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Oncology Flashcards

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1
Q

What is neutropenic sepsis?

A

Neutropenia (<0.5) + Fever >38.5

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2
Q

What causes neutropenic sepsis?

A

Chemotherapy leads to bone marrow suppression, most commonly due to R-CHOP. Usually occurs 5-12 days (up to weeks) after chemotherapy. Altered microbiome in gut, bacteria enters blood stream.

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3
Q

Management of patient presenting with neutropenic sepsis.

A

Sepsis 6
FBC - to monitor leukocyte level
D dimer and fibrinogen to rule out DIC
Immediate IV broad spec antibiotics eg Tazocin
Granulocyte-colony stimulating factor (stimulates bone marrow to produce granulocytes)

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4
Q

What do you give for neutropenic sepsis prophylaxis post chemotherapy?

A

Ciprofloxacin

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5
Q

What are the risk factors for neutropenic sepsis?

A

Elderly

High dose/long course of chemotherapy

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6
Q

Causes of spinal cord compression

A

Spinal mets
Primary tumour in spine
Crush fracture (associated with spinal mets and steroids)

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7
Q

Presentation of spinal cord compression

A 
Pain - worse on lying down
Weakness
Altered sensation
Cauda equina symptoms
If lesion is below L1 you get LMN symptoms, if above UMN symptoms.
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8
Q

Investigations for spinal cord compression

A

Urgent MRI

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9
Q

Management of spinal cord compression

A

Oral dexamethasone (8mg BD)
Radiotherapy
Decompression surgery
(VTE prophylaxis, catheterisation, bisphosphonates)

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10
Q

Causes of SVC obstruction

A

Primary causes: Lung, thymus, lymphoma, other mediastinal disease, thrombotic disorders (Bechet’s, central line)
Most common in children are ALL and Non-hodgkin’s lymphoma

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11
Q

Presentation of SVC obstruction

A 
Face and arm swelling
Plethora
Cyanosis
Dyspnoea
Engorged veins
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12
Q

Investigation for SVC obstruction

A

Urgent contrast CT

CXR

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13
Q

What special test can you do on examination for SVC obstruction?

A

Pemberton’s sign

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14
Q

How do you treat SVC obstruction?

A

Elevate head
Oxygen
Dexamethasone
Stent

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15
Q

How does malignancy cause hypercalcaemia?

A

Boney mets, myeloma and paraneoplastic tumours eg small cell lung cancer increase osteoclast activity.

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16
Q

Presentation of hypercalcaemia

A 
Stones
Bones
Groans
Thrones
Moans
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17
Q

Investigations of hypercalcaemia

A 
Bone profile (alcium, albumin, phosphate, magnesium and ALP)
PTH
FBC, U+Es, LFTs, 
ECG - short QT 
X-ray - to look for bone mets
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18
Q

Management of hypercalcaemia

A

IV fluids (couple of hours)
Bisphosphonates
Calcitonin
Denosumab

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19
Q

What cells produce calcitonin?

Study These Flashcards
A

Parafollicular cells (C cells)

20
Q

Which cells produce PTH?

21
Q

What is Tumour Lysis Syndrome?

Study These Flashcards
A

Rapid breakdown of tumour causes the contents to be release causing raised serum urate, phosphate and potassium. This occurs 12-72 hours after chemotherapy.

22
Q

What are the risk factors for Tumour Lysis Syndrome?

Study These Flashcards
A

Larger tumour

Poor renal function

23
Q

Presentation of Tumour Lysis Syndrome

Study These Flashcards
A 
Fatigue
N+V
Cramps
Weakness
Palpitations
Seizures 
?Chest pain
24
Q

What changes do you see in the blood for Tumour Lysis Syndrome?

Study These Flashcards
A

High urate, phosphate, potassium

Low calcium

25
Management of Tumour Lysis Syndrome
``` Prophylactic Allopurinol or Rasburicase (to prevent raised urate, if high risk give IV immediately before starting chemotherapy, oral allopurinol during chemotherapy to lower risk groups) Active management: IV fluids IV Rasburicase Calcium gluconate Insulin + glucose Nebulised salbutamol Acetazolamide (alkalinises the urine, urate is more soluble at higher pH) ```
26
Causes of SIADH
Small cell lung cancer Brain - Meningitis, cerebral abscess, tumour Lung - Pneumonia, TB, sarcoidosis Metabolic - Alcohol withdrawal, porphyria, hypothyroidism Drugs - Opiates, carbamazepine, vincristine, cyclophosphamide
27
What does ADH do?
ADH acts on distal convoluted tubule and increases aquaporin channels so water is transported into blood.
28
What is the difference between hyperaldosteronism and SIADH?
Electrolytes are not affected by SIADH, only dilutional. Where as aldosterone acts on sodium potassium pump
29
How does SIADH present?
Mild: Nausea, Malaise, Anorexia Moderate: Muscle cramps, weakness, confusion, ataxia Severe: Drowsiness, seizures, coma
30
What causes the cerebral symptoms in SIADH?
Dilutional hyponatremia | When sodium levels in the blood become very low, water enters the brain cells and causes them to swell (cerebral edema)
31
Diagnostic criteria of SIADH
``` Hyponatraemia Plasma hypo-osmolality Urine hyper-osmolality Persistent high sodium in urine Euvolaemia Normal thyroid and adrenal function Elevated ADH level Low blood uric acid level ```
32
Investigations for SIADH
``` U&Es BP Urine sodium Serum ADH TFTs Trial of saline - sodium depletion with respond, SIADH will not ```
33
Treatment for SIADH
``` Water restriction (0.5-1L/24hr) Correct sodium deficit (NaCl) Tolvaptan (competitive vasopressin receptor 2 antagonist) ```
34
Management of anaphylaxis
ABCDE Adrenaline 1:1000 0.5ml IM - Repeat 3 times Hydrocortisone 200mg IV Chlorphenamine 10mg IV Fluid challenge - 500ml bolus over 5-10 mins
35
Presentation of anaphylaxis
``` Urticaria Angioedema Stridor Palpitation Cyanosis Hypotension Tachycardia Reduced cap refill ```
36
What type of reaction is anaphylaxis?
Type 1 hypersensitivity reaction IgE mediated
37
Causes of haemorrhage in cancer
Bone marrow suppression Liver damage - reduced production of coagulation factors Anticoagulation prophylaxis Steroids and NSAIDs
38
What causes massive haemoptysis?
Squamous cell lung cancer - floods bronchial tubes so drown on it.
39
What is a frequent complication of head and neck cancers?
Carotid artery rupture
40
What causes carotid artery rupture in cancer?
Post surgical infection Ligature failure Wound breakdown after radiotherapy Direct tumour invasion
41
How do you prevent carotid artery rupture?
Prophylactic ligature of carotid artery rupture
42
How do you treat haemorrhage in cancer?
``` ABCDE - DON'T LEAVE PATIENT'S BEDSIDE Tranexamic acid Fluid Topical adrenaline Midazolam Use dark towels ```
43
Causes of increased ICP
Primary CNS tumour | Secondary mets: Breast, bowel, kidney, lung, skin
44
Presentation of increased ICP
Headache worse in the morning, worse on sneezing, bending over Focal neurological signs
45
How do you treat increased ICP
Dexamethasone | Manitol
46
Which cancers metastasise to the brain?
``` Breast Bowel Kidney Lung Skin ```

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