Management + staging

Question 1

Why do you use a performance status + name 2

Answer 1

Performance of patient during treatment.

Use Eastern Cooperative Oncology Group table (0 = fully active, 5 = dead)

Karnofsky

Question 2

Grade vs stage

Answer 2

Stage = how advanced cancer is in its progress Grade = what cells look like under microscope - how similar it is compared to normal cells

Question 3

What cancers are TNM staging used for?

Answer 3

Used for solid tumour cancer (not applicable to leukaemia or CNS tumours)

Question 4

What does the T in TNM mean?

Answer 4

Size or direct extent of primary tumour Tx: tumour cannot be assessed Tis: carcinoma in situ T0: no evidence of tumour T1, T2, T3, T4: size and/or extension of the primary tumour

Question 5

What does the N in TNM mean?

Answer 5

Degree of spread to regional lymph nodes Nx: lymph nodes cannot be assessed N0: no regional lymph nodes metastasis N1: regional lymph node metastasis present; at some sites, tumour spread to closest or small number of regional lymph nodes N2: tumour spread to an extent between N1 and N3 (N2 is not used at all sites) N3: tumour spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)

Question 6

What does M mean in TNM?

Answer 6

Presence of distant metastasis M0: no distant metastasis M1: metastasis to distant organs (beyond regional lymph nodes)

Question 7

What are the grades of cancer?

Answer 7

Grade 1 = cancer looks similar to normal cells, growing slowly 2 = cells look unlike normal cells + growing more quickly than normal 3 = cancer looks very abnormal, growing quickly

Question 8

What causes paraneoplastic syndrome?

Answer 8

Caused by humoral factors (hormones + cytokines) released by tumour

Question 9

What types of paraneoplastic syndrome are there?

Answer 9

Hypercalcaemia (from excess PTH release)

Syndrome of inappropriate ADH secretion

ACTH release causing raised cortisol = Cushings

Serotonin release = peristalsis, diarrhoea, bronchoconstriction

Lambert-Eaton = autoantibodies to Ca+ channels, proximal muscle weakness

Question 10

What is SIADH + how is it managed?

Answer 10

Syndrome of inappropriate ADH secretion Causes low sodium + low osmolarity

Give saline through central line

Question 11

What causes hyponatraemia in cancer pts, and what are the S+S?

Answer 11

Caused by SIADH + medications (PPIs)

S+S: anorexia, headache, N+V, personality change, muscle cramps + weakness, confusion, ataxia, seizures, signs of hypervolaemia (pulmonary rales, S3 gallop, peripheral oedema)

Question 12

What is APTT used for?

Answer 12

Measures extrinsic + intrinsic pathways Used to monitor heparin