Oncology (II)

Here’s my first post in this series. Below some more quotes and links related to the book’s coverage.

Types of Pain
1. Nociceptive pain
a. Somatic pain: Cutaneous or musculoskeletal tissue (ie, bone, soft tissue metastases). Usually well-localized, increased w/use/movement.
b. Visceral pain: Compression, obstruction, infiltration, ischemia, stretching, or inflammation of solid & hollow viscera. Diffuse, nonfocal.
2. Neuropathic pain: Direct injury/dysfunction of peripheral or CNS tissues. Typically burning, radiating, may increase at rest or w/nerve stretching.
Pain emergencies: Pain crisis, spinal cord compression, fracture, bowel obstruction, severe mucositis, acute severe side effects of opioids (addiction crisis, delirium, respiratory depression), severe pain in imminently dying pt [patient, US]
Pain mgmt at the end of life is a moral obligation to alleviate pain & unnecessary suffering & is not euthanasia. (Vacco vs. Quill, U.S. Supreme Court, 1997)”

Nausea and Vomiting
Chemotherapy-induced N/V — 3 distinct types: Acute, delayed, & anticipatory. Acute begins 1–2 h after chemotherapy & peaks at 4–6 h, delayed begins at 24 h & peaks at 48–72 h, anticipatory is conditioned response to nausea a/w previous cycles of chemotherapy”

Constipation […] affects 50% of pts w/advanced CA; majority of pts being treated w/opioid analgesics, other contributors: malignant obstruction, ↓ PO/fluid intake, inactivity, anticholinergics, electrolyte derangement”

Prevalence/screening — occurs in up to 75% of all solid tumor pts & up to 99% of CA pts receiving multimodality Rx. Providers should screen for fatigue at initial visit, at dx [diagnosis, US] of advanced dz [disease] & w/each chemo visit; should assess for depression & insomnia w/new dx of fatigue (JCO 2008;23:3886) […] Several common 2° causes to eval & target include anemia (most common), thyroid or adrenal insufficiency, hypogonadism”

*Definition — disturbances in level of consciousness, attention, cognition, and/or perception developing abruptly w/fluctuations over course of d *Clinical subtypes — hyperactive, hypoactive, & mixed […] *Maximize nonpharm intervention prior to pharmacology […] *Use of antipsychotics should be geared toward short-term use for acute sx [symptoms, US] *Benzodiazepines should only be initiated for delirium as an adjunct to antipsychotics in setting of agitation despite adequate antipsychotic dosing (JCO 2011;30:1206)”

Cancer Survivorship
Overview *W/improvement in dx & tx of CA, there are millions of CA survivors, & this number is increasing
*Pts experience the normal issues of aging, w/c are compounded by the long-term effects of CA & CA tx
*CA survivors are at ↑ risk of developing morbidity & illnesses at younger age than general population due to their CA tx […] ~312,570 male & ~396,080 female CA survivors <40 y of age (Cancer Treatment and Survivorship Facts and Figures 2016–2017, ACS) *Fertility is an important issue for survivors & there is considerable concern about the possibility of impairment (Human Reproduction Update 2009;15:587)”

“Pts undergoing cancer tx are at ↑ risk for infxn [infection, US] due to disease itself or its therapies. […] *Epidemiology: 10–50% of pts w/ solid tumors & >80% of pts with hematologic tumors *Source of infxn evident in only 20–30% of febrile episodes *If identified, common sites of infxn include blood, lungs, skin, & GI tract *Regardless of microbiologic diagnosis, Rx should be started within 2 h of fever onset which improves outcomes […] [Infections in the transplant host is the] Primary cause of death in 8% of auto-HCT & up to 20% of allo-HCT recipients” [here’s a relevant link, US].

Localized prostate cancer
*Epidemiology Incidence: ~180000, most common non-skin CA (2016: U.S. est.) (CA Cancer J Clin 2016:66:7) *Annual Mortality: ~26000, 2nd highest cause of cancer death in men (2016: U.S. est) […] Mortality benefit from screening asx [asymptomatic, US] men has not been definitively established, & individualized discussion of potential benefits & harms should occur before PSA testing is offered. […] Gleason grade reflects growth/differentiation pattern & ranges from 1–5, from most to least differentiated. […] Historical (pre-PSA) 15-y prostate CA mortality risk for conservatively managed (no surgery or RT) localized Gleason 6: 18–30%, Gleason 7: 42–70%, Gleason 8–10: 60–87% (JAMA 1998:280:975)”

Bladder cancer […] Most common malignancy of the urinary system, ~77000 Pts will be diagnosed in the US in 2016, ~16000 will die of their dz. […] Presenting sx: Painless hematuria (typically intermittent & gross), irritative voiding sx (frequency, urgency, dysuria), flank or suprapubic pain (symptomatic of locally advanced dz), constitutional sx (fatigue, wt loss, failure to thrive) usually symptomatic of met [metastatic, US] dz


WHO analgesia ladder. (But see also this – US).
Renal cell carcinoma (“~63000 new cases & ~1400 deaths in the USA in 2016 […] Median age dx 64, more prevalent in men”)
Germ cell tumour (“~8720 new cases of testicular CA in the US in 2016 […] GCT is the most common CA in men ages of 15 to 35 y/o”)
Non-small-cell lung carcinoma (“225K annual cases w/ 160K US deaths, #1 cause of cancer mortality; 70% stage III/IV *Cigarette smoking: 85% of all cases, ↑ w/ intensity & duration of smoking”)
Small-cell lung cancer. (“SCLC accounts for 13–15% of all lung CAs, seen almost exclusively in smokers, majority w/ extensive stage dz at dx (60–70%). Lambert–Eaton myasthenic syndrome (“Affects 3% of SCLC pts”).
Thymoma. Myasthenia gravis. Morvan’s syndrome. Masaoka-Koga Staging system.
Pleural mesothelioma (“Rare; ≅3000 new cases dx annually in US. Commonly develops in the 5th to 7th decade […] About 80% are a/w asbestos exposure. […] Develops decades after asbestos exposure, averaging 30–40 years […] Median survival: 10 mo. […] Screening has not been shown to ↓ mortality even in subjects w/ asbestos exposure”)
Hepatocellular Carcinoma (HCC). (“*6th most common CA worldwide (626,000/y) & 2nd leading cause of worldwide CA mortality (598,000/y) *>80% cases of HCC occur in sub-Saharan Africa, eastern & southeastern Asia, & parts of Oceania including Papua New Guinea *9th leading cause of CA mortality in US […] Viral hepatitis: HBV & HCV are the leading RFs for HCC & accounts for 75% cases worldwide […] While HCV is now the leading cause of HCC in the US, NASH is expected to become a risk factor of increasing importance in the next decade”). Milan criteria.
CholangiocarcinomaKlatskin tumor. Gallbladder cancer. Courvoisier’s sign.
Pancreatic cancer (Incidence: estimated ~53,070 new cases/y & ~42,780 D/y in US (NCI SEER); 4th most common cause of CA death in US men & women; estimated to be 2nd leading cause of CA-related mortality by 2020″). Trousseau sign of malignancy. Whipple procedure.

October 21, 2018 - Posted by | Books, Cancer/oncology, Gastroenterology, Medicine, Nephrology, Neurology, Psychiatry

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