Oncology & Palliative Care Flashcards
(134 cards)
What would make you suspect neutropenic sepsis in a chemotherapy patient?
Temp >38 and neutrophil count <0.5x10^9/L
Pt would be unwell and within 6wks of last chemo
How would you treat neutropenic sepsis?
Emipircal treatment with Tazocin (Piperacillin/Tazobactam)
Which cancers are most associated with spinal cord compression?
Lung Prostate Breast Myeloma Melanoma
Causes of spinal cord compression in cancer
Collapse of compression of a vertebral body due to metastases (common), or direct extension of a tumour into the vertebral column (rare)
Signs and symptoms of spinal cord compression in cancer
Back pain in 95% Nocturnal pain Pain on straining Cervical/thoracic pain -> inc concern Limb weakness Difficulty walking Sensory loss Bladder/bowel dysfunction
Management of spinal cord compression in cancer
Admit for bed rest
Urgent (<24hr) MRI of whole spine
Dexamethasone (16mg/24h) PO with gastroprotection
Reduced mobility? - consider thromboproph
Refer urgently to oncology/cancer MDT
Radiotherapy
Causes of SVC obstruction
> 90% are due to malignancies, most commonly lung (75%), lymphoma, metastatic (e.g. breast), thymoma, germ cell
Signs and symptoms of SVC obstruction
Clinical diagnosis
SOB, orthopnoea, stridor, plethora/cyanosis, oedema of face and arm, cough, headache, engorged neck veins, engorged chest wall veins
Management of SVC obstruction
Prop them up Assess for hypoxia + O2 if needed Dexamethasone (16mg/24h) CT to define anatomy of obstruction Balloon venoplasty and SVC stenting to relieve symptoms Radiotherapy or chemotherapy
What is the most common metabolic abnormality in cancer patients?
Malignancy-associated hypercalcaemia
Poor prognostic sign
Causes of malignancy-associated hypercalcaemia
PTH-related protein produced by the tumour
Local osteolysis
Tumour production of calcitriol
Signs and symptoms of malignancy-associated hypercalcaemia
Weight loss Anorexia Nausea Polydipsia Polyuria Constipation Abdo pain Dehydration Weakness Confusion Seizure Coma
Management of malignancy-associated hypercalcaemia
Aggressive rehydration
Bisphosphonates IV (if eGFR >30)
Calcitonin - gives more rapid but short-term effect
Long-term -> control of malignancy
How common are brain mets?
Affect up to 40% of pts with cancer
Most common cancers that met to brain
Lung
Breast
Colorectal
Melanoma
Signs and symptoms of brain mets
Headache - often worse in morning, on coughing Focal neuro signs Ataxia Fits N+V Papilloedema
Management of brain mets
Urgent CT/MRI depending on underlying diagnosis, disease stage, and performance status
Dexamethasone (16mg/24h) to dec cerebral oedema
Stereotactic radiotherapy
Discuss with neurosurgery
What is the cause of tumour lysis syndrome
Chemotherapy for rapidly proliferating tumours (leuk, lymph, myeloma) leads to cell death and inc urate, inc phosphate and dec calcium
What are the risks of tumour lysis syndrome
Arrhythmia
Renal failure
Management of tumour lysis syndrome
Prevent with hydration and uricolytics
List the paraneoplastic syndromes
Hypercalcaemia SIADH Cushing's syndrome Neuropathy Lambert-Eaton myasthenic syndrome Dermatomyositis and polymyositis Acanthosis nigricans Pemphigus Hypertrophic osteoarthropathy
Which malignancies most commonly cause hypercalcaemia?
Lung Oesophagus Skin Cervix Breast Kidney
What metabolic abnormality is seen in SIADH?
Hyponatraemia
Which malignancies most commonly cause SIADH?
Lung
Pancreas
Lymphoma
Prostate