Oncology

Question 1

what are adjuvant and neoadjuvant treatments?

Answer 1

neoadjuvant = before Tx e.g. neoadj. chemo shrinks tumour pre-surg

adjuvant = “alongside”

Question 2

what 4 important categories/ topics should you cover in a chemo [or other] consent ?

Answer 2

1. pros [benefits]
2. cons [SEs/risks]
3. logistics [what it involves]
4. alternatives

Question 3

why might cancer pt be hypoalbuminaemic

Answer 3

using proteins to make CA
liver not working [CA/mets] to make proteins
not eating well

Question 4

what do low and high grade mean in tumour grading

Answer 4

low grade = well-differentiated [good prog]

high grade = poorly differentiated [bad prog]

Question 5

why causes tumour lysis syndrome, what are the consequences, and what are some complications?

Answer 5

chemo for rapidly proliferating tumours [leukaemia, lymphoma, myeloma] leads to cell death

^urate, ^K+, ^phosphate, low calc

arhythmia, renal failure

Question 6

Mx for tumour lysis syndrome

Answer 6

prevent w/ hydration

uricolytics [allopurinol]

Question 7

give 4 examples of paraneoplastic syndromes

Answer 7

hypercalc
siADH
cushings
neuropathy
lambert-eaton myasthenic syndrome
dermatomyositis/polymyositis
acanthosis nigricans
pemphigus
hypertrophic osteoarthropathy

Question 8

paraneoplastic hypercalc occurs when tumour secretes parathyroid hormone-related protein. Give some e.g.s of tumours

Answer 8

lung
oesoph
skin
cervix
breast
kidney

Question 9

cancers ass. w/ SIADH

Answer 9

prostate
lung
pancreas
lymphoma

Question 10

what causes cushings to happen as a paraneoplastic syndrome

Answer 10

tumour secretes ACTH or CRF

Question 11

SEs of radiotherapy

Answer 11

acute - inflammatory e.g. prostatitis [^urinary Sx]

chonic - scar tissue

secondary CA

Question 12

Mx of spinal cord compression in CA

Answer 12

dex +PPI
neurosurg/ortho R/F
radio

Question 13

Ix in spinal cord compression in CA

Answer 13

MRI whole spine

Question 14

causes of SVC obstruction in oncology

Answer 14

lung CA most common
lymphoma node
node mets
thymoma
germ cell
rarer: venous thrombosis

Question 15

clinical features of SVC obstruction

Answer 15

oedema [face, arms]
SOB, stridor
plethora/cyanosis
visual dist [papilloedema]
engorged neck/chest wall veins
cough
headache

Question 16

in a pt with known HF, how could you differentiate their HF from new SVC obstruction

Answer 16

JVP will be fixed raised in SVC ob

but pulsatile raised in hf

Question 17

Mx of SVC obstruction in oncology

Answer 17

dex
\+/- anticoag
stent
treat CA [radio/chemo]
O2 if hypoxic

Question 18

Ix for SVC obstruction

Answer 18

CT

Question 19

Mx of paraneoplastic hypercal?

Answer 19

fluids
bisphos
(calcitonin [rapid])
treat underlying CA

Question 20

what ways can CA patient have bleeding

Answer 20

thrombocytopenic from bone marrow dysfn. from CA or chemo
Ca invades vessel
liver mets = not making clotting factors
tumour itself bleeds
steroids-GI bleed

Question 21

within what time period of recieving chemo should you suspect neutropenic sepsis in an unwell Pt

Answer 21

6 weeks

Question 22

cancers most common for spinal cord comporession

Answer 22

breats
prostate
lung
myeloma
melanoma

Question 23

what are the 2 ways in which cancer can cause spinal cord compression and whichj is more common?

Answer 23

direct invasion of CA [rarer]

collapse/compression of vertebra due to mets

Question 24

most common cancers to metastasise to brain

Answer 24

lung
breast
colorectal
melanoma

Question 25

signs and sx of brain mets

Answer 25

headache [worse in morning, coughing, bending]
focal neuro signs
ataxia
fits
nausea
vomiting
papilloedema

Question 26

Mx of brain mets

Answer 26

dex to reduce cerebral oedema
radio
neurosurg