Cancer Care

Question 1

S.E of chemotherapy

Answer 1

Cardiotoxic (cardiomegaly and arrhythmias)
Hair loss
Exhausted
Myalgia
Oral ulcers and ototoxic
Thrombophlebitis and skin irritation
Healing impaired
nEuropathy
Renal failure
Anaemia and myelosuppresion
Pulmonary fibrosis
Y - sterilitY

Question 2

Principles of palliative care

Answer 2

• Affirm life, but regard dying as normal process
• Address pain relief/ other distressing symptoms
• neither hasten/ postpone death
• Integrate psychological and spiritual aspects
• Provide support to patient and family

Question 3

Most common symptoms at end of life and drugs + doses used to relieve them

Answer 3

• Pain - 2.5-5mg Morphine SC PRN
• N&V - Haloperidol 1.5mg SC PRN OR Levomepromazine 6.25mg SC PRN
• Breathless - Midazolam 2.5-5mg SC (or morphine) PRN +/- oxygen
• Resp secretions - glycopyrronium 200mcg SC PRN (+PT)
• Delirium/ agitation - Midazolam PRN

Question 4

Causes of breathlessness in cancer patients

Answer 4

Cancer related

• primary/ secondary tumour causing airway obstruction; lung infiltration; lymphangitis
• pleural/pericardial effusion
• SVCO
• Phrenic N palsy
• Chest wall pain
• ascites
• Fatigue/weakness

Treatment - related

• surgery –> lobectomy; pneumonectomy
• RT/Chemo –> pul fibrosis
• Meds precipitating fluid retention/ bronchospasm
• Tracheostomy complications (blocked by secretions)

Other
- Infection; HF; pneumothorax; PE; COPD; anaemia; fatigue; Fear/anxiety

Question 5

Management of breathlessness in cancer - non-pharm

Answer 5

PT

• reduce breathing work
• encourage relaxation
• aid expectorations of secretions
• coping strategies
• Positions; visualisation; CBT

Question 6

Management of respiratory secretions at end of life care

Answer 6

GLYCOPYRRONIUM BROMIDE

MOA - binds mAchR - reduces gastric and oral secretions
S.E - Constipation; dizziness; drowsiness; dry mouth; dyspepsia; flushing; headache; n&v palpitations; skin reactions; tachycardia; urinary disorders; vision disorders

Question 7

What can a raised AFP; Ca125; CEA indicate

Answer 7

AFP –> HCC; Teratoma; Hepatitis; Cirrhosis; Pregnancy

Ca125 –> Ovary/uterus/breast Ca; Cirrhosis; pregnancy

CEA –> CRC; Pancreatitis; cirrhosis

Question 8

properties of cancer

Answer 8

• Evading apoptosis
• sustained angiogenesis
• tissue invasion and metastasis
• limitless replicative potential
• self-sufficiency in growth signals
• insensitivity to anti-growth signals