
Hyoscine butylbromide- bowel colic (spasmodic pain)

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62
Q

Cancer patient has itch and jaundice after treatment, what Rx?

A

Colestyramine (1 hour after other drugs)

Sequesters bile acids in gut

63
Q

What opioid can be given in suppository form?

A

Oxycodone 30mg PR

64
Q

Pain killers for neuropathic pain?

A

Pregabalin
Amitrypyline
Gabapentin

65
Q

Examples of weak opioids

A

Codeine
Dihydrocodeine
Tramadol? (Possibly abit strong)

66
Q

To convert an codeine dose to morphine what should you divide the dose by roughly?

A

10 x

67
Q

What histological type of cancer is anal cancer predominantly?

A

Squamous cell

68
Q

Apart from squamous cell, what other types of anal cancer can you get?

A

Squamous 85%

Melanoma
Adenocarcinoma
Basaloid

69
Q

What features are associated with a good or bad prognosis in anal cancers?

A

Good:
About anal margins
Keratinizing

Bad:
Above dentate line
Non-keratonizing

70
Q

How does the position of an anal cancer affect which lymph nodes it spreads to?

A

Above dentate line- pelvic lymph nodes (deep)

Below dentate line- inguinal lymph nodes

71
Q

What are the main histological types of breast cancers?

A

Ductal carcinoma (70%)

Lobular carcinoma (15%)
Medullary cancer- in young, not aggressive
72
Q

Is oestrogen receptor +ve a good prognostic sign in breast cancer?

A

Yes, +ve in 70%

73
Q

Which receptor expression is associated with a bad prognosis in breast cancer?

A

HER2 overexpression

Growth factor receptor

74
Q

What does the triple assessment for breast consist of?

A

Clinical examination
Histology/cytology
Mammography/ultrasound

75
Q

What are the risks associated with lymph node clearance in surgical treatments of breast cancer?

A

Brachial plexopathy

Lymphoedema

76
Q

If a breast cancer is oestrogen receptor positive, what medication is often used for 5 years post-op?

A

Tamoxifen- competitive oestrogen receptor antagonist

77
Q

For post-menopausal women with an oestrogen receptor positive breast cancer, what hormone therapy may help?

A

Aromatase inhibitor ANASTRAZOLE
Prevents oestrogen synthesis peripherally in extra-gonadal tissues
(Hence won’t work when ovaries can make oestrogen instead of the adrenals)

78
Q

What are the options for breast reconstruction following mastectomy?

A

Implants
Latissimus dorsi flap (back muscle)
Transverse rectus abdominus myocutaneous flap

79
Q

Which monoclonal therapy is available for HER2+ breast cancers?

A

Trastuzumab

HER2- growth factor receptor

80
Q

What scale predicts prognosis in breast cancer?

What variables are required?

A

Nottingham Prognostic Index

0.2 x tumour size x histological grade x nodal status

81
Q

What is a fibroadenoma?

On EHx?

A

Benign overgrowth of collagenous stromal and epithelial tissue occurring in the breast

EHx: firm smooth mobile painless lump

82
Q

24 year old with a smooth firm lump in the breast, no pain. What IHx to do to rule out breast cancer?

A

Ultrasound scan

± fine needle aspiration

83
Q

For cystic lumps in the breast what do you find on fine needle aspiration?

A

Clear fluid

mass collapses as fluid is drained

84
Q

Woman aged 52 notices green discharge of her breast with some nipple retraction. What could be the cause?

A 
Breast cancer
Duct ectasia (blockage of the ducts, can be associated with green/bloody discharge ± lump)
85
Q

How should you image women under 35 with suspected breast cancer?

A

Ultrasound, as breast tissue is denser in younger women making mammogram’s less effective

86
Q

What imaging is better for visualising posterior fossa masses in suspected brain tumours?

A

MRI

CT tends to get a bone artefact

87
Q

For glioma’s what can you place in the brain for localised chemotherapy?

A

Carmustine wafers

=Alkylating agent that crosslinks DNA

88
Q

What is the hot new drug that can be used for glioblastoma?

What gene needs to be methylated (epigenetically inactive) for efficacy?

A

Temozolamide
Alkylating agent causes DNA damage

MGMT gene needs to be methylated (mediates DNA repair)

89
Q

Obese woman has a headache, blurring of vision, signs of raised intracranial pressure + papilloedema. On imaging no mass can be found. What could be the cause?

A 
Idiopathic intracranial hypertension 
Secondary to: 
venous sinus thrombosis
tertracycline
nitrofurantoin
other drugs
90
Q

Rx for idiopathic intracranial hypertension

A

Weight loss
Acetazolamide- carbonic anhydrase inhibitor
Loop diuretics
Prednisolone

Surgical management if symptoms worsen or medications fail

91
Q

Histological type of colorectal cancer predominantly?

A

Adenocarcinoma

92
Q

Risk factors for colorectal cancer?

A

Ulcerative colitis + Crohns
FHx- FAP = HNPCC

Diet= low fibre and red meat
Alcohol

93
Q

Which common medication seems to reduce incidence of colorectal cancer by inhibiting polyp growth?

A

Aspirin 75mg

94
Q

How do symptoms suggest whether there is left or right sided colorectal cancer?

A

Left:
PR- bleeding/mucus or mass
Altered bowel habit/obstruction
Tenesmus

Right:
Weight loss
Anaemia
Abdo pain

95
Q

What is the difference between Sigmoid Colectomy and an Anterior Resection surgery for colorectal cancer?

A

Sigmoid colectomy removes sigmoid colon only, anterior resection resects upper rectum and sigmoid colon

96
Q

Chemo agents used as adjuvant chemotherapy for colorectal cancer?

A

FOLFOX:
Folinic acid
5-fluorouracil (pyramidine analogue)
Oxaliplatin (platinum + crosslinks DNA)

97
Q

Which gene mutation in colorectal cancer suggests whether Cetuximab or Panitumumab (anti EGFR antibodies) will work?

A

KRAS and EGFR mutations tend to be mutually exclusive, so if a cancer has KRAS mutations they will be unlikely to have EGFR mutations and thus the Rx won’t work

98
Q

Who is applicable for the NHS Bowel Cancer Screening Programme?

A

60-76 year olds, every two years

Send off faecal occult blood testing kit, sample 3 stools

99
Q

When is a cancer patient considered neutropenic?

A

When neutrophils are 0.5 x10/L or below

100
Q

What hygiene regime may be useful in a neutropenic patient?

Skin, mouth, bum

A

Swab moist skin with chlorhexidine
Use hydrogen peroxide mouth washes every 2 hours
Candida prophylaxis (fluconazole)
Wash perineum after pooping

101
Q

What parameters suggest neutropenic sepsis?

A

Temp above 38 degrees

Or above 37.5 degrees on tests one hour apart

102
Q

Example Rx for neutropenic sepsis?

And if Hickman line?

A

Piperacillin- tazobactam

If Hickman line looks infected, or suspect gram +ve organisms- Vancomycin

103
Q

Neutropenic patient continues to have a fever despite antibiotic regimen, what else could be the cause?

A

CMV
Fungi- candida, aspergillus
Central line infection

104
Q

What is hyperviscosity defined as and what are the risks?

A

WCC > 100 x10/L

WBC thrombi may form in brain, lung or heart (leukostasis)

105
Q

Need to transfuse a patient but they currently have WCC above 100 (putting them at risk of hyperviscosity) how can the WCC be lowered?

A 
Leukopheresis
Hydroxycarbamide (used in sickle cell also, may be interferring with DNA repair?)
106
Q

FBC and clotting features that can occur in Disseminated Intravascular Coagulation?

A 
FBC: low platelets, low fibrinogen
APTT raised (intrinsic pathway, factor 12, 11, 9, 8)
PT raised (extrinsic, factor 7)

Blood film: broken RBCs, schistocytes

107
Q

You give antibiotics to someone with neutropenic sepsis. Which blood measurement helps indicate if treatment is working?

A

Decline in CRP

108
Q

Commonest cancer in childhood?

A

Acute lymphoblastic leukaemia

T and B lymphocyte cell lines

109
Q

Child keeps getting infections and is found to be anaemic, with lymphadenopathy around the cervical lymph nodes. What investigations needed to confirm diagnosis?

A

Blood film- blast cells with large nucleus
Bone marrow aspirate/biopsy
FBC- bone marrow failure so low platelets + RBCs, but high WCC

CXR/CT- mediastinal/abdo lymphadenopathy
Lumbar puncture- CNS involvement

110
Q

Rx for acute lymphoblastic leukaemia

A 
VPAD
Vincristine (microtubules)
prednisolone 
L-asparinase (Deprives of asparagine amino acid)
daunorubicin (crosslinks)
111
Q

Features of acute lymphoblastic leukaemia with a bad prognosis?

A

Adults (commonly occurs in children)
B-cell leukaemia (rather than T cell or precursor-B cell)
Philadelphia chromosome BCR-ABL gene from chromosome translocation 9 and 22

112
Q

What is the philadelphia chromosome about?

Targeted treatment for it?

A

BCR-ABL fusion gene formed by reciprocal translocation of chromosomes 9 and 22.

Imatinib is the small molecular inhibitor for it
Associated with CML and rarely ALL (poor prognosis if so)

113
Q

Which leukaemia type is DIC most associated with?

A

Acute myeloid leukaemia,
specifically acute promyelocytic leukaemia- where thromboplastin is released by the white cells to trigger coagulation activation

114
Q

Acute myeloid leukaemia chemo Rx?

A

Daunorubicin- intercalates DNA

Cytarabine- damages DNA

115
Q

What structure in cells indicates on a blood film that you have AML rather than ALL?

A

Auer rods (crystals of coalesced granules of lysosomes and enzymes)

116
Q

3 causes of enlarged spleen?

M’s

A

Myelofibrosis (marrow fibrosis)
Chronic Myeloid leukaemia
Malaria

117
Q

What are the three phases of chronic myeloid leukaemia?

A

Chronic- months to years, few symptoms
Accelerated- more symptoms, spleen, cell counts
Blast transformation- turns into acute leukaemia, death

118
Q

What is the commonest leukaemia?

A

Chronic lymphocytic leukaemia

119
Q

Which blood cancer is gum hypertrophy associated with?

A

Acute myeloid leukaemia AML

120
Q

Which leukaemias are associated with lymphadenopathy?

A

ALL + CLL

Also lymphomas

121
Q

What complication of chronic lymphocytic leukaemia may lead to rising bilirubin?

A 
Autoimmune haemolysis 
IgM mediated (cold agglutination)
122
Q

What is Richter’s syndrome?

A

Transformation that occurs in 7% of chronic lymphocytic leukaemia, into an aggressive diffuse large B-cell lymphoma.

= Fever without infection
LDH increase
Enlarging lymph nodes

123
Q

What marker can be used to track progression in chronic lymphoblastic leukaemia?

A

CD23 or beta2-microglobulin

124
Q

What histological cell type found on blood film is characteristic of hodgkins lymphoma?

A

Reed-Steinburg cell with mirror-image nuclei

125
Q

What side effects do you get from hormone therapy in treatment of prostate cancer?

A

Like a male menopause
Loss of libido, sexual dysfunction, hot flushes, mood swings
OSTEOPOROSIS

126
Q

TTF1 +ve immunohistochemistry on a cancer biopsy if metastatic suggests which organ origin of the tumour?

A

Lung cancer

127
Q

How can you remember which primaries metastasize to the lungs?

A

Paired organs- thyroid, breast, kidneys, testes, colon/gi cancers

128
Q

What cancers put a patient at risk of tumour lysis syndrome during treatment?

IHx if suspected?

A

Acute leukaemia
Non-Hodgkins lymphoma

U+E, calcium, uric acid, ECG

129
Q

Which schizophrenia medication improves negative symptoms?

A

Clozapine- like apathy and paucity of speech

130
Q

Most important risk factor in bladder cancer?

A

Smoking

131
Q

Abdominal mass in a 2 year old, which different cancers could be the cause?

A 
Wilm's tumour (nephroblastoma)
Neuroblastoma (found by adrenals or head + neck)
Rhabdomyosarcoma
Lymphoma
Ovarian tumours
132
Q

What cell type do neuroblastomas (childhood cancer) originate from?

A

Neural crest cells that form the adrenal medulla and sympathetic ganglions

133
Q

Nephroblastoma is due to a mutation in what type of gene?

A

Tumour suppressor WT1 found on chromosome 11

134
Q

How is neuroblastoma graded?

A

Mitotic rate (low or high)

N-myc mutations = aggressive

135
Q

What mechanism gives rise to a tumour that does not have gradings or different levels of differentiation and mutation but simply has a mutation giving rise to a tumour or not?

A

Tumour-specific translocation
Activator translocated next to an oncogene, acts as an on-off switch

(Examples are sarcoma or PNET)

136
Q

Commonest neonatal tumour?

A

Teratoma

Can lead to haemorrhage during delivery or ano-rectal malformations

137
Q

Patients with ALK +ve non-small cell lung cancer may want to consider which recently approved therapy?

A

Crizotinib
In NSCLC for patients who do not have an aberrant EGFR form, crizotinib targets the EML4-ALK fusion protein that acts as an oncogene

138
Q

Which cancer therapies target angiogenesis?

A

Antibodies: bevacizumab
Small molecules: sunitinib, axitinib

(Also thalidomide, integrin inhibitors)

139
Q

In the unit dose of radiotherapy, 1 gray = ?

A

1 Joules/kg

140
Q

Someone with xeroderma pigmentosa or ataxic telangiectasia can’t have what kind of cancer therapy?

A

Radiotherapy as they have a defect in their DNA repair mechanisms so could not counter the damage in normal cells

141
Q

When switching from immediate release morphine to sustained release, when should the first sustained-release dose be taken?

A

At the same time as the immediate dose was due (can take both together if in pain)

Continue to give breakthrough doses if needed

142
Q

Morphine stimulates nausea via which pathway?

A

Chemoreceptor trigger zone (D2 + 5-HT3)

High Ca and uraemia also stimulate this area

143
Q

Which types of cancer therapies do renal cell carcinoma tend to be resistant to?

A

Radiotherapy + chemotherapy

So use surgery and immunotherapy (IL-2, tyr kinase inhibitors for VEGF)
NB not true for Wilms which is Rx-ed with chemo

144
Q

What is the difference between the staging of Wilms and other cancers of the kidney/bladder/prostate?

A

T3- normally means outside the prostate capsule/bladder wall/into fascia surrounding kidney

But in Wilms extrarenal disease is T2

145
Q

What is the difference between phimosis and paraphimosis?

A

Phimosis is constriction of the opening in the foreskin, so it can’t be retracted over the glans.
Paraphimosis is when a tight foreskin is retracted and can’t be replaced so venous return is occluded and the glans becomes oedematous or even ischaemic

146
Q

Migratory thrombophlebitis (Trousseau’s sign) occurs in which two cancers?

A

Lung + Pancreatic

147
Q

What does B3 deficiency cause?

A

3 things that are not nice (niacin = B3)

Dementia
Diarrhoea
Dermatitis

148
Q

What does B1 deficiency cause?

A

Beriberi (or ber1ber1)
Is this thigh mine? (Thiamine) = polyneuropathy

Heart failure (Wet)
Wernicke Korsakoff (Dry0
149
Q

In spinal cord compression, what types of cancer metastasizing in the spine to cause it are associated with a bad prognosis?

A

Lung or melanoma

150
Q

Drugs that can be given to someone with bowel obstruction secondary to cancer?

A

Steroids- reduce bowel wall oedema
Antiemetics SC
Motility agents if subacute- metoclopramide
Octreotide- antisecretory

151
Q

IHx for cancer of unknown primary?

A

CT abdo, pelvis, head
Consider PET to look for primary and mets, help decide how radical to go with surgery or when to go palliative

No endoscopy + colonoscopy unless suggests GI origin
No mammogram unless breast is likely
No tumour marker testing

152
Q

What are the different stages of performance status?

A 
0- fully active
1- can carry out light work
2- up and above 50% of waking hours
3- confined to bed/chair 50% of time
4- completely confined to bed or chair
153
Q

Which are the different ectopic hormones that different types of lung cancer can produce?

A

Small cell- ACTH (cushings) + ADH (SIADH)

Squamous- PTH (high Ca)

Fifth Year Medicine (32 decks)

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