oncology

• Adjuvant hormonal therapy for ER +ve breast cancer: anastrozole in post-menopausal women 
• Local anesthetic toxicity can be treated with IV 20% lipid emulsion 
• The first-line investigation of a testicular mass is an ultrasound
• Beta-hCG may be raised in some testicular cancers, usually non-seminomas. As this test is not sensitive for all types of testicular cancer it is not used as a first line investigation. 
• Non-seminoma germ cell testicular tumours (e.g. teratomas) are associated with raised hCG and AFP
• CA 15-3 is a tumour marker most commonly associated with breast cancer. It may also be raised in benign breast diseases, benign liver disease, sarcoidosis, and lupus.CA 19-9 is a tumour marker most commonly associated with pancreatic cancer, but can also be associated with colorectal cancer and hepatocellular carcinoma.
• PSA is an enzyme produced in the prostate. Physiologically, it has a role in liquifying semen to allow the sperm to mobilise more easily, and in thinning of the cervical mucous. It is raised in prostate cancer, as well as in prostatitis and benign prostatic hyperplasia. It is not classically raised in teratomas.
• CEA is a glycoprotein that is used as a tumour marker, primarily in colorectal cancer. It can also be raised in gastric, pancreatic, lung, and breast cancer.
• Consider non-urgent referral in people aged < 30 years with an unexplained breast lump with or without pain
• MEN type I

  3 P's

  Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasiaPituitary (70%)Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)Also: adrenal and thyroid

  Medullary thyroid cancer (70%) 

  MEN type IIa

  2 P's

  Parathyroid (60%)Phaeochromocytoma

  Medullary thyroid cancer

  MEN type IIb

  1 P

  PhaeochromocytomaMarfanoid body habitusNeuromas
• Moderate Severe asthma

  PEFR 50-75% best or predictedSpeech normalRR < 25 / minPulse < 110 bpm

  Severe asthma

  PEFR 33 - 50% best or predictedCan't complete sentencesRR > 25/minPulse > 110 bpm

  Life-threatening asthma

  PEFR < 33% best or predictedOxygen sats < 92%Silent chest, cyanosis or feeble respiratory effortBradycardia, dysrhythmia or hypotensionExhaustion, confusion or coma
• Severe asthma PEFR 33 - 50% best or predicted
• • Small Cell Lung Cancer (SCLC): A fast-growing type of lung cancer, primarily linked to smoking, accounting for about 15% of cases.
• • Paraneoplastic Syndromes: Health issues caused by Small Cell Lung Cancer that are not directly due to the tumour itself.
  • SIADH: Causes low sodium levels due to excessive water retention.
  • Cushing's Syndrome: Results from excess cortisol production, leading to weight gain, high blood pressure, and diabetes.
  • Lambert-Eaton Myasthenic Syndrome (LEMS): Causes muscle weakness due to immune attack on nerve endings.
  • Hypercalcaemia: Rarely occurs; leads to high calcium levels causing confusion and weakness.
• Adenocarcinoma of the lung is associated with gynaecomastia. 
• The central adipose deposition, 'moon face', new hypertension and impaired glucose tolerance are all in keeping with Cushing's syndrome, This is a paraneoplastic phenomenon seen in small cell lung cancer due to the tumour secreting ACTH. 
• Continuous positive airway pressure (CPAP)  This is a type of non-invasive ventilation but principally it helps with oxygenation by delivering positive pressure, which helps maintain open airways. It is used in conditions where the principal pathophysiology is type 1 respiratory failure i.e. pulmonary oedema/covid pneumonitis.
• Aromatase inhibitors (e.g. anastrozole) may cause osteoporosis
• Chronic myeloid leukaemia - imatinib = tyrosine kinase inhibitor
• HPV subtypes 16,18, 33 are carcinogenic and increase the risk of cervical cancer
• Spinal cord compression - back pain is the earliest and most common symptom
• Dexamethasone is used to suppress nausea and vomiting with intracranial tumours
• Squamous cell lung cancer has the strongest association with smoking
• BRCA2 mutation is associated with prostate cancer in men
• If neoplastic spinal cord compression is suspected, high-dose oral dexamethasone should be given whilst awaiting investigations
• Woman with bone metastases- most likely to originate in the breast