Year 3 - Diseases > Cancer > Flashcards

Cancer Flashcards

(21 cards)

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1
Q

Define neutropenic sepsis

A
  • Sepsis is a syndrome defined as life-threatening organ dysfunction due to a dysregulated host response to infection
  • Septic shock is a subset of sepsis, which describes circulatory, cellular, and metabolic abnormalities which are associated with a greater risk of mortality than sepsis alone.
  • In a hospital setting, septic shock is defined as sepsis with persisting hypotension despite fluid correction and inotropes (requiring vasopressors to maintain a mean arterial pressure [MAP] of 65 mmHg or more), and hyperlactataemia with a serum lactate level of greater than 2 mmol/L, where MAP is the driving pressure of tissue perfusion
  • Neutropenic sepsis is a complication of anti-cancer and other immunosuppressive drug treatment, with temp over 38 or any symptoms/signs of sepsis with a neutrophil count of 0.5x10^9 or lower.
  • Febrile neutropenia is a fever in a person with neutropenia
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2
Q

Describe aetiology of neutropenic sepsis

A
  • Cytotoxic chemotherapy
  • Haematopoietic stem cell transplant
  • Immunosuppressive drugs (azathioprine, methotrexate, sulfasalaxine, infliximab)
  • Penicillin, carbimazole, valproic acid, allopurinal, NSAIDs
  • Infections (viral HIV, influenza, hep B, TB shigella)
  • Autoimmune (crohns, RA, SLE)
  • Bone marrow failure (eg. aplastic anaemia)
  • B12 and folate deficiencies
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3
Q

List risk factors for neutropenic sepsis

A
  • Infants and people over 60 at higher risk following chemotherapy
  • Corticosteroids
  • Antibiotics
  • Advanced malignancy
  • History of previous febrile neutropenia
  • Previous surgery
  • Co morbidities (diabetes mellitus, liver disease, renal disease, poor nutritional status)
  • Central venous access devide
  • TPN
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4
Q

Describe epidemiology of neutropenic sepsis

A
  • Increasing
  • 20 cases a month in specialist units, 3 in general hospital in UK
  • 7-45% of people with neutropenia develop shock
  • Febrile neutropenia 8 per 1000 people with chemo
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5
Q

List symptoms and signs of neutropenic sepsis

A
  • Symptoms hinting at infection (dysuria, diarrhoea, productive cough)
  • Chills, shivers, rigors, temperature over 38
  • General malaise, agitation, behavioural change, changes in mental state
  • Concern from carers
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6
Q

Describe investigations for neutropenic sepsis

A
  • Neutrophil count under 0.5 x 10^9 per litre
  • Higher temp then 38
  • Other signs or symptoms consistent with sepsis
  • Investigate underlying cause (blood culture, Xray, sputum, lactate, unrine output, urine dip.ect)
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7
Q

Define cholangiocarcinoma

A
  • Cancers arising from the bile duct epithelium
  • Intrahepatic within the liver, extrahepatic outside. Alternatively names perihilar and distal.
  • Perihilar involving bifurcation of the ducts are also known as Klatskin’s
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8
Q

Describe epidemiology of cholangiocarcinoma

A
  • 2/3 in patients between 50-70
  • Slight male predominance
  • Increased incidence
  • Highest rate in north east Thailand (80 per 100000), and south american countries and northern japan
  • Low rates in UK and US, lowest in canada (0.3 per 100000)
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9
Q

Describe aetiology/risks of cholangiocarcinoma

A

Intrahepatic

  • Chronic liver disease due to hepB or C leading to cirrhosis
  • Alcoholic liver disease
  • Bile duct diseases
  • Choledocholithiasis
  • Cholecystolithiasis
  • UC
  • HIV
  • Primary sclerosing cholangitis (7-13%)

Both

  • Chronic typhoud carriers
  • Liver flukes
  • Heavy drinking
  • Exposure to certain toxins/medications (PCB, isoniazid, OCP)
  • Radionuclides (thorium dioxide)
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10
Q

List symptoms and signs of cholangiocarcinoma

A
  • Painless jaundice
  • Weight loss
  • Abdominal pain
  • Pruritis
  • Acute cholangitis (fever, jaundice, RUQ pain)
  • Palpable gallbladder
  • Hepatomegaly
  • Dark urine
  • Pale stools
  • Fever
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11
Q

List investigations of cholangiocarcinoma

A
  • Serum bilirubin raised
  • Alk phos, GGT, aminotransderases raised
  • PT increased
  • CA19-9 raised in 85%
  • Serum carcinoembryonic antigen (CEA)
  • CA19-9 + CEA calculate likelihood of tumour progression
  • CA-125
  • Abdo ultrasound - malignant VS benign (dilated intrahepatic ducts, mass lesion if intrahepatic)
  • Consider abdo CT/MRI
  • MR angiograpy for staging
  • ERCP with staining for tissue diagnosis
  • MRCP
  • Percutaneous transhepatic catheterisation
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12
Q

Define renal cell carcinoma

A

Renal malignancy arising from the renal parenchyma/cortex, accounts for around 85% of kidney cancers

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13
Q

Describe epidemiology of renal cell carcinoma

A
  • 80-90% of all kidney cancers
  • Kidney cancer 4.2% of all new cancers, median age at diagnosis 64 years
  • 6th and 7th most common diagnosed adult malignancy in men and women respectively
  • 6.0 and 3.1 per 100000 incidence in males and females respectively
  • More than 50% of renal massess diagnosed incidentally
  • 2:1 male to female ratio
  • 15% of dialysis patients
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14
Q

Describe aetiology/risks of renal cell carcinoma

A
  • Smoking most well established risk
  • Obesity and hypertension (BMI over 35 results in 71% increased risk of RCC)
  • Renal transplant, end-stage renal disease with dialysis
  • Pelvic radiation
  • Increased age
  • Familial - von hippel lindau, folliculin, mesenchymal epithelial transition factor, fumarate hydratase, succinate dehydrogenase and BAP1
  • VHL lifetime risk 70%
  • Developed counties, black/American-indian ethnicity
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15
Q

List signs and symptoms of renal cell carcinoma

A
  • Often asymptomatic
  • Haematuria, flank pain, palpable abdo mass (CLASSICAL TRIAD)
  • Systemic - fever, weight loss, sweats, pallor, cachexia, myoneuropathy
  • Hepatic - ascites, hepatomegaly, spider angiomata (paraneoplastic)
  • Myoneuropathy
  • Lower limb oedema
  • Variocele (due to compression of renal vein)
  • Birt Hogg Due papules, hereditary leimyomatous skin fibromas
  • Vision loss and retinal angiomatosis in von Hippel Lindau
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16
Q

List investigations for renal cell carcinoma

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A
  • FBC (paraneoplastic (anaemia, erythrocytosis)
  • LDH (raised)
  • Corrected calcium (rasied), ALP raised in mets
  • LFTs (abnormal in mets/paraneoplastic)
  • Coagulation profile
  • Creatinine (raised)
  • Urinalysis (haematuria, proteinuria), cytology
  • Abdo/pelvic ultrasound (mass, lymphadenopathy)
  • CT abdo pelvis (contrast enhanced - definitive test for diagnosis and staging)
  • MRI abdo pelvis
  • Biopsy (not required if malignant mass seen on imaging, as resection performed. However if smaller, or advanced with mets, biopsy used to monitor histology)
  • CXR
  • 25% have mets at presentation
17
Q

Define tumour lysis syndrome

Study These Flashcards
A
  • An oncological emergency characterised by metabolic and elecrolyte abnormalities that can occur after initiation of any cancer treatment, or spontaneously
  • Caused by breakdown of large numbers of cancer cells and subsequent release of large amounts of intracellular content, resulting in overwheming homeostatitic mechanisms
18
Q

Describe epidemiology of tumour lysis syndrome

Study These Flashcards
A
  • More prevalent in haematological malignancies (eg. ALL, Burkitts lymphoma)
  • Advanced age may be a risk
  • 6.1% incidence in non-Hodgkin lymphoma and 5.2% in ALL, 3.4% in AML
  • Uncommon in solid tumours
19
Q

Describe aetiology/risks of tumour lysis syndrome

Study These Flashcards
A
  • Initiation of cancer treatment in haematological malignancies
  • Cytotoxic chemo, corticosteroids, hormonal therapy and radiotherapy. Some reports in imunotherapy
  • Increased if disease bulk is good, rapidly dividing cells, good response to treatment
  • Pre existing renal impairment, dehydration and volume depletion are also risk factors
  • High serum lactate dehydrogenase and ECC
20
Q

List symptoms of tumour lysis syndrome

Study These Flashcards
A
  • Syncope, chest pain, dyspnoea (hyperkalaemia, hyperphosphataemia or hypocalcaemia)
  • Seizures (hyperphosphataemia or hypocalcaemia)
  • Nausea and vomiting
  • Anorexia
  • Diarrhoea
  • Muscle weakness
  • Muscle cramps
  • Lethargy
  • Paraesthesia
  • Lymphadenopathy
  • Splenomegaly
  • Hypertension/hypotension
  • Oligouria/anuria/haematuria
  • Tetany, trousseau sign, chvostek sign, laryngeal spasm
  • Peripheral oedema (renal failure)
  • Gout ( due to release of uric acid - also called podagra)
21
Q

Describe investigations for tumour lysis syndrome

Study These Flashcards
A
  • Serum uric acid increase (25% from baseline)
  • Serum phosphate raised (25%, over 1.45mmol/L)
  • Serum potassium over 6mmol/L
  • Serum calcium below 1.75mmol/L
  • FBC (raised WBC)
  • Lactate dehydrogenase (raised)
  • Serum creatinine (raised)
  • Serum urea (raised in renal impariemnt, AKI, dehydration)
  • Urine pH (<5)
  • ECG showing arrythmia
Year 3 - Diseases
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