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Oncology Flashcards

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1
Q

What is metoclopramide contraindicated in?

A

bowel obstruction

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2
Q

What anticipatory med should you give in partial bowel obstruction?

A

Hyoscine butylbromide (e.g. 60mg/24 hours via a subcutaneous infusion)

useful in EOL care as it can reduce colicky abdo pain and reduce excess respiratory or gastric secretions

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3
Q

What is oxygen saturation recommendation from NICE for acutely unwell patients?

A

94-98%

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4
Q

What condition can be caused by cytotoxic chemotherapy?

A

neutropenic sepsis (temp greater than 38.5 degrees or 2 consecutive readings over 38 degrees) in a patient with a neutrophil count less than 0.5x10^9 or expected to fall to this level in the next 2 days

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5
Q

How is neutropenic sepsis managed?

A

empirical IV treatment with piperacillin and tazobactam (tazocin)

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6
Q

Where does lung cancer tend to spread?

A

bone, brain, liver and adrenals

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7
Q

What are areas of decreased radiolucent lesions on imaging a sign of?

A

osteolytic lesions (e.g. seen in thyroid, multiple myeloma, lung, renal cell cancers)
bones are broken down, become weak and easily breakable

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8
Q

What kind of bone lesions do prostate cancer metastasis cause?

A

osteoblastic metastasis (radiodense lesions)
cancer cells activate osteoblasts, increased irregular bone growth, causes dense and sclerotic hardening of bone

prostate cancer is most common cancer in males to metastasise to bones

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9
Q

Where does colorectal cancer tend to metastasise to?

A

liver, lungs, brain and peritoneum

bone mets are not common

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10
Q

What investigations would you do for metastasis?

A

imaging (CT, MRI, PET, bone scans)
biopsy (tissue samples to confirm diagnosis and identify the type of cancer cells)

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11
Q

What should you remember for medications with syringe drivers?

A

name, dosage per 24 hours (x/24hours) and via what route (subcutaneous infusion)

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12
Q

What are risk factors for hepatocellular carcinoma (HCC)?

A

chronic viral hepatitis (B + C), cirrhosis, non-alcoholic fatty liver disease, primary billiary cirrhosis, alcohol misuse, type 2 diabetes, obesity, inherited metabolic diseases, rare diseases (wilsons, porphyria cutanea tarda, alpha 1-antitrypsin deficiency)

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13
Q

what is HCC?

A

hepatocellular carcinoma (primary malignancy of the liver) which arises in patients with underlying chronic liver disease and cirrhosis

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14
Q

What do you offer patients at HIGH risk of HCC

A

Alpha-fetoprotein (AFP) tumour marker and an abdominal ultrasound every 6-12 months

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15
Q

What is the usual starting dose for morphine?

A

20-30mg/24 hours orally

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16
Q

What do patients with spinal cord compression present with?

A

upper motor neuron signs: hyperreflexia, spasticity, positive babinski’s sign
bladder incontinence or retention
sensory disturbance: typically below the level of the lesion
stabbing sensation at the level of the lesion
deep and localised back pain
pain is worse at night and when lying flat

can have a mix of sensory and upper motor neuron neurology in legs that indicate the cord is being compressed

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17
Q

What is the differential diagnosis for SCC?

A

multiple sclerosis: optic neuritis, limb weakness, sensory loss, ataxia and bladder dysfunction

transverse myelitis: acute development of limb weakness, sphincter dysfunction, sensory problems

peripheral neuropathy: sensory loss, pain and weakness in the limbs

musculoskeletal back pain: severe paain, spasms with no significant weakness

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18
Q

What investigation is indicated for suspected SCC or cauda equina syndrome?

A

whole spine MRI (show soft tissue changes)

give dexamethasone 16mg daily (divided doses) with PPIs for gastric protection

intention for surgical decompression within 48 hours,

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19
Q

What would brown-sequard syndrome (hemisection of the cord) present with?

A

causes ipsilateral (same side) weakness and proprioception/vibration loss

pain and temperature loss on the opposite side (contralaterla side)

commonly due to trauma

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20
Q

What does anterior cord syndrome present with?

A

ACS is damage to anterior 2/3s of spinal cord
usually caused by ischaemia of anterior spinal atery

present with bilateral loss of pain and temperature sensation
autonomic dysfunction
urinary incontinence

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21
Q

What are the causes of SCC

A

Trauma
Malignancy
Infection (e.g. Tuberculosis)
Disc prolapse (protruding intervertebral disc can compress the spinal cord)
epidural haematoma (accumulation of blood in epidural space can compress the spinal cord)

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22
Q

What are risk factors for head and neck cancers?

A

tobacco use, alcohol consumption, human papillomavirus (HPV) and Epstein-Barr virus (EBV) infection

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23
Q

What are common clinical features of head and neck cancers?

A

dysphagia
odynophagia (pain when swallowing)
dysphonia (hoarsness, abnormal voice)
ALARM symptoms (tiredness, unexplained weight loss, loss of appetite)
Lymphadenopathy
Airway compromise (stridor)
Bad breath (halitosis)
Focal neurology (VII cranial nerve palsy)

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24
Q

differential diagnoses for head and neck cancers?

A

thyroid nodules (dysphagia, dysphonia, neck swelling)
lymphadenopathy (infections, inflammatory conditions, other malignancies)
gastroesophageal reflux disease: dysphagia and odynophagia (pain when swallowing)
vocal cord polyps (dysphonia)
nasal polyps (nasal obstruction, anosmia)

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25
What does hyoscine butylbromide do?
anti-muscarinic drug that drys out secretions and reduces noise given subcutaneously in doses of up to 20mg every 6-8 hours
26
What are two functions of morphine in EOL care?
pain or breathlessness
27
What is Haloperidol used for?
DRUG INDUCED NAUSEA and vomiting, agitation, delirium
28
What is levomepromazine used for
anti-emetic to relieve nausea and vomiting at the end of life
29
what is prochlorperazine used for?
nausea and vomiting
30
What medications might you stop in EOL care?
medications that modify long term risk like atorvastatin, aspirin, bisoprolol, metformin (not eating), blood pressure reduced anyway
31
What marker is rasied in colorectal carcinoma?
CEA (carcinoembryonic antigen) BUT is not used for screening
32
What marker is raised in ovarian cancer?
CA 125 (cancer antigen 125) BUT not used in screening
33
What marker is raised in medullary thyroid carcinoma?
calcitonin and can be used in detecting RECURRENCE of malignant disease following treatment. NOT PART OF SCREENING
34
What signs can you get in hepatocellular carcinoma vs gastrointestinal cancers vs metastatic lung cancer vs germ cell tumours?
hepatocellular: abdo pain, weight loss, jaundice Gastro: persistent abdo pain, unexplained weight loss, changes in bowel habit metastatic lung cancer: persistent cough, breathlessness, unexplained weight loss, fatigue germ cell: palpable mass, testicular pain or discomfort, gynecomastia in men, irregular menstruation or vaginal bleeding in women
35
What are other causes of increased AFP levels besides hepatocellular carcinoma?
gastro-intestinal cancers metastatic lung cancer pregnancy (fetal neural tube defects) germ cell tumours
36
What is cyclizine used for?
nausea and vomiting associated with intracranial disease (first line anti-emetic)
37
What is first line for CHEMO INDUCED NAUSEA AND VOMITING?
Ondansetron
38
What first line is used for NAUSEA associated with delayed gastric emptying where there is NO BOWEL OBSTRUCTION?
Metoclopramide
39
How do you treat a patient with moderate hypercalcaemia?
IV fluids and IV bisphosphonates (alendronate, risedronate, zoledronic acid) bisphosphonates inhibit bone resorption; risk of nausea and vomiting, difficulty swallowing, irritation of oesophagus, osteonecrosis of the jaw)
40
How do you treat acute hypocalcaemia?
IV calcium gluconate (can also stablise myocardium of heart in severe hyperkalaemia)
41
What are the differentials of confusion in oncology?
metabolic causes like hypoglycaemia or hypercalcaemia infection (pneumonia, UTI) metastatic spread to the brain anaemia intense pain side effects of pain medication (haloperidol causes increased drowsiness, morphine, opiates)
42
What is tumour lysis syndrome?
serious metabolic disorder caused by rapid death of tumour cells in response to chemotherapy, causes a massive release of intracellular contents into the bloodstream causing electrolyte imbalances hyperkalaemia hypocalcaemia hyperphosphatemia hyperuricaemia
43
What tumours are associated with tumour lysis syndrome?
acute leukaemias and high grade lymphomas
44
What investigations would you do in tumour lysis syndrome?
U+Es (potassium and phosphate raised) calcium (low) uric acid (high) ECG for Hyperkalaemia changes that can cause arrythmias
45
What signs and symptoms associated with tumour lysis syndrome?
dysuria or oliguria abdominal pain weakness nausea or vomiting diarrhoea muscle cramps pruritus seizures cardiac arrythmias
46
What are differentials of tumour lysis syndrome?
AKI: oliguria, fatigue, fluid retention Hyperkalaemia: muscle weakness, fatigue, palpitations, hyperphosphatemia: muscle cramps, itching, perioral tingling or numbness hypocalcaemia: numbing/tingling in the hands, feet and around mouth, muscle cramps and seizures
47
What is management for tumour lysis syndrome?
IV fluids dialysis in severe cases Allopurinol or rasburicase adminstered to prevent/treat hyperuricaemia
48
What is the most common cause for SVCO?
Pulmonary tumour compressing on superior vena cava worsening upper limb and facial swelling distended neck veins plethoric facies (facial redness and swelling) positive pemberton's test (raise arms over head for over a minute, will cause facial plethora and cyanosis)
49
how is SVCO diagnosed and managed?
CT scan of thorax dexamethasone 8mg BD IVC stenting
50
What are differentials for N + V
chemo or radiotherapy blockage/progression of disease (e.g. bowel obstruction) metabolic (uraemia, hypercalcaemia, hyperuricaemia) infection anxiety anticipatory vomiting
51
What is another name for hereditary non-polyposis colorectal cancer (HNPCC)?
Lynch syndrome (strong familial link to colorectal cancer, endometrial cancer and ovarian cancer) caused by mutations in MSH1/MSH2 DNA mismatch repair genes autosomal dominant inheritance increases risk by 60% for colorectal cancer and 40% for endometrial cancer
52
What genetic syndrome can lead to colon carcinoma and polyps in the colon
familial adenomatosis polyposis coli mutations in APC gene autosomal dominant
53
What gene is affected in retinoblastoma that happens in children?
retinoblastoma gene (Rb)
54
What germline mutation of what tumour supressor gene leads to Li Fraumeni syndrome that increases the risk of sarcoma and cancer of breast, brain and adrenal glands?
p53 tumour supressor gene autosomal dominant disorder
55
What syndrome causes mutation of pituitary, parathyroid and pancreas?
MEN 1 syndrome
56
What syndrome causes mutations in the RET oncogene that leads to medullary thyroid cancer, phaeochromocytoma and parathyroid adenoma?
MEN 2A syndrome
57
What syndrome causes mutations in the RET incogene that leads to gastro-intestinal complaints, mucosal neuroma, medullary thyroid cancer and phaeochromocytoma, craniosynostosis (birth defect in which the bones in a baby's skull join together too early. This happens before the baby's brain is fully formed.)
MEN 2B rhymes with baby which causes craniosynostosis
58
What are differentials for masses in the liver?
hepatocellular carcinoma (chronic liver disease like hep B and C and cirrhosis) lymphoma (primary liver lymphoma or secondary mets) cholangiocarcinoma (comes from bile ducts in liver) haemangioma (benign blood vessel tumours) hydatid cyst (infection with echinococccus granulosus tapeworm) hepatic abscess metastatic lesions
59
common signs and symptoms of liver lesions
abdominal pain jaundice weight loss fatigue loss of appetite nausea and vomiting
60
What is haemochromatosis?
most common inherited liver disease that leads to iron overload. causes cirhossis and diabetes as excess iron deposits in the liver and the pancreas does not present with jaundice, weight loss or changes to stool/urine
61
What is Gilbert syndrome?
inherited metabolic disorder that causes excess unconjugated bilirubin because the conjugating enzymes in the liver cells (hepatocytes) dont work. presents as painless jaundice during times of stress
62
What is the triad for acute cholangitis?
fever jaundice right upper quadrant pain
63
What are signs and symptoms for cholangiocarcinoma
painless jaundice weight loss itching (excoriations) PMH of ulcerative colitis and primary sclerosising cholangitis
64
What are the 3 steps to the WHO analgesic ladder?
Step 1: non-opoid: paracetamol, NSAIDs step 2: weak opoid: codeine and tramadol step 2: strong opoid: morphine, oxycodone, fentanyl, buprenorphine can have adjuvants for neuropathic pain amitryptyline: TCA duloxetine: SNRI antidepressant gabapentin: CCB for epilepsy and neuropathic pregabalin: CCB for epilepsy and neuropathic pain capsaicin cream (topical)
65
What are common subtypes of lung cancer?
small cell and non-small cell tumours non small cell lung cancer is most common most common type is squamous cell, then adenocarcinoma
66
What are key signs and symptoms of thyroid cancer?
mass in neck, dysophonia (hoarseness), difficulty swallowing, breathing problems, persistent cough, pain in neck of throat
67
What is the most common neoplasm in the thyroid gland?
papillary thyroid cancer (80% of thyroid cancer) show orphan-annie cells (optically clear nuclei) 'cold' nodule: does not take up iodine which is suggestive of papillary or follicular carcinoma other types: follicular adenoma (15%) medullary thyroid (3%) anaplastic thyroid (2%)
68
What are differentials for thyroid cancer?
benign thyroid nodules: non cancerous growths in thyroid thyroiditis: inflammed thyroid causing pain/swelling hyperthyroidism or hypothyroidism goitre: non cancerous enlargement of thyroid gland
69
What do iodine uptake tests in radionuclide scan help distinguish between in thyroid disease?
functioning toxic nodules and thyroid mets from follicular and papillary carcinomas cold nodules: do not uptake iodine in follicular/papillary carcinoma of thyroid thyroid mets/toxic nodules would take up iodine
70
Why is tazocin given in neutropenic sepsis?
broad spect; covers staphs, streps, anaerobes, problem gram positives (coagulase negative staph) and problem gram negatives (pseudomonas)
71
What is G-CSF? (granulocyte colony stimulating factor)
given in some chemo regimes to reduce risk of neutropenic sepsis
72
What are side effects of morphine
hallucination, confusion, drowiness opiates can also cause respiratory depression in patients with lung disease and hypoxia is another cause of delirium
73
What are side effects of haloperidol?
dry mouth, urinary retention, restlessness, drowsiness
74
What are side effects of metoclopramide?
drowsiness, headache, nausea and diarrhoea
75
What can levomepromazine cause?
drowsiness, dry mouth, postural hypotension, constipation
76
What drugs can accumulate in renal failure with patients that need pain medications
tramadol codeine
77
Which pain medication is less likely to accumulate in renal impairment?
oxycodone (twice as potent as oral morphine so half the dose of oral morphine is needed)
78
What are side effects of dexamethasone
poor healing, skin thinning, hypertension, poor glycaemic control, increased appetite, salt and water retention, increased predisposition to infection, osteopenia and cushing's syndrome
79
What are side effects of anti-muscarinic drugs like hyoscine hydrobromide?
dry mouth, constipation and urinary retention
80
Differentials for SOB in oncology
pneumonia anxiety lung collapse due to tumour or narrowing of airway pleural effusion (malignant; cancer cells can spread into pleura, causing irritation and fluid build up) radiation pneumonitis anaemia oncological emergency (superior vena cava obstruction)

Things I am likely to forget (7 decks)

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