Cancer Flashcards
(34 cards)
How do you calculate the breakthrough dose for a pt on regular daily morphine?
Breakthrough dose = 1/6th of daily morphine dose
Identify appropriate investigations for testicular cancer
- Bloods: serum beta-hCG (raised, esp in choriocarcinoma), serum AFP (raised in non-seminomas)
- Imaging :
- First line: USS testicle
- CT abdo/pelvis (for staging)
(passmedicine, BMJ)
Generate a management plan for testicular cancer
- Surgical
- 1st line: inguinal (radical) orchidectomy
- retroperitoneal LN dissection (1w later, after tumour markers back) if non-seminoma
- Medical (post-orchidectomy)
- If seminoma: external beam radiation OR carboplatin chemotherapy
- If non-seminoma: chemotherapy (eg bleomycin + etoposide + cisplatin)
(BMJ)
Identify the possible complications of testicular cancer
Short: surgery-related infertility, chemo-related AKI, chemo-related neutropenia
Long: radio/chem-related secondary malignancy
(BMJ)
Summarise the prognosis for patients with testicular cancer
Highly curable when diagnosed early
Excellent 5y prognosis if Stage 1: teratoma = 85%, seminoma = 95%
(passmedicine)
GP: indications for 2-week wait referral to ENT for ?laryngeal carcinoma
Pt >45 with either
- persitent unexplained hoarseness, or
- unexplained neck lump
(Passmedicine)
GP: indications for 2-week wait referral for CXR in ?lung Ca?
Pt >40 with 2+ of the following unexplained, or 1+ if previous smoker:
- cough
- fatigue
- SOB
- wt loss
- appettite loss
- chest pain
Also consider if:
- persistent/recurrent chest infections
- finger clubbing
- signs of lung ca O/E
- thrombocytosis
- supraclavicular lymphadenopathy
(ALL pts >40 with unexplained haemoptysis should be reffered straight onto 2w cancer pathway)
(Passmedicine, NICE)
GP: indications for referral directly onto 2-week wait cancer pathway for ?lung cancer
1) CXR suggestive of Lung Ca
2) Pt >40 with unexplained haemoptysis
Explain the risk factors of gastric cancer
RFs:
H pylori infection
Pernicious anaemia
Gastric adenomatous polyps
Blood type A (gAstric cAncer)
Smoking
Diet: nitrates, salty, spicy
(Passmedicine)
What are the red flags for gastric cancer?
Red Flags for gastric cancer:
- new onset dyspepsia in pt>55
- progressive worsening dysphagia
- odynophagia
- unexplained wt loss
- unexplained persistent vomiting
- epigastric pain
(Passmedicine)
Summarise the prognosis for patients with gastric cancer
Mortality: varies according to Stage. 5 year - Stage 1A (70%), Stage 1B (50%), Stage II (40%), Stage IIIA (20%), Stage IIIB (10%), Stage IV (5%)
(BMJ)
Generate a management plan for gastric cancer
UGI MDT (consider staging, comorbidities, nutrional status, preference)
- Surgery
- Endoscopic mucosal/submucosal resection (if mucosal cancer)
- Oesophageal/gastric resection with regional lymphadenectomy
- antibiotics + antithrombotics
- Medicine
- Chemotherapy: 1st line in oesophageal SCC
- Adjuvant chemo post-op may be indicated in some ca subtypes
(British Society Gastroenterologists)
Identify appropriate investigations for gastric cancer
Imaging
Diagnosis: endoscopy with biopsy
Staging: CT chest abdo pelvis
(Passmedicine)
Identify the possible complications of gastric cancer
Short: Bleeding, perforation, obstruction, malnutrition, surgical complications
Long: Chemoradiotherap-associated neutropenia / thrombocytopenia
(BMJ)
Identify the possible complications of tumour lysis syndrome
Complications of tumour lysis syndrome include:
- hyperkalaemia (–> arrythmias, seizures, lactic acidosis)
- hyperphosphataemia
- hypocalcaemia
- hyperuricaemia
- acute renal failure
(passmedicine)
Generate a management plan for tumour lysis syndrome
Medical
- Prechemotherapy protection
- IV hydration (maintain high UO)
- Allopurinol PO/IV or Rasburicase IV (recombinant version of urate oxidase, enzyme for urate metabolism)
- Phosphate binder (aluminium hydroxide)
- loop diuretic (furosemide) if high risk, to maintain GFR
- Acute
- All of the above
- correct hyperkalaemia
- sodium bicarbonate
- renal dialysis (if severe acidosis or uraemia or CNS toxicity)
(BMJ)
Identify appropriate investigations for tumour lysis syndrome
- Bloods: UEs, calcium studies (inc phosphate), FBC, lactate
- Urine: urine pH
- Imaging: ECG
(BMJ)
Explain the risk factors for pancreatic cancer
- increasing age
- smoking
- diabetes
- chronic pancreatitis (alcohol does not appear an independent risk factor though)
- hereditary non-polyposis colorectal carcinoma, Peutz-Jeghers syndrome
- multiple endocrine neoplasia
- BRCA2 gene
(passmedicine, BMJ)
Summarise the epidemiology of pancreatic cancer
UK incidence ~12 / 100 000. Increased incidence with age (peak 65-75y)
M=F
(BMJ)
Recognise the presenting symptoms of pancreatic cancer
Couvoisier’s sign: palpable gallbladder, jaundice, NO abdominal pain/tenderness
Non-specific presentation: wt loss, anorexia, epigastric pain, back pain, steatorrhoea
(BMJ)
Identify appropriate investigations for pancreatic cancer
- Confirm diagnosis:
- Bloods: Ca19-9 (sensitivity 70-90%), LFTS (obstructive picture)
- Imaging: HR CT abdo - diagnostic ix of choice, USS abdo (60-90% sensitivity), ERCP if CT is equivocal for ampullary tumours
- Assess complications:
- Bloods: clotting, FBC
(BMJ)
Generate a management plan for pancreatic cancer
- Surgical
- Stage I-II:
- Whipple procedure (pancreaticoduodenectomy + antrectomy)
- +/- pre-operative biliary stenting in pts with cholangitis or chemo/radio
- Stage III-IV: palliative endoscopic biliary stenting or palliative surgery
- Stage I-II:
- Medical
- pancreatic enzyme replacement: CREON (pancrelipase PO)
- analgesia (WHO ladder, usually opiods)
- +/- neoadjuvant chemotherapy (if ?mets or borderline performance status)
- +/- adjuvant chemoradiotherapy in incompletely resected cancer or Stage III-IV
(BMJ)
Identify the possible complications of pancreatic cancer
- Short: surgical complications (pancreatic leaks / fistula), early delayed gastric emptying, DVT/PE, bleeding, cholangitis
- Long: duodenal obstruction
(BMJ)
Summarise the prognosis for patients with pancreatic cancer
Mortality: >95% die of the disease
Stage I - II: 5y survival 20% (~10% if node +ve, about 30% if node -ve)
Stage IV - survival 3-6m
(BMJ, UpToDate)
