Why do you use a performance status + name 2
Performance of patient during treatment.
Use Eastern Cooperative Oncology Group table (0 = fully active, 5 = dead)
Grade vs stage
Stage = how advanced cancer is in its progress Grade = what cells look like under microscope - how similar it is compared to normal cells
What cancers are TNM staging used for?
Used for solid tumour cancer (not applicable to leukaemia or CNS tumours)
What does the T in TNM mean?
Size or direct extent of primary tumour Tx: tumour cannot be assessed Tis: carcinoma in situ T0: no evidence of tumour T1, T2, T3, T4: size and/or extension of the primary tumour
What does the N in TNM mean?
Degree of spread to regional lymph nodes Nx: lymph nodes cannot be assessed N0: no regional lymph nodes metastasis N1: regional lymph node metastasis present; at some sites, tumour spread to closest or small number of regional lymph nodes N2: tumour spread to an extent between N1 and N3 (N2 is not used at all sites) N3: tumour spread to more distant or numerous regional lymph nodes (N3 is not used at all sites)
What does M mean in TNM?
Presence of distant metastasis M0: no distant metastasis M1: metastasis to distant organs (beyond regional lymph nodes)
What are the grades of cancer?
Grade 1 = cancer looks similar to normal cells, growing slowly 2 = cells look unlike normal cells + growing more quickly than normal 3 = cancer looks very abnormal, growing quickly
What causes paraneoplastic syndrome?
Caused by humoral factors (hormones + cytokines) released by tumour
What types of paraneoplastic syndrome are there?
Hypercalcaemia (from excess PTH release)
Syndrome of inappropriate ADH secretion
ACTH release causing raised cortisol = Cushings
Serotonin release = peristalsis, diarrhoea, bronchoconstriction
Lambert-Eaton = autoantibodies to Ca+ channels, proximal muscle weakness
What is SIADH + how is it managed?
Syndrome of inappropriate ADH secretion Causes low sodium + low osmolarity
Give saline through central line
What causes hyponatraemia in cancer pts, and what are the S+S?
Caused by SIADH + medications (PPIs)
S+S: anorexia, headache, N+V, personality change, muscle cramps + weakness, confusion, ataxia, seizures, signs of hypervolaemia (pulmonary rales, S3 gallop, peripheral oedema)
What is APTT used for?
Measures extrinsic + intrinsic pathways Used to monitor heparin