Cancer Overview: Ovarian, Testicular Cancer, Hypercalcemia

Cancer Ovarian Cancer: platinum-based drugs are the first-line treatment (Carboplatin & Taxol) If a patient with malignancy presents with acute neck pain with focal neurological deficits this is a ‘red flag’ for urgent investigation. An urgent MRI spine is required to assess for spinal cord compre...

Cancer Ovarian Cancer: platinum-based drugs are the first-line treatment (Carboplatin & Taxol) If a patient with malignancy presents with acute neck pain with focal neurological deficits this is a ‘red flag’ for urgent investigation. An urgent MRI spine is required to assess for spinal cord compression (which is caused by plasmacytoma). Conditions: Testicular Cancer: Alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG) are key tumour markers for testicular cancers. Risk Factors: undescended testes, male infertility, family history and increased height - Testicular cancer arises from the germ cells in the testes (which produces sperm). Presentation: painless lump on testicle, non-tender (feeling numb on palpation), reduced sensation, hard, irregular. Hypercalcemia in cancer patient: Hypercalcemia is common in patients with cancer, due to increased bone resorption and release of calcium from bone. The most common cause of hypercalcemia in patients with non-metastatic solid tumours is secretion of PTHrP. When managing hypercalcemia, a crucial aspect is the rehydration of patients. To achieve this, administering 3 litres of normal saline daily is recommended. This fluid therapy enhances calcium excretion from the body. The Staging and Grading of Cancer - Grade: reflection of how abnormal the cells look under the microscope, in cancer cells become deregulated and proliferate abnormally (dysplasia). As dysplasia develops, the cancer cells lose features, become less differentiated and presumed to be higher grade.  - Stage: reflection of the degree of spread. Helps guide treatment, estimate prognosis, compare results overtime and standardise clinical trials. TNM Staging System: Tumour Stage: extent of local and primary tumour growth: - T0: no tumour - TIS: carcinoma in situ - T1,2,3, 4: size and extent of primary local tumour Nodal Status: refers to the presence or absence of malignancy in the regional lymph nodes - N0: no nodal malignancy - N1, N2, N3: degree of lymph nodes involved Metastasis: refers to the absence or presence of metastasis - M0: no metastasis - M1, M2 – type or location According to the NICE guidelines, concurrent chemoradiotherapy is the recommended initial treatment for limited stage small cell lung cancer. The goal is to target both the primary tumour and any potential micro metastases to maximise chances of disease control and improve overall survival outcomes. Colorectal Cancer: CEA (Carcinoembryonic antigen) is a tumour marker most commonly used to monitor patients with colorectal malignancies. It is a glycoprotein present in normal mucosal cells, its levels increase in adenocarcinoma, particular if colorectal. As its sensitivity and specificity is low, it is only used to monitor disease rather than as a diagnostic tool. Patients receiving chemotherapy are at risk of developing neutropenic sepsis, defined as pyrexia – this is life threatening illness that can progress to septic shock. Evidence shows that prompt administration of broad-spectrum IV antibiotics Breast cancer is more common in females with a history of ovarian cancer. Higher socio-economic groups are associated with an increased risk of breast cancer. With a superior vena cava obstruction, the immediate treatment is dexamethasone infusion to reduce swelling, but the only long-term symptoms relief is stenting the SVC. Lymphoma: a type of cancer affecting the lymphocytes inside the lymphatic system. Cancerous cells proliferate inside the lymph nodes, causing them to become abnormally large (lymphadenopathy). Hodgkin’s Lymphoma is the most common specific type of lymphoma, presents with Reed-Sternberg cells. - Risk factors: HIV, Epstein-Barr virus, autoimmune conditions (rheumatoid arthritis and sarcoidosis) and family history. Symptoms include unexplained fever, weight loss, fatigue and lymphadenopathy in the neck, armpits and groin, Non-Hodgkin Lymphoma: all other blood cancers. - Risk factors: HIV, Epstein-Barr virus, H.pylori infection, Hep B or C, exposure to pesticides and family history When managing hypercalcaemia (elevated calcium), a crucial aspect is the rehydration of patients – which is achieved by administering 3litres of normal saline. Etoposide (chemotherapy medication): is a topoisomerase II inhibitor (which is a crucial enzyme in chromosome condensation and regulation during the cell cycle). This drug forms a complex with the enzyme and prevents DNA re-joining – causing breaks and arresting the cell cycle, thus, halting tumour growth. In men with prostate cancer, the treatment of choice for pain relief is external beam radiation therapy (EBRT). In prostate cancer, bone metastases are common – especially to the spine CEA = tumour marker for colorectal malignancies. AFP & hCG = tumour marker for testicular cancer