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Oncology Flashcards

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0
Q

Give 3 tests you would do in a suspected neutropenic septic patient?

A

Blood culture
MSU
Swabs from exit sites or other infected foci

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1
Q

Define neutropenic sepsis?

A

Fever > 38 degrees OR > 37.5 over 1hr

Neutropenia < 0.5 OR < 1 & falling

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2
Q

Which Abx. would you administer in neutropenic sepsis?

A

IV Tazocin (IV Imipenem if penicillin allergic)

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3
Q

How can you prevent neutropenic sepsis? 3 things

A

Dose reduction of chemotherapy

Prophylactic GCSF (Granulocyte colony stimulating factor)

?Stop chemo

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4
Q

Give 5 symptoms that might be felt with a metastatic spinal chord compression?

A 
Pain
Weakness
Sensory change
Urinary retention
Constipation/Incontinence
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5
Q

What is the investigation of choice in MSCC?

A

MRI

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6
Q

Give 3 treatment options for MSCC?

A

Radiotherapy - mainstay Rx.

Steroids - high dose glucocorticoids (dexamethasone)

Surgery - with RT

Urgent chemotherapy - very sensitive tumours

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7
Q

Give 5 situations that you would consider surgery to treat MSCC?

A 
Single vertebral involvement
No evidence of widespread disease
Radio resistant tumour
To obtain diagnosis
Previous Radiotherapy to site
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8
Q

Give 5 causes of a Superior vena cava obstruction?

A

EXTRINSIC
Right sided tumours
Superior mediastinal lymphadenopathy

INTRINSIC
Thrombosis
Foreign body (catheter)
Tumour

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9
Q

Give 4 symptoms experienced with SVCC?

A 
Swelling of the face and upper body in general
Distended neck veins
SOB
Headache
Lethargy
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10
Q

Give 3 possible oncology related causes of hypercalcaemia?

A

Humoural - Tumour secretion of PTH

Osteolytic mets with local cytokine release

Tumour production of calcitrol

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11
Q

What’s the normal range of calcium?

A

2.1-2.6

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12
Q

Give 4 blood tests you would do in a suspected hypercalcaemia?

A 
Calcium
U&E - Dehydration?
PTH - Cause?
Phosphate - low in hyperparathyroidism
Myeloma screen - cause?
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13
Q

How do you manage hypercalcaemia?

A

Rehydration 1st
Bisphosphonates
Others: Calcitonin, corticosteroids
Managements of malignancy

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14
Q

What is tumour lysis syndrome?

A 
Metabolic complication of treatments of rapidly dividing cancers causing:
Hyperuricemia
Hyperkalaemia
Hyperphosphatemia
Acute renal failure
Hypocalcaemia
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15
Q

How do you manage tumour lysis syndrome prophylactically? 3 things

A

Prehydration and vigorous hydration throughout treatmenr
Monitor electrolytes and fluid balance
Allopurinol - Uric acid

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17
Q

Give 5 risk factors for developing breast cancer?

A

Age (over 50)

Early mernache and late menopause

Nulliparity and late age of 1st pregnancy

Family history - 1st degree (BRCA 1 & 2)

Exogenous oestrogens

Diet (fat, obesity, alcohol)

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17
Q

What is the triple assessment?

A 
Full clinical exam
Bilateral mammography (?with US)
FNA cytology (?with core biopsy)
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18
Q

Give 6 indications for referral to a breast clinic?

A 
Screen detected breast cancer
Breast lump
Pain
Nipple discharge 
Nipple retraction, distortion or eczema
Change in breast contour
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19
Q

Give 5 indications for a mastectomy?

A 
Patient choice
Tumour size >40mm
Multifocality of cancer
Recurrent cancer after conservative
Radiotherapy is contraindicated
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20
Q

What 2 risks are associated with aromatase inhibitor use?

Study These Flashcards
A

Osteoporosis

Endometrial carcinoma

21
Q

How can a cancer develop resistance to treatment? 5 things

Study These Flashcards
A 
Decreased drug uptake
Increased drug efflux
Increased DNA repair
Alteration of drug target
Increased catabolism
Increased drug detoxification
22
Q

Give 4 risk factors for developing prostate cancer?

Study These Flashcards
A

Increasing Age
Family history
BRCA 2 gene mutation
Ethnicity (Black)

23
Q

Give 3 possible presentations of prostate ca?

Study These Flashcards
A

Asymptommatic
Urinary symptoms
Bone pain

24
Give 3 diagnostic tests for prostate ca?
DRE PSA Biopsy (Transrectal US)
25
How can you manage metastatic prostate ca? 3 things
Hormonal - Surgical/Medical castration Radiotherapy Bisphosphanates
26
Give 3 management options for localised prostate ca?
Active monitoring/watchful waiting Radical prostatectomy Radiotherapy
27
Give 3 risk factors for developing bladder cancer?
Smoking Occupational exposure Schistosomiasis
28
How often is the bowel screening and what does it involve?
Every 2 years Ages 60-69 FOB & Colonoscopy
29
Give 4 suspicious symptoms for colorectal ca?
``` Rectal bleeding Change in bowel habit Weight loss Anaemia Palpable abdominal mass ```
30
Give 3 non metastatic manifestations of bronchial carcinoma?
Inappropriate ADH secretion - Hyponatraemia Ectopic ACTH secretion - Cushing Hypercalcaemia - PTH release
31
Give 3 common presenting symptoms in bladder ca?
Haematuria Dysuria Increased frequency of micturition
32
Give management options for superficial bladder ca?
Resection by diathermy | BCG or mytomycin C injections
33
How can you treat muscle invasive bladder cancer?
Radiotherapy | Surgery
34
What are common side effects seen in radiotherapy to the bladder? 3 things
Radiation fibrosis Cystitis Proctitis
35
State 6 possible acute side effects of chemotherapy?
Myelosupression: anaemia, infection, bleeding (thrombocytopenia). The most serious problem being Neutropenic sepsis. GI effects: nausea and vomiting, diarrhoea, constipation, fatigue, Skin damage: oral mucositis, rash, skin changes, nail changes Alopecia Organ damage: especially the kidneys, liver, lungs and heart. Gonadal failure: infertility Teratogenicity
36
Give 5 possible long term side effects of chemotherapy?
``` Lung fibrosis Cardiac dysfunction Neurological damage Renal impairment Secondary malignancy Psychological problems. ```
37
Give 5 possible acute side effects of radiotherapy?
``` General fatigue Skin changes: erythema, dry desquamation skin tanning, hair loss GI effects Myelosuppresion Pneumonitis ```
38
State 5 possible long term side effects of radiotherapy?
``` Renal impairment Neck fibrosis (woody texture) Muscles of mastication fibrosis Lymphodema Dry mouth (xerostomia) ```
39
Give 5 examples of hormonal and biological treatments?
Hormone Tamoxifen (breast cancer) - Selective oestrogen receptor modulator (SERM) which blocks oestrogen receptors GnRH agonist (prostate cancer) - excessive testerone stimulation of prostate leading to down regulating of receptors Biological Herceptin (breast) - monoclonal antibody targeting HER 2 receptors Rituximab (non-hodgkin lymphoma) - B cell lysis GCSF (granulocyte colony stimulating factor) - stimulated bone marrow to produce white cells
40
Which age group is breast cancer screening undertaken?
Women 47-73 years old
41
What factors are included in the Nottingham prognostic index for breast cancer?
Size of the lesion Number of lymph nodes involved Grade of tumour
42
Give 5 common locations for lung cancer spread?
``` Liver Brain Bone Adrenal gland Skin ```
43
State 4 poor prognostic factors in breast cancer?
``` Cancer >2cms High grade (2/3) Young patient Metastasis present Negative oestrogen/progesterone receptors ```
44
Give 4 risk factors for developing malignant melanoma?
Sun exposure FHx Fair skinned people Albinos
45
How is melanoma diagnosed?
Glasgow 7 point checklist
46
State 4 risk factors for developing colorectal carcinoma?
Environmental (high fat diet, alcohol, red meat) IBD Neoplastic polyps Low fibre diet
47
How is a malignant melanoma managed? 4 things
Use dermatoscope to analyse lesion Refer to dermatologist Excisional surgery Biopsy sentinel nodes for mets
48
When would you refer a ?Melanoma?
``` ABCDE Asymmetry Border irregular Colour irregularity Diameter > 6mm Evolving over time ``` Refer if >3
49
Give 4 types of melanoma?
Nodular melanoma Lentigo maligna melanoma Superficial spreading melanoma Acral lentiginous melanoma

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