oncology Flashcards
(25 cards)
when would emergency radiotherapy be indicated?
-spinal cord compression caused by metastasis
what would you do if you suspect spinal cord compression
- start dexamethasone 8mg BD with PPI
- arrange an urgent MRI scan with contrast
- contact the oncology team
- contact the spinal cord compression coordinator
- refer for assessment
how would someone with spinal cord compression present?
- pain: tight and band like ! radiates from back to front
- UMN signs below the level of compression, eg weakness
- sensory level
- bladder and bowel symptoms
what are the chemotherapy emergencies?
- neutropenic sepsis
- hypersensitivity reactions
- tumour lysis syndrome
what do you do if you suspect neutropenic sepsis!
- urgent FBC,blood cultures etc
get IV access start Antibiotics, start resuscitation
how would you diagnose neutropenic sepsis?
WCC <1.0 and pyrexial
how would you recognise a hypersensitivity reaction?
- hypotension
- fever
- dyspnoea
- oedema of the oropharyync
- tachycardia
- wheeze
- low O2 sats
how would you manage a hypersensitivity reaction?
- Stop the causative agent!
- administer O2 sats
- give IV fluid challenge
- give antihistamine : stat dose 10mg chlorpheniramine STAT
- give IV steroids hydrocortisone 200mg
- give adrenaline IM 0.5ml 1:1000
- consider salbutamol/adrenaline nebuliser
how would you treat tumour lysis syndrome
lots of IV fluids
correct the electrolyte abnormalities
discuss with the renal team and critical care team
prophylaxis: use urate inhibitors eg allopurinol or rasburicase
how would the bloods look in tumour lysis syndrome?
raised potassium, raised phosphate, raised urate
decreased calcium
which cancers commonly metastasize to the lung
breast, bowel, testicular, kidney, bladder, melanoma, sarcoma,
which cancers commonly metastasize to the liver
breast, bowel, lung
which cancers commonly metastasize to the bone
breast, lung, prostate, kidney, thyroid
which cancers commonly metastasize to the brain
melanoma, breast, bowel, lung, kidney
which factors influence tmt in lung cancer
- patient choice
- stage of disease
- histological characteristics (response to drugs)
- support network
- lung, renal function
- co morbidities
- fitness and performance status
how do we measure performance status in cancer patients?
ECOG scale
0= normal 5= deceased
which mutations are more common in lung ca in never smokers ?
EGFR mutation
makes them more responsive to tyrosine kinase inhibitors
if a cancer patient presents with headaches and confusion what are your differentials?
- brain mets
also need to exclude
cerebrovascular accident
electrolyte abnormalities
what do you need to give if there is cerebral oedema?
- dexamethasone 8mg BD PO
how would you treat acute hypercalcaemia?
- IV fluids (raised Ca can lead to diuresis and dehydration)
- IV Bisphosphonate eg ZOLEDRONIC ACID
how would you manage imminent spinal cord compression from spinal mets?
- dexamethasone 8mg BD
- opioid analgesia
- neurosurgical review and stabilisation
- radiotherapy may be indicated also
what are the features of headaches due to brain mets?
- different from headaches the pt may have had in the past
- non responsive to analgesia
- worse in the morning and lying down
- worse over time
- can last 1-2 days
- may be associated with nausea and vomiting
what else do you need to ask about if you suspect brain mets ?
seizures
weakness
poor coordination
visual disturbances and diplopia
what do you need to tell to do once you are aware of brian metastases?
the patient will need to inform the DVLA
it is likely they will need to surrender their license
