Cancer care Flashcards
(79 cards)
1
Q
S&S of small cell lung
A
S&S:
• Central
• ADH secretion –> Hyponatremia
• ACTH secretion –> Cushings syndrome:
○ bilateral adrenal hyperplasia
○ Leading to high levels of cortisol and hypokalaemic alkalosis
• Lambert-Eaton syndrome - Abs to Na VGCs –> myasthenic like syndrome
2
Q
Tx of small cell
A
Tx:
• Usually metastatic by diagnosis
• If no mets consider surgery
• If mets, radio + chemo
3
Q
S&S of spinal cord compression
A
S&S: • Back pain - RED FLAGS: ○ New onset >55yrs ○ PMH of tumour ○ Thoracic pain ○ Systemically unwell ○ Etc • Lower limb weakness • Sensory changes Autonomic dysfunction
Earliest and most common is back pain worse when coughing or strainining
4
Q
Tx and ix of spinal cord compression
A
Tx:
• High dose dexamethasone
• Urgent assessment for radiotherapy or surgery
ix - MRI spine
5
Q
RFs of oesophageal cancer
A
RFs: • Smoking • Alcohol • GORD • Barretts
6
Q
ix of oesophageal cancer
A
Ix:
• Upper GI endoscopy
• CT staging
7
Q
S&S of oesophageal cancer
A
S&S: • Dermatological - acanthosis nigricans • Dysphagia progressive weight loss chest pain hoarseness
8
Q
Tx of oesophageal cancer
A
Tx: • Surgical resection • Ivor-Lewis oeseophagectomy • Adjuvant chemo palliative stenting
9
Q
What is neoadjuvant and adjuvant chemo
A
neoadj - before tx
adj - post tx
10
Q
How describe skin lesions?
A
ABCDE Symptoms A - Asymmetry B - Border irregular C - Colour D - Diameter E - Evolution Symptoms - bleeding, oozing, itching, altered sensation
11
Q
S&S of colorectal cancer
A
S&S: • Rectal bleeding • Change in bowel habit • Weight loss • Anaemia • Palpable mass
Right vs left sided:
• Right presents later as blood is not as fresh, and there are less symptoms
12
Q
Staging of colorectal ca
A
Staging - Dukes:
1. A - Within bowel wall 2. B - Through bowel wall 3. C - Lymph nodes involved 4. D - Distant mets
13
Q
ix and tx of colorectal ca
A
Ix:
• Colonoscopy
• Staging CAP CT
Tx:
• Surgery +/- adjuvant chemo
○ Low rectal cancer - AP excision of rectum
14
Q
S&S of stomach ca
A
S&S: • Dyspepsia - >1 mth and >50 • Weight loss • Vomiting • Dysphagia • Anaemia • Enlarged vircows node.
15
Q
Ix and tx of stomach ca
A
Ix:
• Gastroscopy
• Staging CT
Tx:
• Gastrectomy
16
Q
Define neutropenic sepsis
A
Neutrophil count <0.5*10^9 + :
• Temp >38C
• OR Sx consistent with sepsis
in pts taking anticancer tx
17
Q
S&S of neutropenic sepsis
A
S&S: • Can be perfectly well • Sx related to source of infection • Tx history of cancer (often 5-10 days post chemo) • Fever • Drowsy • Confused • Hypotension - V urgent referral needed
18
Q
SVCO causes
A
Causes: • Extrinsic compression: ○ Right sided tumours ○ Superior mediastinal lymphadenopathy • Intrinsic compression: ○ Thrombosis ○ Foreign body Tumour
19
Q
S&S of SVCO
A
S&S: • Swelling of face, neck, arms • Distended neck and chest wall veins • SOB • Headache • Lethargy
20
Q
Tx of SVCO and IX
A
Ix:
• CXR
• CT chest with contrast
Tx: • Chemotherapy • Radiotherapy • Stent - palliative • Consider anticoag
21
Q
Patho of malignancy induced hypercalcemia. S&S
A
Occurs in 5-30% of cancers
Caused by tumour secretion of PTHrP
S&S: • Dehydration • Psychiatric manifestations + confusion • Anorexia • Constipation
22
Q
Ix and tx of malig induced hypercal
A
Ix:
• Calcium
• U&E - dehydration
• PTH/PTHrP
Tx:
• IV access and bloods to check other electrolytes
• CXR and ECG
• IV fluids then IV bisphosphonates
23
Q
S&S of tumour lysis and commonly caused by
A
Presentation:
• 3-7 days post chemo
• Cardiac arrhythmia
• Oligouria
Common cancers causing:
• Small cell lung
• Germ cell tumours
• Myeloma
24
Q
Tx of tumour lysis and prevention
A
Tx:
• Prevention:
○ Prehydration
○ Monitoring of electrolytes and fluid balance
○ Allopurinol
• Tx:
○ Hydration throughout
○ Correct electrolytes and fluid balance
§ Hyperkalaemia - K+ lowering regimens
§ Hyperphosphatemia - phosphate binders (Ca carbonate)
25
ovarian tumour marker
ca 125
26
pancreatic tumour marker
ca19-9
27
breast tumour marker
ca15-3
28
prostate tumour marker
psa
29
hepatic tumour marker
alpha feto protein
30
colorectal tumour marker
CEA
31
test cancer tumour marker
beta HCG and alpha feto protein
32
Drugs for neuropathic pain
Drugs for neuropathic pain:
• Gabapentin/pregabalin (never at same time)
• TCA - amitryptiline
• Capsaicin
33
give who step ladder. define adjuvant
Step 1 - non opioid +/- adjuvant
Step 2 - mild opioid + step 1
step 3 - strong opioid + step 1
adjuvant - non opioid analgesic
34
give examples of mild opioid
```
Mild Opioid:
• Codeine
• Dihydrocodeine
• Tramadol
• Oxycodone
```
35
examples of strong opioids
Strong Opioid:
• Morphine
• Alfentanyl
• Methadone
36
how do you reverse morphine od
naloxone
37
how do you calculate how much morphine to give a pt
1. Zomorph is given BD, once in day, once at night
2. Give pt PRN 5-10mg dose of morphine until pain is controlled
3. Calculate total dose of morphine taken
a. Divide by 2 to get BD dose of Zomorph
Divide by 6 to get PRN dose of oramorph
38
When is SC morphien used
SC used if pt vomiting or cant take drugs orally
39
When is transdermal morphine used
Transdermal - Used if pt refuses SC route or is demented and keeps pulling line out etc
40
How to calculte SC dosage of morphine
To get SC dosage:
• For Daily dose - Divide by daily dose by 2 and put over 24 hrs
• For PRN dose - Divide PRN by 2
Morphine is metabolised 50% by first pass effect
41
ADRs of opioids
```
ADRs of opioids:
• Constipation
• Nausea
• Drowsiness
• Pruritis
• Resp depression
• Dry mouth
```
42
what co-prescribe with morphine?
Co-prescriptions:
• Constipation - Always co prescribe Osmotic laxative (laxido)
• Nausea - haloperidol
43
antiemetic for dizziness and head movement nausea
Cyclizine, dexamethasone
44
What antiemetic for slow gastric emptying
Metoclopromide or Demperidone
45
What antiemetic for BO
Cyclizine, dexamethasone
46
What antiemetic for fear/anxiety
haloperidol, BZD
47
what antiemetic for drug induced
haloperidol
48
what antiemetic for metabolic nausea
haloperidol
49
What prescribe for excess resp secretions
hyoscine butylbromide
50
Antidepressant for depression and anxiety in cancer?
1st choice - Citalopram
| 2nd choice - Sertraline
51
S&S of non hodgkins lymphoma
S&S:
• Enlarged painless lymph nodes (75%) - cervical, axillary, inguinal
• Systemic (25%) - Weight loss, Night sweats, Fever, Lethargy
52
Ix of non hodgkins and staging system
Ix:
• Bloods - FBC, U&E, LDH, LFT
• Marrow and node biopsy
Ann arbor staging
53
Tx of non hodgkins
Tx:
• Localised - radiotherapy
• Diffuse - chemo
• R-CHOP if high grade
54
Explain ann arbor staging
Ann arbor staging:
• Stage 1 - single lymph node region
• Stage 2 - 2+ lymph node regions on 1 side of diaphragm
• Stage 3 - Both sides of diaphragm
• Stage 4 - Spread to liver or bone marrow or spleen
At each stage can have 'A' symptoms (no systemic sx other than pruritis) or 'B' symptoms (weight loss, fever, night sweats). B indicates worse disease
55
S&S of hodgkins lymphoma
S&S:
• Enlarged painless lymph nodes (75%) - cervical, axillary, inguinal
• Systemic (25%) - Weight loss, Night sweats, Fever, Lethargy
56
Pathology of leukaemia
1) stem cell can divide into myeloids (RBCs) or lymphoids (B and T cell)
2) leukaemia is these blasts unable to differentiate and so build up in bone marrow and cause loss of other differentiated cells (pancytopenia)
3) if this occurs quickly - acute.
4) blasts spill out into blood and appear as larger than differntiated and low amounts of cytoplasm
57
S&S of AML. ix
S&S:
• Pancytopenia - fatigue, infection, bleeding, DIC
• Hepatosplenomegaly
```
Ix:
• WCC raised, normal or low depending on if blast cells are in blood
• Red cells and platelets lowered.
• Blood film
• Bone marrow biopsy is definitive
```
58
Tx of AML and cx of tx
Tx:
• Chemotherapy - cytarabine, daunorubicin
• Supportive care - walking exercises
• Bone marrow transplant - Destroy leukaemic cells with chemo and then repopulate marrow by transplant:
○ Complication of graft vs host disease, relapse, infertility
59
ALL S&S
```
S&S:
• Cytopenia - fatigue, infection, bleeding
• Hepatosplenomegaly
• Lymphadenopathy
• Pneumocystitis pneumonia common
```
same as AML but with lymphadenopathy
60
Ix of ALL
```
Ix:
• Blood film
• Bone marrow
• WCC high
• CXR and CT to look for lymph involvement
```
Lymph involved in ALL
61
Tx of ALL
Tx:
• Supportive - blood/platelet transfusions, IV fluids
• Infections - prophylactic abx and antivirals and antifungals
• Chemo
• Bone marrow transplants
62
What is myelodysplastic syndrome?
Build up of blasts but <20% blasts so not quite AML
63
Patho of chronic leukaemia
* Cells mature only partially (acute leukaemia cells don’t mature)
* Results in premature cells that don’t work effectively
* They take up space in bone marrow and result in cytopenias.
64
CML S&S
```
CML S&S:
• Hepatosplenomegaly - abdo fullness
• Fatigue
• Bleeding
• Immunosuppresion
• Weight loss
• Fever
• Night sweats
```
65
CML Ix
```
CML Ix:
• WBC up (>100)
• Urate Up
• B12 up
• Bone marrow
```
66
CLL S&S
```
CLL S&S:
• Lymphadenopathy - pain in lymph nodes
• Autoimmune hemolytic anaemia
• Fatigue
• Bleeding
• Immunosuppresion
• Weight loss
• Sweats
```
67
CLL ix and Tx
CLL Ix:
• Raised lymphocytes
• Decrease Hb, neutrophils, platelets
CLL tx:
• Chemo
• Steroids if autoimmune hemolysis
68
What is multiple myeloma
Bone marrow cancer - Expansion of a single clone of IG secreting terminally differentiated B cells
69
S&S of multiple myeloma
S&S:
• Osteolytic bone lesions - backache, path frac, hypercalcemia
○ Lesions due to increased osteoclast activation from myeloma cell signalling
• Anaemia, neutropenia, thrombocytopenia due to infiltration
• Recurrent bacterial infections - immunoparesis
• Renal failure
• Hyperviscosity - clotting
70
Tx of multiple myeloma
Tx:
• Supportive - bone pain analgesia, bisphosphonate, erythropoeitin and blood transfusion anaemia, IV fluids for renal failure, abx prophylaxis
• Chemo
71
Ix of multiple myeloma
```
Ix:
• FBC - normocytic normochromic anaemia
• Blood film - roleaux formation
• Increase calcium
• Increase urea and creatinine
• Bence Jones protein in urine
```
72
Patho of polycythemia rubra vera
Patho:
| • Myeloproliferation resulting in increase RBC, and platelets and neutrophils.
73
S&S of polycyth rubra vera
S&S:
• Hyperviscosity - strokes
• Pruritis post hot bath
• Splenomegaly
74
Ix and tx of polycyth rubra vera. Epi
Epidemiology:
• 60 age peak
Ix:
• JAK2 mutation - Diagnostic
• FBC and blood film
Tx:
• Phlebotomy
75
S&S of prostate carcinoma
```
S&S:
• Hesitancy during micturition
• Nocturia
• Poor stream
• Post void dribble
• Bone pain if mets
```
76
Ix of prostate carcinoma
```
Ix:
• DRE
• Serum PSA:
○ Different ages have differing levels of acceptable PSA
• Trans rectal USS biopsy
• CT and bone scan for staging
```
77
Tx of prostate carcinoma
```
Tx:
• Watch and wait - elderly with multiple comorbs and low gleason score
• Radiotherapy
• Bracytherapy
• Radical prostatectomy - ED and urine incontinence is common ADR
• Hormonal therapy:
○ LHRH analogues eg Goserelin
○ Anti-androgen
• Orchidectomy
```
78
S&S of BPH
S&S:
• Voiding sx - weak flow, hesitancy, straining, incomplete emptying
• Storage sx - urgency, frequency, incontinence, nocturia
• Complications - UTI, retention, obstruction uropathy
79
Tx of BPH
Tx:
• Watchful waiting
• Medical - alpha 1 antagonist (tamsulosin), 5 alpha-reductase inhibitors (finasteride - blocks conversion of test to DHT, therefore decreasing prostate size)
• Surgery - transurethral resection of prostate
