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Y4 Cancer > Cancer Complications And Emergencies > Flashcards

Cancer Complications And Emergencies Flashcards

(67 cards)

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1
Q

What are the most likely cancers to spread to the bones ?

A

Breast
Prostate
Lung
Kidney
Thyroid
Myeloma
Lymphoma

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2
Q

Which bones are usually effected in metastases ?

A

Spine
Pelvis
Proximal femurs

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3
Q

What are some complications of bone metastases ?

A

Bone pain
Hypercalcaemia
Pathological fractures
Spinal cord compression

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4
Q

Which cancer is most likely to cause osteoblastic bone metastases ?

A

Prostate

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5
Q

Which cancer is most likely to cause osteolytic bone metastases ?

A

Multiple myeloma

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6
Q

What is the pathophysiology of osteoblastic bone mets ?

A

Cancer cells activate osteoblasts, increasing deposition of new bone and increasing numbers of irregular bone
This results in dense, sclerotic / hardening of bones

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7
Q

What is the pathophysiology of osteosclerotic bone mets ?

A

Cancer cells cause excessive breakdown of bone. This results in weak, easily breakable bones

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8
Q

What cancer can result in mixed osteoblastic and osteosclerotic bone mets ?

A

Breast cancer

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9
Q

What is the clinical presentation of bone metastases ?

A

Bone pain - worse at night ( vary from dull and aching to sharp and intense )

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10
Q

Why do bone mets cause bone pain ?

A

Bone destruction
Bone instability
Subsequent fractures

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11
Q

What are some important tests to perform when suspecting bone mets ?

A

FBC
Serum calcium
Sreum alkaline phosphatase
Bone scan
CT
MRI
PET/ CT

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12
Q

What is the management of bone mets ?

A

Localised therapy - radiation
Systemic - bisphosphonates and systemic radiation

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13
Q

How do bisphosphonates manage bone pain from bone mets ?

A

It binds to hydroxyapatite on bone surfaces undergoing rapid resorption.
Internalisation of the bisphosphonate into osteoclasts which disrupts bone resorption.
Promotes osteoclast apoptosis

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14
Q

Which cancers are most likely to cause brain mets ?

A

Lung
Renal cell carcinoma
Melanoma
Breast
Colorectal

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15
Q

How do brain mets occur ?

A

Cancer cells must get into the circulation, survive in the circulation and arrest in a capillary bed. Once in the capillary bed of the brain they must extravasate into the brain parenchyma and grow.

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16
Q

What are symptoms from brain mets most likely due to ?

A

The tumour mass and oedema

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17
Q

What are the most common symptoms from brain mets ?

A

Headache
Focal weakness
Altered mental state
Seizures
Ataxia
Stroke
Nausea and vomiting

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18
Q

What can a frontal lobe tumour cause ?

A

Anosmia

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19
Q

What can a temporal or occipital lobe tumour cause ?

A

Visual field deficits - homonymous hemianopia

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20
Q

What can brainstem and cerebellar tumours cause ?

A

Ataxia and incoordination
Nystagmus
Upper motor neurone signs

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21
Q

What imaging is used when suspecting brain mets ?

A

Contrast enhanced MRI

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22
Q

What is the management of brain mets ?

A

Dexamethasone
VTE prophylaxis
Radiotherapy ( whole brain or focal )
Surgery

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23
Q

What are some factors that effect the management of brain mets ?

A

Prognosis and performance status
Quality of life
Patient preference
Extent of disease
Type of cancer
Symptoms associated with cancer

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24
Q

What is febrile neutropenia ?

A

A serious complication of chemotherapy characterised by a reduction of neutrophils below normal cell counts. Due to the blunted immune system there is an impaired ability to fight infections.

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25
What is the management of febrile neutropenia ?
Considered a medical emergency Empirical abx immediately- piperacillin-tazobactam
26
What happens when low levels of calcium are detected ?
Low serum calcium stimulate the parathyroid gland to release parathyroid hormone which increases calcium levels in 3 ways : renal tubular, vitamin D activation and mobilisation from bone. Vitamin D increases calcium absorption from the GI tract and decreases renal excretion.
27
How does calcitonin work ?
Calcitonin is a hormone released by parafollicular cells in the thyroid gland that is involved in decreasing serum calcium levels by preventing renal absorption and calcium mobilisation from bone.
28
What is the pathophysiology of Hypercalcaemia of malignancy ?
Humoral Hypercalcaemia mediated by increased parathyroid hormone related peptide Local osteolytic Hypercalcaemia due to breakdown of bone Excess ectopic or primary PTH secretion
29
What are some signs and symptoms of Hypercalcaemia ?
Stones - renal (AKI, nephrolithiasis ) Bones (pain and fractures ) Moans - pyschiatric ( confusion, altered mental state, mood changes ) Groans - abdo ( constipation, pain, nausea and vomiting )
30
What are some investigations when suspecting Hypercalcaemia ?
Serum calcium Serum albumin PTH PTHrP Vitamin D levels
31
What is the management of Hypercalcaemia ?
IV fluids to correct dehydration Exogenous calcitonin ( fast action ) Bisphosphonates - zolendronic acid ( longer term ) Systemic treatment of malignancy
32
What are some causes of spinal cord compression due to malignancy ?
Primary spinal tumours Any metastatic tumours
33
What are the most common signs and symptoms of spinal cord compression ?
Back pain - radiating Reduced power, difficulty walking Hyperreflexia - UMN lesion Bladder and bowel dysfunction
34
What are some differentials for back pain in cancer patients ?
MSK disease - muscle spasm, spinal stenosis Spinal epidural abscess Metastatic disease Radiation myelopathy
35
What imaging is used when back pain is present in cancer patients ?
MRI CT
36
What is the management of spinal cord compression in cancer patients ?
Dexamethasone 16mg + PPI Analgesia Surgery Radiation therapy
37
What is superior vena cava syndrome ?
The impediment of blood flow through the SVC caused by thrombosis, invasion or compression by pathology involving nearby anatomical structures. It is a medical emergency
38
Wht are the causes of impediment of blood flow in the superior vena cava ?
Thrombosis in the SVC Invasion Extrinsic pressure exerted by pathology involving nearby anatomical structures
39
When do clinical features of SVC syndrome present ?
The degree of obstruction is no longer adequately compensated for by the formation of venous collaterals
40
What are some benign causes of SVC obstruction ?
Thrombosis Aortic aneurysm Retrosternal thyroid
41
What are some malignant causes of superior vena cava obstruction ?
Non-small cell lung cancer Small cell lung cancer Non-Hodgkin’s lymphoma
42
What are the major features of SVC obstruction ?
Dyspnoea Distension ( oedema of face with erythema ) Dilated chest wall veins
43
What is the management for SVC obstruction ?
Dexamethasone 16mg + PPI Stent Radiotherapy Chemotherapy ( SCLC, lymphoma and teratoma \ Anti coagulation if thrombus
44
How does malignancy increase the risk of developing VTE ?
Venous stasis secondary to prolonged periods of immobility Tumours can compress the vasculature impairing venous return Hypercoagulability is increased by cancer cells
45
What is virchow’s triad ?
Venous stasis Endothelial dysfunction Hypercoagulable state
46
What are some patient related risk factors for a VTE ?
History of previous VTE Thrombophilia Obesity Age over 50 Comorbidity
47
What are some treatment related risk factors for a VTE ?
Surgery Having chemotherapy Having hormonal therapy EPO stimulating agents Hospitalisation
48
What investigation should be performed when you are suspecting a DVT ?
Doppler USS
49
What should be performed when suspecting a PE ?
D dimer CTPA VQ scan
50
What is the management of VTE ?
Prophylaxis - aspirin, Dalteparin Mainstay treatment - low molecular weight heparin
51
What are oncological emergencies ?
Group of conditions that occur as a direct or indirect result of cancer or its treatment that are potentially life threatening
52
What are some signs and symptoms of neutropenic sepsis ?
Fever Tachycardia HYPOTENSION Raised RR Drowsy Confusion
53
What increases the risk of infection in cancer patients ?
Prolonged neutropenia Severe neutropenia Significant co-morbidities Aggressive cancer Central lines Mucosal disruption Hospitalisation
54
If suspecting neutropenic sepsis what investigations should be performed ?
FBC U&E’s LFTs Lactate / ABG CRP Cultures / swabs - blood, urine, sputum, wound CXR
55
What is the management of neutropenic sepsis ?
Don’t wait for FBC Empirical IV broad spectrum abx within an hour Fluid resus O2 Consider catheter Consider G-CSF
56
What is the smog common site for a spinal cord compression due to mets ?
Thoracic
57
If there are signs of spinal cord compression due to malignancy what should be ordered and how quickly ?
MRI of the spine within 24 hours
58
Why is surgery used in the management of spinal cord compression due to malignancy ?
Relieves compression Removes tumour Stabilises spine Preserves greater degree of mobility
59
Why is radiotherapy given in spinal cord compression due to malignancy ?
Relieves compression of the spine and nerve roots by causing cell death in rapidly dividing tissue Relieves pain Stabilises neurological deficit
60
What is the normal range of corrected calcium ?
2.2-2.51 mmol/L
61
What cancers is Hypercalcaemia common in ?
Breast SCC Renal Myeloma Lymphoma
62
How quickly do bisphosphonates take to work ?
Up to 4 days
63
What is tumour lysis syndrome ?
A metabolism emergency that presents as severe electrolyte abnormalities. Massive tumour cell lysis —- release of large amounts of K+, phosphate and uric acid into circulation
64
What electrolyte imbalances can occur from tumour lysis syndrome ?
Hyperuricaemia Hyperkalaemia Hyperphosphataemia Hypocalcaemia
65
What is the most common cancers to cause tumour lysis syndrome ?
Haematological cancers - lymphomas and leukaemia Myeloma
66
How does tumour lysis syndrome present ?
3-7 days after chemo N + V Diarrhoea Anorexia Lethargy Haematuria Fluid overload Cardiac arrhythmias Muscle cramps, tetany and seizures
67
How can tumour lysis syndrome be prevented ?
Focus on hydration Allopurinol Rasburicase Dialysis

Y4 Cancer (12 decks)

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