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phase 3b > Oncology > Flashcards

Oncology Flashcards

1
Q

What is hodgkins lymphoma?

A

malignant tumour of lymphatic system - characterised histologically by Reed Sternburg Cells

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2
Q

Describe the histology of Hodgkin’s lymphoma

A

Reed Sterburg cells (multinucleated giant cells)

abnormal and smaller mononuclear cells originating from B lymphocytes

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3
Q

Risk factors for Hodgkins lymphoma

A

EBV

previous mononucleosis

HIV

immunosuppression

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4
Q

Presentation of Hodgkins lymphoma

A
  • enlarged but asymptomatic lymph node in lower neck or supraclavicular region (pain with alcohol)
  • cyclical fever
  • chest discomfort - cough dyspnoe (mediastinal lymph node involvement)
  • B symptoms - night sweats, fever, weight loss
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5
Q

Staging of Hodgkins lymphoma

A

Ann Arbor

  1. one lymph node region or structure (spleen, thymus, waldeyers ring)
  2. >1 lymph node region on same side
  3. involvement both sides
    1. splenic, hilar, coeliac or portal
    2. para-aortic iliac or mesenteric
  4. extranodal
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6
Q

Modifying features of Hodgkins lymphoma

A

A: no symptoms

B: night sweats, fever, weight loss

X: > 1/3rd mediastium widening or >10cm diameter of mass

E: extranodal site

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7
Q

Potential examination findings of Hodgkins lymphoma

A

Lymphadenopathy

Hepatomegaly

Splenomegaly

Superior VC syndrome (facial swelling associated with SOB)

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8
Q

Hodgkins lymphoma investigations

A

FBC (leukamia, mono)

ESR (>70 bad prog)

LFT (low albumin bad prog)

HIV

CXR (lymphadenopathy and mediastinal expansion)

Lymph node and bone marrow biopsy (staging)

CT thorax and abdo (staging)

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9
Q

ABVD chemo

A

Doxorubicin

Bleomycin

Vinblastine

Dacarbazine

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10
Q

BEACOPP chemo

A

Bleomycin

Etoposide

Doxorubicin

Cyclophosphamide

Vincristine

Procarbazine

Prednisolone

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11
Q

What can additional things can you give with chemo

A
  • Abx to any pt with severe neutropenia
  • Recombinant human granulocyte colony - stimulating factor stimulates neutrophil production so could reduce duration of chemo induced neutropenia reducing incidence of associated sepsis
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12
Q

Management of Hodgkins lymphoma

A

Early: ABVD then radio (preceeded by BEACOPP in unfavourable prog)

Advanced: ABDV/BEACOPP

ASCT= autologous stem cell transplant

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13
Q

follow up for Hodgkins lymphoma

A

OPD 2-5 years

TFT if radio to neck and upper mediastinum

made aware theyre increased risk of secondary mags, CVD, pulmonary disease and infertility

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14
Q

Prognosis of Hodgkins lymphoma

A

80-90% patients achieve permanent remission

poor prognostic indicators

  • increasing age
  • male
  • B symptoms
    *
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15
Q

what are the oncological emergencies?

A
  1. neutropenic sepsis
  2. spinal cord compression
  3. SVC obstruction with airway compromise
  4. hypercalaemia
  5. tumour lysis syndrome
  6. raised ICP
  7. SIADH
  8. Haemorrhage
  9. Anaphylaxis
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16
Q

Causes and presentation of neutopenic sepsis

A

Bone marrow suppression due to chemo

usually presents 5-12 days after chemo

generally unwell, confusion or drowsiness

HR>90 RR>20

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17
Q

Investigations and management of neutropenic sepsis

A
  • Septic screen
  • neutrophils <0.5 with either temp>38 or Sx sepsis

Mx: immediate empirical Abx - IV Tazosin

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18
Q

Cause and presentation of spinal cord compression

A

causes: extradural mets, direct extension of tumour, crush fracture

Presentation: back pain, weakness, sensory loss, bowel and bladder dysfunction

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19
Q

Investigations and management of spinal cord compression

A

Ix: URGENT MRI whole spine

Mx: dexa, radio, decompression surgery

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20
Q

SVC obstruction causes

A

malignancy

  • lung
  • thymus
  • lymphoma
  • mediastinal enlargement

thrombotic disorders

thrombus around IV Central line

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21
Q

SVC obstruction presentation

A

Dyspnoea, orthopnoea

cyanosis

face/arm swelling

cough

headache

engorged veins

22
Q

SVC obstruction test, investigations and management

A

Pembertons test: hold arm about head for more than 1min = cyanosis, increased JVP, insp stridor

Ix: URGENT contract CT

Mx: dexo, SVC stent, balloon venoplasty

23
Q

Raised ICP causes and presentation

A

Causes: Primary CNS tumour, mets (breast, bowel, kidney, lung, skin)

Px: headache, focal neuro, N&V, papilloedema, fits

24
Q

Raised ICP investigations and management

A

Ix: URGENT MRI/CT

Mx: dexa, radio or surgery, mannitol for symptomatic

25
Tumour lysis syndrome cause
rapid cell death after starting chemo causes release of cell contents rise in serum urate K+ and phosphate precipitating renal failure seen 12-72 hours after chemo
26
Presentation of tumour lysis syndrome
* fatigue * N&V * diarrhoea * weakness and cramps * seizures
27
Tumour lysis syndrome investigations
increased uric acid increased K+ and phosphorus decreased calcium
28
Tumour lysis syndrome prophylaxis
hydration low risk: allopurinol 7 days before chemo high risk: Rasburicase stat dose
29
Neutropenic sepsis prophylaxis
Ciprofloxacin (fluroquinolone) during expected period of neutropenia
30
Hypercalaemia causes
lytic bone mets myeloma tumour producing osteoclast activating factor or PTH like hormones
31
hypercalaemia presentation
* bones * stones * abdo groans (and constipation) * fatigue * N&V
32
Investigations and management of hypercalaemia
Ix: high serum calcium \>2.6 Mx: rehydrate IV bisphosphonate
33
Patho behind non-hodgkins lymphoma
Genetic mutation causes B/T cells to divide uncontrollably producing a neoplastic cell. This can be 1) nodal lymphoma 2) extranodal lymphoma - GI tract - Bone Marrow - Spinal cord
34
What types of B cell lymphoma are there?
Indolent e.g. follicular lymphoma and marginal zone lymphoma aggressive e.g. **Diffuse large B cell lymphoma** mantle cell lymphoma highly aggressive e.g. Burkitts lymphoma (chromosomal translocation 8-\>14) associated with EBV
35
Types of T cell lymphoma
adult T cell lymphoma mycosis fungoides
36
Non-Hodgkins lymphoma symptoms
gastric MALT: GORD + constitutional symptoms Burkitts: abdo swelling, nausea and diarrhoea
37
NHL investigations
Lymph node biopsy CT - staging
38
NHL Management
localised - Radiotherapy High grade - R-CHOP Rituximab Cyclophosphamide Hydroxydaunomycin Vincristine Prednisolone
39
Which cancer is associated with coeliac disease?
small bowel T cell lymphoma
40
What is bacteria is assoicated with Burkitts lymphoma?
H. pylori
41
how do you treat h.pylori?
PPI clarithromycin metronidazole or amoxicillin
42
What are the possible causes of a mediastial tumour?
Terrible lymphoma (Hodgkins) Teratoma Thymoma Thyroid Mass
43
Tumour Lysis Management
* Hydration, 10mls 10% _calcium gluconate_ (lowers potassium, protects the heart) * 10 units rapid acting _insulin_ and 50mls 50% _glucose_ * _Calcium polystyrene sulfonate_ (reduces K+ ) * ±furosemide * _Rasburicase_ (reduces Uric acid) * _Aluminium hydroxide_ (reduces phosphate) * Haemodialysis
44
Causes of SIADH
* Produced by SCLC * Brain: Meningitis * Lung: Pneumonia, TB * Alcohol withdrawal * Drugs: opiates, carbamazepine, vincristine, cyclophosphamide
45
Presentation of SIADH
Mild – nausea, vomiting, headache, anorexia, lethargy Moderate – muscle cramps, weakness, confusion Severe – drowsiness, seizures, coma
46
Signs of SIADH
Signs: hyporeflexia, ataxia, tremour
47
Investigations of SIADH
* High ADH * Urine: Hyperosmolar and hypernatraemic * Plasma: Hypo-osmolar and hyponatraemic, low uric acid * Normal BP, thyroid and adrenal function Test: give saline - Na depletion responds, SIADH doesn’t
48
SIADH management
Treat cause Fluid restriction - maybe lifelong _Tolvaptan_ - V2 receptor antagonist which stops aquaporins
49
What is anaphylaxis?
Type 1 hypersensitivity reaction IgE mediated
50
How do you manage anaphylaxis?
* ABCDE * High flow 02 * **_IM adrenaline 0.5MG (1in 1000)_** * Repeat after 5 mins X3 then switch to IV * IV fluid - 500ml bolus in 5/10 mins * **_Chlorphenamine 10mg IM_** * **_Hydrocortisone 200mg IM_**

phase 3b (15 decks)

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