Oncology Flashcards
(51 cards)
what is performance status
describes a patients fitness in relation to how well they will cope with treatment
0-5
0 fully active
5 deceased
Pancreatic cancer tumour marker
CA 19-9
Ovarian cancer tumour marker
Ca125
Breast cancer tumour marker
Ca15-3
Note tumour markers have low specificity
Features of bony metastases
Bone pain
Raised ALP
Hypercalcaemia
Pathological fractures
Management and of chemotherapy nausea and vomiting
Low risk; metaclopramide first line
High risk; 5-HT3 antagonists such as ondansetron
Higher risk, opioids, anxiety, over 50, type of chemotherapy
Signs of spinal cord compression
- back pain
- lower limb weakness
- sensory changes
- neurological signs; depending where compression occurs. If below L1 LMN signs (cauda equina) if above UMN signs
Investigation and management of spinal cord compression
Full spine MRI urgently
High dose oral dexamethasone
Urgent oncological review for radiotherapy or surgery
flat bed rest + analgesia
Spinal metastases presentation
Can precede spinal cord compression so important to detect
Unrelenting lumbar back pain
Any thoracic or cervical back pain
Nocturnal pain
Worse with sneezing/coughing
Associated tenderness
Needs MRI within a week if no neurological features
What is superior vena cava obstruction?
What cancer most associated with?
Other causes?
Oncological emergency caused by compression of the superior vena cava
Most commonly caused by lung cancer
Other causes;
- lymphoma, breast Ca and other malignancies
- aortic aneurysm
- mediastinal fibrosis
- goitre
- SVC thrombosis
Features of superior vena cava obstruction
Dyspnoea - most common symptom
Swelling of face, neck and arms
Headache
Visual disturbance
Pulseless jugular venous distention
Management superior vena cava obstruction
A-E approach
- endovascular stent for symptom relief
- certain malignancies may benefit from chemo or chemo-radiotherapy
- glucocorticoids are often given (dex)
ask oncology team; depends on individual patient and malignancy
lung cancer presentation at GP pathway
urgent CXR if 2 of following age40+ or one + a smoker
- cough
- fatigue
- SoB
- chest pain
- weight loss
- appetite loss
if CXR suggests malignancy or is unclear then 2ww to specialist
what information do radiology need before doing a CT
previous contrast reaction?
renal function
diabetes - if on metformin may need to be stopped for scan
important tests at any 2ww specialist appointment
PMHx - fitness for surgery/chemo/radio
FBC
renal function
liver function
bone profile
lung cancer specific investigations
pulmonary function tests
bronchoscopy and biopsy
CT staging scan (mot cancers need)
main oncological emergencies
neutropenic sepsis
SVCO
hypercalcaemia
spinal cord compression
management neutropenic sepsis
A-E
plus
sepsis six; Abx, oxygen, fluids in, blood cultures, urine output, lactate out
investigate for cause
involve seniors
when does neutropenia most occur after chemotherapy
around 5-12 days after treatment
treatment of hypercalcaemia
IV fluid rehydration - monitor balance and electrolytes
bisphosphonate after rehydration
small cell lung cancer features
typically centrally located
rapidly growing
often smoking related
chemo/radiosensitive but rarely cured
short prognosis
squamous cell lung cancer features
typically centrally located - early symptoms
smoking related
best survival rate
adenocarcinoma of lung features
typically peripherally located
slowest growing
can be non-smokers
can respond well to systemic agents
may metastasise early due to location
TNM staging lung cancer
T1 <3cm
T2 3-5cm
T3 5-7cm
T4 >7cm
N0-N3 (n2 and 3 mediastinal nodes, ipsi and contra)
M0
M1a, b and c
a extra nodule
b intra thoracic mets
c extra thoracic mets
