Advanced Oncology Admissions

What is neo-adjuvant?

Treatment prior to definitive radical treatment

What is Adjuvant?

Treatment post definitive treatment → should be cancer free

What is Radical?

Curative approach

What is palliative?

Non-curative treatment of cancer with a focus on quality of life and possible increase in life expectance. They may have multiple lines of palliative treatment

What is Best Supportive Care?

No further systemic oncological treatment lines are available or appropriate (exp hormones).

What is Terminal?

from which death can reasonably be expected within a timeframe of days.

What are the Pain characteristics suggesting spinal metastases:?

• severe unremitting back pain

• progressive back pain

• mechanical pain

  • (aggravated by standing, sitting or moving)

• back pain aggravated by straining

  • (for example, coughing, sneezing or bowel movements)

• night-time back pain disturbing sleep

• localised tenderness

• claudication

  • (muscle pain or cramping in the legs when walking or exercising).

What are the Symptoms and signs suggesting cord compression?

• bladder or bowel dysfunction

• gait disturbance or difficulty walking

• limb weakness

• neurological signs of spinal cord or cauda equina compression

• numbness, paraesthesia or sensory loss

• radicular pain.

What is more common in cancer/chemo?

Febrile Neutropenia more common

What are points to remember with older patients?

• Early trauma scanning

• Anticoagulation reversal

• Pain relief and hydration (helps prevent delirium)

• Know your local pathways for referral to specialist services

• Patient’s and relative’s wishes need to be considered

PE and cancer?

• VTE risk 9x higher than in general population.

• Increased risk: both cancer and anti-cancer treatments.

  • of bleeding whilst anti-coagulated

  • of recurrent VTE

• More likely in: pancreatic, gastric, lung or primary brain.

Dose VTE cancer?

Apixaban 10mg every 12 hr for 7 days

How does immunotherapy work?

• De-active the t-cells in two ways.

• PD-L1: tumour cell deactivates T-cell

• CTLA-4: Blocks the antigen from connecting to the T-cell and activating it.

What are the toxicity effects immunotherapy?

Skin → dermatitis
Hepatic → Transaminitis
Gastro → Colitis
Renal
Eye
Endocrine
Pulmonary → Pneumonitis
Neurologic