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Phase 4 - GR > Oncology > Flashcards

Oncology Flashcards

1
Q

Name 3 causes of new confusion in a patient on the ward

A 
Sepsis 
hypercapnia 
hypercalcaemia 
raised ammonia 
AKI -> dehydration -> reduced opiate excretion 
steroids 
low Na 
Brain mets
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2
Q

Mx of hypercalcaemia

A

saline -> bisphosphonates [zoledronate]

2- calcitonin

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3
Q

Adverse effects of zolendonic acid

A

osteonecrosis of jaw
gastritis
oesophagitis

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4
Q

Mx of raised ammonia

A

phosphate enemas

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5
Q

How does AKI cause confusion in patient on opiates?

A

Dehydration -> decreased opiate excretion -> increased levels of opiates -> confusion and sedation

mx - naloxone

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6
Q

Mechanism of steroid psychosis

A
  • > reduced Na and increased K

- > reduced BP (due to low Na)

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7
Q

2 Drug causes of reduced NA

A 
steroids 
PPI - omeprazole / lanzoprazole 
ssri 
Carbamazepine 
fluids (Eg 5% dextrose)

(rinitidine is good to change PPI)

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8
Q

What happens in the metastatic cascade

A

DIIE AEA [like someone shouting it]

Detachment
Invasion
Intravasation (blood or lymph)
Evasion of host defence
Adherence
Extravasation
Angiogenesis
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9
Q

When might you use radiotherapy - 3 indications

A

Pt medically unfit surgery,
anatomically unresectable, close proximity to vital structures,
neo-adjuvant to shrink structure,
adjuvant to decrease risk of recurrence,
palliative for bone/brain mets + spinal cord compression

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10
Q

2 main types of radiotherapy

A

External beam radiation therapy - using CT/MRI to target tumour

Internal radiation therapy - brachytherapy - radiation source placed near target tumour

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11
Q

Name 2 acute and 2 chronic comps of radiotherapy

A

Acute (during treatment or <2-3 weeks)
Fatigue (80%)
Skin - Erythema, dry and moist desquamation, irritation
GI - loss of taste, oral mucositis (complicated by yeast/bacterial superinfection), diarrhoea, nausea, vomiting
BM - cytopenias
Lungs - pneumonitis, fever, cough, dyspnoea

Chronic
Infertility
Lymphoedema
Delayed healing
Loss of salivary flow
Transverse myelitis, Lhermitte’s 
Increased risk CV events/stroke
Hypothyroidism
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12
Q

Name 3 SEs of chemo

A

Myelosuppression - anaemia, infection, bleeding
One week after, FBC prior to admission

Alopecia

Infertility

Nausea, vomiting and diarrhoea
-Major cause of distress - use domperidone or metoclopramide

Fatigue

Teratogenicity

Mouth ulcers

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13
Q

What is extravasation

A

Problem with chemo -
pain, redness and inflammation -> may lead to skin necrosis + amputation (dissolving soft tissue).
May see brown demarcation of veins

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14
Q

Mx of extravasation

A

Topical agents e.g. dimethyl sulfoxide, heat, cold,

debridement and grafting may be required

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15
Q

Common severe reaction to chemo

A

Anaphlaxis - T1 hypersensitivity

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16
Q

What is the risk with chemo induced myelosupression

A

Neutropenic sepsis

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17
Q

Ix in anyone who has fever and recent chemo

A

FBC, LFT, U + Cr, CRP, lactate, blood cultures (multiple sites), urine culture, NOT LP (may introduce infx), swabs and cultures from central line (each part)

Worry about neutropenic sepsis

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18
Q

Pt presents with Sx of spinal cord compression (in onc) what exam should you do?

A

peripheral nerve

precuss spine

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19
Q

mets -> spinal cord compression
Ix for Dx?
Mx?

A

MRI whole spine,

  • > refer to neurosurgery/spinal surgery
  • > Or if more widespread give radiotherapy

+ IV DEXAMETHASONE + prevention VTE + PPI

  • Analgesia
  • Lay flat
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20
Q

Dexamethasone

A

Just god shit keep it in the brain for all onc

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21
Q

Mx painful spine mets

A

Analgesia (NSAID/non-opiate/opiate)

Bisphosphonates if myeloma/breast cancer (lytic lesions)

Palliative radiotherapy

Vertebroplasty

22
Q

3 precipitating factors for DVT in Ca

A

cancers tend to be prothrombotic

Surgery and chemotherapy may damage vessel walls (increased clots)

Patients tend to be less active

23
Q

Describe 1 way malignancy can cause hyperCa

A

Secretion of PTH related peptide by tumour (humoral hypercalcaemia)

Local release of factors increasing osteoclast proliferation (local osteolytic hypercalcaemia) - including PTH-rP

Boney mets

Autonomous production of calcitriol by lymphoma

24
Q

Name 3 Ix in HyperCa of malignancy

A

Total calcium
Elevated but influenced by albumin and calcium binding Igs (MM)

Serum ionised calcium
If abnormal albumin

Serum albumin
Adjusted serum calcium is (0.02 x [normal albumin - pt albumin]) + serum calcium

Resting ECG
?Shortened QT

Serum PTH
Elevated in PTH mediated i.e. primary hyperparathyroid/ ectopic hyperparathyroid

Serum phosphorus
Low in humoral

Serum calcitriol - high in calcitriol mediated

Skeletal survey - osteopenia, osteolytic lesions, pathological fractures + CXR lung cancer, TB, sarcoidosis

25
Q

Name 2 medications that worsen hypercalcaemia

A 
Thiazide diuretics
Calcitriol
Calcium supplementation
Antacids
Lithium
26
Q

Mx of mod/severe hyoer Ca

A

IV saline
(dehydration)

IV bisphosphonates (block bone reabsorption)

Furosemide
-avoid fluid overload

27
Q

Most common cause of SVCS? What happens

A

Malignancy - its in the onc deck idiot
75% - lung ca

Venous return from head, thorax and upper extremities is obstructed leading to an increased venous pressure

28
Q

Name 3 sx/signs of SVC obstruction

A

FIXED (non-pulsatile) + RAISED JVP

Oedema of face and upper extremities (80%)
Dyspnoea (60%) - worse leaning forward
Facial plethora (venous engorgement)
Cough
Distended neck veins + chest veins - worse leaning forward
Hoarse voice

29
Q

Ix in SVCO

A

Chest x-ray (widened mediastinum or mass in lung)

CT thorax with contrast (collat vess, loc, sev, path),

USS upper extremities (dilated SVC, thrombu

30
Q

2 Options Mx of acute airway obstruction (comp of SVCO)

A

Secure airway (intubate/surgical) + local radiotherapy + corticosteroids (dexamethasone)

OR

Secure airway + percutaneous endovascular stent (bleeding risk, patency)

31
Q

What is tumour lysis syndrome? most common Ca to get it with?

A

Combination of metabolic and electrolyte abnormalities occurring spontaneously following initiation of cytotoxic treatment in patients with cancer.

Characterised by excessive cell lysis.

Lymphoma

32
Q

Lab findings in tumour lysis

A

hyperuricaemia, hyperphosphataemia, hyperkalaemia,
->Arrhythmia

hypocalcaemia
-> muscle cramps / tetany

33
Q

Why do you get AKI in TLS

A

uric acid nephropathy
(+ calcium phosphate deposition)

[will also cause K to go up higher]

34
Q

What is lambert-eaton myasthemic syndrome ? which Ca common?

A

AI disorder of NM junction

SCLC

35
Q

How does lambert-eaton present?

A

Limb weakness (proximal legs + arms)

Dry mouth ( + metallic taste)

Weakness

Dysarthria, ptosis, diplopia, impotence

36
Q

Name 3 Ix in lambert eaton

A

Nerve conduction studies - doubling of compound muscle action potential post exercise

Anti VGCaC - positive

Anti AChR - negative

Chest CT - ? malignancy

Serial LuFT - low FVC - ? resp crisis

37
Q

Mx of lambert eaton if no resp weakness?

resp weakness

A

-> treat cause + amifampridine ± pred

intubation and ventilation + plasma exchange/IVIG

38
Q

How does carcinoid syndrome present

A

flushing/diarrhoea (± wheeze, palpitations, telangiectasia, abdo pain)

39
Q

What causes sx in carcionoid

A

serotonin

(+ kinins)

from neuroendocrine tumours

40
Q

Dx of carcinoid

A

elevated urinary-5-hydroxyindoleacetic acid (24 hr)

41
Q

Mx of carcinoid

A

octreotide - somatostatin analogue) + surgical resection

42
Q

Name 3 Ca that met to bone

A 
Breast - C
Prostate - P
Bronchus - M
Myeloma - 
Thyroid
43
Q

What is a sanctuary site?

A

an area that chemotherapy does not reach well e.g. brain and scrotum in ALL

44
Q

period between chemo and becoming neutropenic

A

1-2 weeks

45
Q

When would tazosin not be good for neutropenic sepsis? What could you give

A

if on high dose methotrexate - both act on folic acid

give meropenem

46
Q

What increases risk of becoming neutropenic on chemo

A

age
more cytotoxic chemos
multiple courses
Hx of becoming neutropenic

47
Q

What might you give with pts high risk becoming neutropenic

A

GCSF - boosts bone marrow to produce more

[granulocyte stimulating factor]

48
Q

moans bones stones and groans is?

A

Bone pain, vomiting diarrhoea, abdo pain, seizures, arrhythmias, Kidney stones

49
Q

5 ca mets to bone

A

breast lung kidney prostate thyroid

50
Q

Mx of TLS

A

allopurinol
rasburicase
Mx of HyperK
Fluids

[Consider dialysis]

Phase 4 - GR (22 decks)

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