Flashcards in Oncology Deck (56)
Super vena caval obstruction is an oncological emergency. What would cause it and what would be the patients symptoms?
Mediastinal mass causing mechanical obstruction of the SVC
Difficulty breathing and/or swallowing, stridor, oedematous face and venous congestion
A 65 year old man presents with a lump in the left side of his neck. On examination there is a firm, non tender swelling overlying the angle of the mandible. The patient has asymmetrical facial features with drooping of the angle of the mouth on the left and an inability to close his left eyelid. What is the most likely diagnosis?
Malignant parotid tumour
80% of parotid masses are benign, with 80% being benign pleomorphic adenomas and most of the remainder Warthins tumours
Involvement of the facial nerve is a feature of malignancy
A 23 year old woman noticed a lump in her right breast. It is hard, immobile and does not change with her menstrual cycle. On questioning her mother and sister were treated for breast cancer. She had genetic testing which showed she is BRCA1 positive. On biopsy, the tissue showed abnormal mitotic activity, chromosome number and was HER2 positive. What is the best treatment option for her?
she has an aggressive breast cancer but also has a strong family history so removal of the affected breast is required but also prophylactically removing the other is advised as she is at high risk of recurrence
What symptoms might a prolactinoma present with?
Reduced bone mineral density - hypooestrogenism
72 year old man with 6 month hx 10kg weight loss. Never smoked, drinks modest alcohol, treatment for T2DM, father died of rectal carcinoma at 65. On examination pale and jaundiced, 3 finger irregular hepatomegaly. Low Hb, low MCV. What is the likely diagnosis?
Metastatic colonic neoplasia
Occult blood loss, FH
69 year old man with 6 month history 10kg weight loss. Smoker 10 cigarettes per day and has otherwise been well. On examination, polycythemic. Dipstick shows ++ blood. What is the likely diagnosis?
Ectopic elaboration of EPO, microscopic haematuria
56 year old male with 6 month history 7kg weight loss and bone aches and pains. On examination, pale with no other signs. Urine dip shows +++ protein. What is the likely diagnosis?
Plasma cell malignancy associated with bone marrow suppression and renal cell dysfunction/amyloid deposition
A 19 year old female presents with two month hx of weight loss and night sweats. She has left sided cervical lymphadenopathy. What is the likely diagnosis?
A 55 year old male presents with 2 month history of weight loss and increasing fatigue. On examination he is pale, has bilateral cervical and axillary lymphadenopathy and splenomegaly. What is the likely diagnosis?
Chronic lymphocytic leukaemia
With carcinoid syndrome, where typically is the primary? What causes the syndrome?
Mets to the liver
What substances are secreted by carcinoid mets?
5HT, bradykinin, histamine, substance p, prostaglandins
Which cells do carcinoid tumours arise in?
What are the classic signs and symptoms of carcinoid syndrome?
Flushing with hypotension
What is diagnostic for carcinoid syndrome?
Raised urinary 5-hydroxyindoleacetic acid on a low serotonin diet
What is pellagra in relation to cancer?
Dermatological manifestation of carcinoid syndrome
Dermatitis, diarrhoea and mental disturbance
What is a Philadelphia chromosome and what is it associated with?
T(9;22) associated with CML
What is palliative care?
Improves quality of life of patients and their families facing problem associated with life-threatening illness
Prevention and relief of suffering by early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual
What is a life limiting or terminal illness?
Illness where it is expected that death will be a direct consequence of the specified illness
What is end of life care?
Holistic care for those in the last days-weeks of life, allowing them to live as well as possible until they die
What does the gmc guidance define as end of life?
Approaching the end-of-life are likely to die in the next 12 months and those who have: Advanced, progressive, incurable conditions, General frailty and co-existing conditions that mean they are expected to die within 12 months, Existing conditions if they are at risk of dying from a sudden acute crisis in their condition, Life-threatening acute conditions caused by sudden catastrophic events
What do patients under palliative care want?
Appropriate treatment of pain and other symptoms
Achieve a sense of control
Communication regarding their care
Co-ordinated care throughout the course of illness
Avoid inappropriate prolongation of the dying process
Relieve burdens on family
Strengthen relationships with loved ones
Sense of safety in the health care system
What types of conditions are commonly seen in the palliative care specialty?
Cardiac disease: end-stage heart failure
Respiratory disease: COPD and pulmonary fibrosis
Chronic kidney disease
Neurological illness: Parkinson’s disease and MND
Chronic liver disease
Who should be referred for palliative care?
Patient has active, progressive and usually advanced disease for which the prognosis is limited (although it can be several years) and the focus of care is quality of life
Patient has one or more of the following needs which are unmet: Uncontrolled or complicated symptoms, Specialised nursing/therapy requirements, Complex psychological/emotional issues, Complex social/family issues, Difficult decision making about future care
What forms part of advanced care planning?
What the patient wants: advanced statement
What the patient doesn't want: advanced decision to refuse treatment and DNAR
Who will speak for the patient: proxy spokesperson, lasting power of attorney
What are the main causes of death in England and Wales?
What is the gold standards framework?
Systematic, evidence based approach to optimising care for all patients approaching the end of life, delivered by generalist care providers. This includes care:-
For people considered to be at any stage in the final years of life
For people with any condition or diagnosis
For people in any setting, in whichever bed they are in
Provided by anyone in health or social care
At any time needed
What is the gold standards framework surprise question?
Would you be surprised if your patient dies within the next few months, weeks or days?
If the answer is ‘no’ then check for general and specific indicators of deterioration and if present put on GSF register
What is the SPICT tool?
Supportive and Palliative Care Indicators Tool
Guide to identifying patients likely to die in the next 12 months
What are the general indicators of deteriorating health used in the SPICT tool?
Performance status poor or deteriorating, limited reversibility (Needs help with personal care, in bed/chair for 50% or more of day)
2 or more unplanned hospital admissions in past 6 months
Weight loss (5 – 10%) over past 3 – 6 months
Persistent, troublesome symptoms despite optimal treatment of any
Lives in nursing care home or NHS continuing care unit, or needs care to remain at home
Patient requests supportive and palliative care, or treatment withdrawal