Fever >38 or hypothermia 20 HR > 90 beats/minute WBC >12

Oncology Flashcards by Miranda King

Purine Analogues

Fludarabine 
Cladribine 
Pentostatin 
Clofarabine 
Nelarabine 
Azathioprine

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R-CHOP chemotherapy components

Rituximab 
Cyclophosphamide 
Doxorubicin 
Vincristine 
Prednisolone

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ABVD chemotherapy components

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

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Who needs irradiated blood?

Any Hodgkins Lymphoma
Any Purine Analogue Chemotherapy
Immunosuppressed

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Who needs CMV negative blood?

Pregnant women - not essential at delivery

Neonates

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SIRS Criteria

Fever >38 or hypothermia <36
RR > 20
HR > 90 beats/minute
WBC >12

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Neutropaenic Sepsis =

Sepsis and neutrophil count <0.5

If chemotherapy within last 21 days, then neutrophil count <1

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Definition of standard risk of neutropaenic sepsis

Neutropaenia
Sepsis
NEWS < 6

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Definition of high risk of neutropaenic sepsis

Neutropaenia
Septic shock
NEWS > 7

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Management of standard risk neutropaenic sepsis

Piperacillin or Tazobactam

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Management of standard risk neutropaenic sepsis

Penicillin Allergic

Teicoplanin + Aztreonam

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Management of high risk neutropaenic sepsis

Piperacillin/Tazobactam
+
Gentamicin

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Management of high risk neutropaenic sepsis

Penicillin Allergic

Teicoplanin + Aztreonam + Gentamicin

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Chemotherapy and Gentamicin

Get advice if on cisplatin chemotherapy

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Neutropaenic Sepsis and Previous ESBL Management

Meropenem

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When should antibiotic therapy be reviewed in neutropaenic sepsis?

48-72 hours
If afebrile consider converting to oral antibiotics
If persistent consider switching to meropenem

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Types of non-small cell lung cancer

Adenocarcinoma
Squamous cell
Large cell
Mixed/Undifferentiated

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ABVD chemotherapy is used in

Hodgkins Lymphoma

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CHOP/R-CHOP is used in

Non-Hodgkins Lymphoma

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MVAC chemotherapy is used in

Advanced bladder cancer

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Types of bladder cancer

Transitional cell carcinoma

Squamous cell carcinoma

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Association with transitional cell carcinoma

Smoking
Aniline dyes
Rubber manufacture

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Associations with squamous cell carcinoma of the bladder

Schistomiasis

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Adjuvant VS Neo-Adjuvant

Adjuvant = to reduce cancer recurrence 
Neo-Adjuvant = to down-stage the tumour prior to tumour

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Bone Marrow Suppression in Chemo (3)

Neutropaenia Anaemia Thrombocytopaenia

GI Toxicitiy in Chemo (2)

Nausea/vomiting | Mucositis

Neurotoxicity in Chemo (2)

Peripheral Neuropathy | Ototoxicity

Cardiac Toxicity in Chemo (2)

Reduced ejection fraction | Coronary vasospasm

Bladder Toxicity in Chemo

Haemorrhagic Cystitis

MOA of Anti-Metabolite Chemotherapy

Inhibit folic acid synthesis OR Inhibit purine/pyramidine synthesis

Examples of Anti-Metabolites (4)

5FU Azathioprine Fludarabine Methotrexate

MOA of Anti-Microtubule Agents

Prevent microtubule function

Examples of Anti-Microtubule Agents (3)

Paclitaxel Vincristine Vinblastine

Types of Alkylating Agents

Platinum Drugs Nitroureas Cyclophosphamide, Dacarbazine

Cetuximab target

EGFR1

Rituximab target

CD20

Describing the dose of radiotherapy

Measured in Gray (Gy) A fraction describes a single treatment e.g. Radiation at 60Gy in 30 fractions (2Gy per fraction)

Short Term/Temporary Effects of Radiotherapy (5)

``` SOB Cough Oesophagitis Headaches Skin changes ```

Long Term/Permanent Effects of Radiotherapy (2)

Fibrosis | Memory changes

What is SABR? What is it used for? What are the side effects?

Sterotactic ablative body radiotherapy = more accurate delivery of external beam radiotherapy: use higher doses/fraction Lung cancer S/E: rib fractures, myelopathy

What is Bracytherapy? | What is it used for?

= small radiotherapy sources into or next to the tumour | Uses: cervical cancer, endometrial cancer, prostate cancer

Management of Chemotherapy Induced Nausea and Vomiting

Dexamethasone NK1 Antagonist 5HT3 Antagonist

Benefit of the 5HT3 Antagonist in CINV

Effective for acute events

Benefit of the NK1 Antagonist in CINV

Effective for delayed events

Acute CINV =

Within 24 hours of chemotherapy

Delayed CINV =

24 hours - 7 days post chemotherapy

Example of NK1 Antagonist

Aprepitant

Examples of 5HT3 Antagonist (2)

Ondansetron | Granisetron

Management of anticipatory nausea and vomiting

Lorazepam

Metoclopramide | Contraindications

Cannot be used in Parkinson's Disease

Extra-thoracic presentations of lung cancer (3)

Liver - painful due to the stretching of the liver capsule Bone - lytic lesions. May also result in cord compression Brain - mass effect may result in headaches, vomiting, visual loss or seizure

Paraneoplastic syndromes associated with lung cancer (4)

Hypercalcaemia SIADH secretion Cushing's syndrome Hypertrophic osteoarthropathy

Curative radiotherapy dose in lung cancer

55Gy in 20 fractions

Radiotherapy offered in small cell lung cancer

Offer prophylactic irradiation of the brain (mets)

Two main groups of ovarian tumour

Epithelial cell tumours | Germ cell tumours

Types of epithelial ovarian tumour (4)

Serous Mucinous Endometriod Clear cell

Stage 1A vs Stage 1B Endometrial Carcinoma

1A - contained within the endometrium | 1B - spread into the myometrium

When to use Trastuzumab in Breast Cancer

HER2 Positive

Most common area for BPH to develop

Transitional zone of the prostate

Most common area for prostate cancer to develop

Peripheral zone of the prostate

Grading system used in prostate cancer

Gleason System

When would radical prostectomy be considered? | 2 conditions

Lifespan >10 years | T1-3 stage tumour

Which lymph nodes drain the prostate?

Internal iliac nodes

Management of oedema in brain tumours

Steroids

Initial investigation of choice in suspected brain tumour

CT head

Benign brain tumours (5)

``` Pituitary adenoma Cranio-pharyngioma Meningioma Acoustic neuroma Dermoid tumour ```

Malignant brain tumours (5)

``` Glioma Pineoblastoma Primary Cerebral Lymphoma Medulloblastoma Germinoma ```

Association with Primary Cerebral Lymphoma

HIV

Grading of Glioma

I - fibrillary astrocytoma II - astrocytoma or oligodendroglioma III - anaplastic astrocytoma OR oligodendroglioma IV - glioblastoma multiforme

Management of malignant brain tumours

Radiotherapy - 60Gy in 30 fractions | Temozolamide chemotherapy

Presentation of pain in spinal cord compression

Radicular pain = band around the middle, burning pain

Investigation of suspected spinal cord compression

Urgent MRI of spine

Management of spinal cord compression

Radiotherapy

Causes of hypercalcaemia in malignancy (3)

Release of PTH-related protein Local destruction of bone Tumour produces vitamin D analogues

Management of hypercalcaemia

Rehydration - lots of saline Bisphosphonates - IV pamidronate (can cause renal failure so checking U&Es important) Systemic management of the malignancy

Pathophysiology of pericardial tamponade

Pericardial effusion develops Compresses the ventricle, reducing cardiac output Collapses the right atrium increasing venous back pressure

Beck's Triad - What an indication of? - Components?

= pericardial effusion 1. Jugular venous distension 2. Muffled heart sounds 3. Hypotension with narrowed pulse pressure

Investigation of choice in suspected PE

CTPA

Lung cancer associated with hypercalcaemia

Squamous cell carcinoma

Potential complication of cervical cancer

Ureteric obstruction

Chemo drug associated with cardiomyopathy

Doxorubicin

How does chemotherapy result in a proteinuria?

Causes direct renal tubular damage = proteinuria

Oncology Flashcards

(82 cards)