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Phase 3b > Oncology > Flashcards

Oncology Flashcards

(48 cards)

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1
Q

Management of malignant hypercalcaemia

A

IV 0.9% saline (4-6L, 200-300ml/hr)

Single dose IV bisphosphonates (Zoledronic acid and pamidronate)

IM/SC calcitonin (works quickly)

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2
Q

Causes of malignant hypercalcaemia?

A

Osteolysis (lytic bone metastases)

Humoral (PTHrP in breast cancer or squamous cell lung carcinoma)

Dehydration

Tumour specific mechanisms

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3
Q

Presentation of malignant hypercalcaemia

A

Bones, stone, groans and psychic moans

GI: abdo pain, constipation, vomiting, weight loss
Renal: stones, polyuria, polydipsia
Neuro: fatigue, weakness, confusion
Psych: depression

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4
Q

Management of malignant spinal cord compression

A

Corticosteroids

Surgical decompression

Radiotherapy (for pain control or if unsuitable for surgery)

Chemotherapy (if chemosensitive tumours)

Hormone deprivation (for newly diagnosed prostate cancer)

Analgesia

VTE prophylaxis and pressure sore prevention

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5
Q

Presentation of SCC

A 
Worsening back pain 
Leg weakness
Sensory loss below level of lesion 
Bladder and bowel dysfunction (LATE)
Radicular pain

LMN signs at level of lesion, UMN below level

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6
Q

SVC obstruction investigations

A

Clinical
CXR (widened mediastinum or mass on right side of heart)
CT scan

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7
Q

Presentation of SVCO

A 
Facial, neck, arm and torso oedema 
Dyspnoea, cough, chest pain at rest
Dilated veins in arms and neck and chest wall
Syncope 
Cyanosis 
Severe respiratory distress
Engorged conjunctiva 
Convulsions
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8
Q

Management of SVCO

A 
High dose steroids 
Stenting 
Raise head, give oxygen 
Chemo 
Radiotherapy 
Anticoagulation if central vein thrombosis present
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9
Q

What are the SIRS criteria?

A 
HR >90
RR >20
BP systolic <90
Urine output less than 0.5-1ml/kg/hr
Temp >38 or <36
Acute confusion
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10
Q

When would you get a patient with neutropenic sepsis reviewed by a senior clinician

A

Lactate >2
Evidence of end-organ failure
Haemodynamic instability

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11
Q

Abx treatment of patients with neutropenic sepsis

A

Piperacillin with tazobactam (Tazocin) +/- gentamycin

Switch to oral if improving after 24-48 hours

Consider 2nd line (e.g. meropenem) if no improvement after 48 hours

Consider other cause e.g. fungal (candida) or virus if no improvement after 5 days

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12
Q

How do you prevent neutropenic sepsis in high risk patients

A

Fluoroquinolones e.g. ciprofloxacin

G-CSF (granulocyte colony-stimulating factor)

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13
Q

What two criteria are required for diagnosis of neutropenic sepsis

A

> 38 fever

<0.5-1 x 10^9/L neutrophils

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14
Q

Most common causative organisms for neutropenic sepsis

A

Staph epidermidis (gram negative, coagulase negative)

Pseudomonas aeruginosa

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15
Q

Most common viral causes of neutropenic sepsis

A 
Herpes zoster 
Varicella zoster 
Epstein-Barr 
HSV 
Cytomegalovirus
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16
Q

Acquired causes of neutropenia?

A 
Drugs (e.g. carbimazole or chemotherapy)
Infection 
Bone marrow disease 
Autoimmune disease 
Nutritional deficiency
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17
Q

Genetic cause of neutropenia

A

Chediak-Higashi syndrome (autosomal recessive)

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18
Q

Red flags for back pain

A 
Recent infection 
<20 or >55 onset 
Thoracic pain 
Immunocompromise 
History of malignancy 
Fevers, chills, unexplained weight loss 
Night back pain, no better when supine 
IV drug use
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19
Q

Cauda equina presentation

A 
LMN signs and symptoms 
Painless urinary retention and overflow incontinence 
Saddle anaesthesia 
Radicular and lower back pain 
Reduced anal tone
Impotence 
Absent ankle jerk 
Asymmetrical weakness
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20
Q

Most common anatomical region of spinal cord to be affected by malignant spinal cord compression

21
Q

Gold standard investigation for spinal cord compression

Study These Flashcards
A

MRI whole spine

22
Q

Most common malignancies to cause malignant spinal cord compression

Study These Flashcards
A 
Breast 
Prostate 
Multiple myeloma 
lymphoma 
Lung cancer
23
Q

What collaterals might circumvent a SVCO

Study These Flashcards
A

Azygous
Internal mammary
Long thoracic (femoral and vertebral)

24
Q

Most common cause of SVCO

Study These Flashcards
A

Non-Hodgkin lymphoma

Non-small cell lung carcinoma

25
What is Pemberton's sign?
Raise arms for 1-2 minutes | Increased facial plethora, dilated veins and respiratory distress
26
Investigation of choice for SVCO
Contrast-enhanced CT scan - modality of choice X-ray may be initially given (widening mediastinum and pleural effusion) Superior vena cavogram (gold standard)
27
Causative organism of fibrosing mediastinitis
Histoplasmosis infection | Can cause SVCO
28
What is the most common cause of malignant hypercalcaemia?
Tumour release of PTH-related peptide
29
What mediastinal involvement might you see in lung carcinoma
Pancoast tumour: Brachial plexus compression --> shoulder or arm pain, weakness and atrophy Horner's syndrome Pleural effusion: dyspnoea and chest pain Pericardial effusion SVCO
30
What are the features of paraneoplastic syndrome?
Small Cell: Ectopic cushing's - increase in cortisol release from adrenal glands SIADH: ADH release leading to water retention Squamous cell: PTH-rh leading to hypercalcaemia Hypertrophic pulmonary osteoarthropathy (HPOA) --> clubbing and periosteal proliferation of tubular bone Hyperthyroidism Adenocarcinoma: HPOA Gynaecomastia HPOA
31
What findings might you see on CXR in a patient with lung cancer?
``` Hilam enlargement Pleural effusion Lung collapse Rib lesions Pulmonary opacity (tumour) ```
32
Lung cancer investigations
CXR CT Staging: Bronchoscopy (primary tumour visualised and sample taken) CT-guided fine needle biopsy (more reliable) Needle aspiration Thomococentesis (fluid from pleural cavity) PET scan for NSC - determines whether curative treatment Bloods - thrombocytosis, leukocytosis
33
Management of lung carcinoma according to staging?
Surgery for I and II Chemo (increases survival by a year) and radiotherapy for III Laser therapy and stenting (managing airway obstruction)
34
When would you refer a patient using suspected cancer pathway>
Over 40 and unexplained haemoptysis CXR findings suggestive of lung cancer
35
When would you offer a patient CXR within 2 weeks?
Over 40 and two of the following or smoked before and one of the following: ``` Cough Fatigue SOB Weight loss Chest pain Appetite loss ``` ``` CONSIDER if: Lymphadenopathy Clubbing Thrombocytosis Chest signs consistent with lung cancer Recurrent chest infections ```
36
Which lung cancers are not related to smoking?
Adenocarcinoma and alveolar cell carcinoma +++sputum
37
What are the features of the three types of non-small cell carcinoma?
``` Squamous cell: Central PTH-rP secretion Clubbing HPOA ``` Adenocarcinoma: Peripheral Non-smokers Large cell: Peripheral Anaplastic, poorly differentiated, poor prognosis Beta hCG production
38
What features is small cell carcinoma associated with?
ADH --> hyponatraemia ACTH --> Cushing's, adrenal hyperplasia and hypokalaemic acidosis Lambert-Eaton myasthenic syndrome
39
What might cause a false positive PSA?
Prostatitis UTI BPH Vigorous DRE
40
What % of free:total PSA suggests cancer?
<20% --> biopsy advised
41
What nodes are most likely to be affected by prostate cancer spread?
Obturator nodes
42
Management of localised (T1/T2) prostate cancer?
Watchful waiting: elderly, co-morbidities, low Gleason score Surgical: prostatectomy and obturator node excision. Risk of ED Radiotherapy: risk of rectal malignancy and radiation proctatitis. Use of brachytherapy. Potentially curative Active surveillance: T1c, Gleason 3+3, PSA <0.15, cancer in less than 50% of biopsy cores
43
Management of localised advanced (T3/T4) prostate cancer?
hormonal therapy radical prostatectomy: risk of ED radiotherapy: external beam and brachytherapy. risk of bladder, colon, and rectal cancer
44
Management of metastatic prostate cancer?
Hormonal therapy: Synthetic GnRH agonist e.g. Goserelin (Zoladex) cover initially with anti-androgen to prevent rise in testosterone Anti-androgen cyproterone acetate Orchidectomy
45
Preferred treatment for cancer associated thrombosis?
Dalteparin
46
Management of brain mets
Dexamethason (8g) PPI to protect stomach Anti-emetics
47
What three conditions are associated with bone sclerosis (increased density)
Metastatic prostate and breast carcinoma | Sickle cell disease
48
Which cancers commonly cause bony tumour deposits
``` Myeloma Melanoma Thyroid Renal Prostate Lung Breast ```

Phase 3b (18 decks)

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