Oncology

Question 1

What are the cancer screening principles?

Answer 1

• must be an important health problem
• latent or early symptomatic stage
• natural history, development from latent to declared disease, adequately understood
• test must be suitable with a high level of accuracy
• test acceptable to the population
• accepted treatment
• facilities for the diagnosis and treatment
• agreed policy who to treat
• cost should be economically balanced in relation to possible expenditure on medical care
• continuing process, not a once and for all

Question 2

What is the immediate management of SVC obstruction?

Answer 2

• Dexamethasone 8mg BD
• PPI cover
• oxygen
• LMWH

Question 3

What is the definitive management of SVC obstruction?

Answer 3

• stent
• radiotherapy
• chemotherapy

Question 4

What is the mangement of VTE in cancer?

Answer 4

• D dimer is not useful as raised anyway
• DOAC (apixaban)
• LMWH

Question 5

What are the issues with a doac in cancer?

Answer 5

• can interact with chemo
• higher risk of GI bleed

Question 6

When should you think of neutropenic sepsis?

Answer 6

• Recent chemo with any of: Fever >38, hypothermia<36, chills, shivers, sweats, any indication of infection
• SIRS/sepsis with neutropenia <1/0.5

Question 7

What is the management of neutropenic sepsis?

Answer 7

• sepsis 6
• broad spectrum antibiotics within 1 hour of presentation
• screen for source
• monitor FBC daily
• IV piperacillin/tazobactam 4.5g 6 hourly
• • van IV if MRSA suspected
• • IV gent if NEWS≥7 or less than 7 but currently chemo or stem cell transplant

Question 8

What is the tissue diagnosis for brain mets?

Answer 8

• Neurosurgery
• EBUS+ FNA
• CT guided biopsy

Question 9

What is the immediate management of brain mets?

Answer 9

• Dexamethasone 8mg BD
• PPI
• Advise not to drive

Question 10

What is the definitive management of brain mets?

Answer 10

• Surgery
• radiotherapy
• chemotherapy

Question 11

What cancers are the most likely cause of brain mets?

Answer 11

• lung
• renal cell
• breast
• melanoma
• GI cancer

Question 12

What are the symptoms of brain mets?

Answer 12

• ICP symptoms
• neurological deficit
• seizure

Question 13

What is the management of an obstructive hydrocephalus?

Answer 13

shunt

Question 14

Titration of steroid in the context of cancer

Answer 14

• 25% every 3 days
• maintenance dose of 2-4mg OD if required
• If seizure then add levetiracetam

Question 15

What are the most common causes of bone mets?

Answer 15

• breast cancer
• prostate
• lung
• myeloma

Question 16

Immediate management of malignant spinal cord compression

Answer 16

• MRI whole spine
• Dexamethasone 8mg BD
• PPI protection
• analgesia
• laxative
• contact oncolgy on call

Question 17

What is the definitive management of spinal cord compression

Answer 17

• surgery
• radiotherapy
• chemotherapy