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Flashcards in Oncology Deck (38)
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1

Features of spinal cord compression

  • back pain - the earliest and most common symptom - may be worse on lying down and coughing
  • lower limb weakness
  • sensory changes: sensory loss and numbness
  • neurological signs depend on the level of the lesion. Lesions above L1 usually result in upper motor neuron signs in the legs and a sensory level. Lesions below L1 usually cause lower motor neuron signs in the legs and perianal numbness. Tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion
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2

Management of spinal cord compression

  • high-dose oral dexamethasone → 18 mg PO 
  • urgent oncological assessment for consideration of radiotherapy or surgery

3

Features of superior vena cava obstruction 

  • dyspnoea is the most common symptom
  • swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
  • headache: often worse in the mornings
  • visual disturbance
  • pulseless jugular venous distension
  • Pemberton's sign → venous congestion in neck, dilated veins in the upper chest and arms

4

Management of superior vena cava obstruction 

  • general: dexamethasone, balloon venoplasty, stenting
  • small cell: chemotherapy + radiotherapy
  • non-small cell: radiotherapy

5

Hypercalcaemia treatment 

  • IV fluids (3-4 l a day)

 

  • IV bisphosphonates → Pamidronate or Zolendronate 

 

  • Denosumab and calcitonin → in some difficult causes

6

Causes of hypercalcaemia in ca patient

  • metastasis to bone (due to osteolysis) 
  • PTHrP from squamous cell lung cancer

7

Features of hypercalcaemia

  • 'bones, stones, groans and psychic moans'
  • corneal calcification
  • shortened QT interval on ECG
  • hypertension

8

Features of ICP 

  • headache
  • nausea
  • vomiting
  • papilloedema → occurs very late in disease
  • possible slower onset with non specific symptoms e.g. drowsiness, mental deterioration 

9

Management of increased ICP

  • MRI
  • high dose dexamethasone
  • gamma-knife radiotherapy may be needed

10

What's the definition of hyperviscosity? 

Either of:

  • Hb >18
  • high WCC
  • high platelets

 

Cause:

  • untreated leukaemia
  • myeloma (high level of immunoglobulins)
  • Waldenstrom's macroglobulinemia (high level of immunoglobulins)

11

Clinical features of hyperviscosity 

  • hypoxia
  • pulmonary infiltrates
  • confusion
  • headaches
  • visual disturbances
  • papilloedema
  • retinal venous dilation
  • cardiac failure
  • priapism 

12

Management of hyperviscosity 

  • plasmapheresis
  • leukopheresis 
  • treat underlying malignancy 

13

Definition of neutropenic sepsis 

  •  neutrophil count of < 0.5 * 109

 in a patient who is having anticancer treatment and has one of the following:

  • a temperature higher than 38ºC or
  • other signs or symptoms consistent with clinically significant sepsis

14

The timeframe in which neutropenic sepsis usually occurs?

7-14 days post chemo

15

Prophylaxis of neutropenic sepsis 

if it is anticipated that patients are likely to have a neutrophil count of < 0.5 * 109 as a consequence of their treatment they should be offered a fluoroquinolone

16

Treatment of neutropenic sepsis 

  • antibiotics must be started immediately 

- start with empirical antibiotic therapy with piperacillin with tazobactam (Tazocin) immediately

- add vancomycin if the patient has central venous access 

  •  assessment by a specialist and risk-stratified to see if they may be able to have outpatient treatment

 

  • if patients are still febrile and unwell after 48 hours an alternative antibiotic such as meropenem is often prescribed +/- vancomycin
  • if patients are not responding after 4-6 days do investigations for fungal infections (e.g. HRCT)
  • there may be a role for G-CSF in selected patients

17

(6) Hallmarks of cancer (pathophysiology)

The Hallmarks of Cancer (Weinberg):
 
1. Autonomy from growth signals
2. Insensitivity to growth inhibitory signals 
3. Avoidance of programmed cell death 
4. unlimited replicative potential
5. sustained angiogenesis 
6. invasion and metastasis 
 

18

(3) genetic syndromes (+ a bit of info) predisposing to colorectal cancer  

19

20

Difference between adjuvant vs neo-adjuvant rafiotherapy

  •  adjuvant → given after the surgery/ alongside other treatment 

 

  • neo-adjuvant → given before the surgery to shrink the tumour size

21

Types of radiotherapy (4) + describe

  • External beam radiotherapy/teletherapy → high dose x-ray (radiation produce by the machine and given to the pt)

 

  • Brachytherapy → source of radiation near tumour (via needle, scope etc) 

 

  • Radionucleotide therapy → injection of radiation source into the pt e.g. radioiodine therapy in thyroid ca 

 

  • Proton beam therapy → used mostly in paediatrics (charged particles leave their energy at a certain point) so less radiation left behind= less long term side effects

22

MoA of radiotherapy (2)

MoA:

  • DNA of cancer cells is damaged → decreased cancer cells ability to reproduce

 

  • ability of the cancer cell repair is decreased → ca cell death

23

What's: 

  • cancer 
  • carcinoma 
  • sarcoma

  • cancer → solid malignancy 

 

  • carcinoma → malignancy growing from the epithelium 

 

  • sarcoma → malignancy growing from mesenchymal tissue

24

What does it mean: 

  • Disease-free survival 
  • Progression-free survival 
  • Overall survival 

  • Disease- free survival → time after e.g.  that 'cured' cancer to death 

 

  • Progression-free survival → period when the cancer is not growing 

 

  • Overall survival → takes into account also different causes of death (e.g. cancer + other conditions)

25

Other causes (than neutropenic sepsis) of fever in chemotherapy pt

  • malignancy related fever
  • PE 
  • chemo-induced fever (e.g. Bleomycin) 

26

What scoring system do we use for neutropenic sepsis patients

MASCC score

score of >/ 21 indicates low risk ⇒ pt can be managed as an outpatient on oral antibiotics 

*of course, clinical judgement should be used 

* social situation, frailty etc is also considered

27

What does 'fraction' mean in terms of radiotherapy?

Fraction = dividing total dose into small fractions given over several weeks 

- it allows differentiating between repairability of normal and cancer tissues

 

- SEs usually appear bu the end of the treatment course and

- it takes same time to recover from SEs (e.g. side effects happened after 5 weeks of the treatment course → it will take 5 weeks to recover from them) 

28

SEs of radiotherapy to breast

- swelling 

- redness 

29

SEs of radiotherapy to abdo 

  • nausea
  • vomiting
  • diarrhoea

30

SEs of radiotherapy to chest

  • cough
  • SOB 
  • reflux