cancer teaching

Question 1

Clincial vs medical oncologist

Answer 1

Clinical - also deliver chemo teaching

Question 2

Define neutropenic sepsis

Answer 2

Oral temp above 38.3
neutropenia

Have you taken paracetamol?

Cold neutropenic sepsis - hypothermic + sepsis

Answer 3

Avoid paracetamol
Buy a temp
Ensure they have capacity
Neutrophil life span = 5.4 days

IV antibiotics - door to needle time = 60 mins

Question 4

When is

Answer 4

2 weeks after

Question 5

Do they have CVADs

Answer 5

Central venous access device

Question 6

What is the key response to neutropenic sepsis?

Answer 6

Bloods - FBC, U and E, LFTs, CRp, Lactate above 4,
Check allergies
Treat in rhesus
PROMPT antibiotics

Question 7

Which

Answer 7

Double lumen pickman line - is it pussy? Angry looking? Do we need to take a swab?

Answer 8

Have you taken paracetamol?
Do you have a sore throat?

Cancer diagnosis?
When did you have chemo?
Sources of infection?

Portercath - permanent line - commonly seen in breast cancer patients
Grippers

PICC line

MASCC score on your phone - if <21, high risk of febrile neutropenia; but the answers can vary between patients

Management
GCSF treatment
Firstline ab - tax with amicacin

if penecillin allergic - meropenem

Question 9

How to avoid neutropenic sepsis

Answer 9

Height and weight - adjust chemo to surface area
BLoods before chemo as some chemo is renal and hepatotoxic

Give them a cancer treatment record
UCOMS - traffic light system of symptoms

Answer 10

Immuno patients with diarrhoea can die if you have immunotherapy related collitis

Question 11

Metastatic spinal cord compression

Answer 11

Direct tumoa
Collapse of vertebral body

Question 12

Difference between MRI

Answer 12

T1 - water is white
T2 - water is dark

Answer 13

Most commonly in thoracic spine
Breast lung and prostate cancer most common

Back pain - 95 per cent
Tingling and numbness in extremities =
Limb weakness - can be bilateral
Difficulty passing urine
Bowel disturbance

Saddle anaestheisa - PR
Full neuroexam

Question 14

When is

Answer 14

Most commonly in thoracic spine
Breast lung and prostate cancer most common

Back pain - 95 per cent
Tingling and numbness in extremities =
Limb weakness - can be bilateral
Difficulty passing urine
Bowel disturbance

Saddle anaestheisa - PR
Full neuroexam

Question 15

How do you manage metastatic cord compression?

Answer 15

Management
Bed Rest
Urgent spine MRI
Liaise with MSCC coordinator
First line = Steroids and PPI; 8mg BD; shrinks the tumour but not bone; you don’t need to wait for an MRI necessarily

Question 16

Treatment of MSCC?

Answer 16

Neurosurgery

Question 17

What can neurosurgery be used for?

Answer 17

Diagnosis
NOTE neurosurgery should not be done after radiotherapy

Question 18

How do we assess ECOG performance status?

Answer 18

ECOG performance status

Question 19

What is radiotherapy given for?

Answer 19

Mechanical pain
If unsuitable for surgery
Treatment field = one above and one below

Question 20

What is a side effect of radiation?

Answer 20

Radiation necrosis

Question 21

What do you need to prescribe with

Answer 21

REMEMBER PPI

Question 22

What common things

Answer 22

Lung cancer
Lymphoma
Metastatic disease to mediastinum

Syphillus, TB, central line thombus, congestive heart failure

Question 23

SVCO presentation

Answer 23

Dysnpoea
Facial swelling

Question 24

How do you manage SVCO?

Answer 24

Ensure airway is not compromised
Do not lie flat
Monitor vital signs and level of concsiousness

CT chest

HCG, AFP, LDH, HIV test

Answer 25

Steroids = short term relief but avoid if the diagnosis is not known or if lymphoma is suspected.
Take a biopsy, only then can you treat

Question 26

What does 30 grey in 10 fractions mean?

Question 27

When would you give a stent for SVCO?

Answer 27

If it’s palliative