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Phase 3b > Oncology > Flashcards

Oncology Flashcards

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

A

Thoracic

21
Q

Gold standard investigation for spinal cord compression

A

MRI whole spine

22
Q

Most common malignancies to cause malignant spinal cord compression

A 
Breast 
Prostate 
Multiple myeloma 
lymphoma 
Lung cancer
23
Q

What collaterals might circumvent a SVCO

A

Azygous
Internal mammary
Long thoracic (femoral and vertebral)

24
Q

Most common cause of SVCO

A

Non-Hodgkin lymphoma

Non-small cell lung carcinoma

25
Q

What is Pemberton’s sign?

A

Raise arms for 1-2 minutes

Increased facial plethora, dilated veins and respiratory distress

26
Q

Investigation of choice for SVCO

A

Contrast-enhanced CT scan - modality of choice
X-ray may be initially given (widening mediastinum and pleural effusion)
Superior vena cavogram (gold standard)

27
Q

Causative organism of fibrosing mediastinitis

A

Histoplasmosis infection

Can cause SVCO

28
Q

What is the most common cause of malignant hypercalcaemia?

A

Tumour release of PTH-related peptide

29
Q

What mediastinal involvement might you see in lung carcinoma

A

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
Q

What are the features of paraneoplastic syndrome?

A

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
Q

What findings might you see on CXR in a patient with lung cancer?

A 
Hilam enlargement 
Pleural effusion 
Lung collapse 
Rib lesions 
Pulmonary opacity (tumour)
32
Q

Lung cancer investigations

A

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
Q

Management of lung carcinoma according to staging?

A

Surgery for I and II

Chemo (increases survival by a year) and radiotherapy for III

Laser therapy and stenting (managing airway obstruction)

34
Q

When would you refer a patient using suspected cancer pathway>

A

Over 40 and unexplained haemoptysis

CXR findings suggestive of lung cancer

35
Q

When would you offer a patient CXR within 2 weeks?

A

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
Q

Which lung cancers are not related to smoking?

A

Adenocarcinoma and alveolar cell carcinoma +++sputum

37
Q

What are the features of the three types of non-small cell carcinoma?

A 
Squamous cell: 
Central 
PTH-rP secretion 
Clubbing 
HPOA

Adenocarcinoma:
Peripheral
Non-smokers

Large cell:
Peripheral
Anaplastic, poorly differentiated, poor prognosis
Beta hCG production

38
Q

What features is small cell carcinoma associated with?

A

ADH –> hyponatraemia
ACTH –> Cushing’s, adrenal hyperplasia and hypokalaemic acidosis
Lambert-Eaton myasthenic syndrome

39
Q

What might cause a false positive PSA?

A

Prostatitis
UTI
BPH
Vigorous DRE

40
Q

What % of free:total PSA suggests cancer?

A

<20% –> biopsy advised

41
Q

What nodes are most likely to be affected by prostate cancer spread?

A

Obturator nodes

42
Q

Management of localised (T1/T2) prostate cancer?

A

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
Q

Management of localised advanced (T3/T4) prostate cancer?

A

hormonal therapy

radical prostatectomy: risk of ED

radiotherapy: external beam and brachytherapy. risk of bladder, colon, and rectal cancer

44
Q

Management of metastatic prostate cancer?

A

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
Q

Preferred treatment for cancer associated thrombosis?

A

Dalteparin

46
Q

Management of brain mets

A

Dexamethason (8g)
PPI to protect stomach
Anti-emetics

47
Q

What three conditions are associated with bone sclerosis (increased density)

A

Metastatic prostate and breast carcinoma

Sickle cell disease

48
Q

Which cancers commonly cause bony tumour deposits

A 
Myeloma 
Melanoma 
Thyroid 
Renal
Prostate 
Lung 
Breast

Phase 3b (18 decks)

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