Clinical Problems in Oncology A Practical Guide to Management

Clinical Problems in Oncology: A Practical Guide to Management is an easy-to-use, compact
reference with essential, practical information on managing oncological emergencies, as well as
the side effects and complications of cancer and its treatment. Because patient responses can vary
widely, depending on the type of treatment prescribed, this resource offers medical professionals
the specific information they need to improve the evaluation and treatment of cancer patients at
the point of care.

The compact format includes a wide range of clinical information, from the dose of drugs that would
typically be used, through guidance on the practical procedures that are frequently used
to treat oncology patients. Some of the book’s highlights include:

• Toxicity grading and management, including at-a-glance summaries of the most common toxicities associated with chemotherapy
• Prescribing guidelines, including how to write up electrolyte replacement properly
• Information on specialised oncology procedures (such as SIR spheres), and how to manage complications
• Types of vascular access lines and how to check their position, access them and troubleshoot problems

With an expert team of writers who have contributed materials in their areas of expertise, Clinical
Problems in Oncology is an ideal reference for oncologists in training, oncologists in non-training
positions, oncology registrars and general practitioners.

List of contributors, ix

Preface, xi

Acknowledgements xii

List of abbreviations xiii

1 Introduction to clinical problems in oncology 1
Sing Yu Moorcraft

General approach to the management of oncology patients 2

Performance status 6

Tumour markers 6

2 Oncological emergencies 13
Daniel L.Y. Lee

Anaphylaxis and hypersensitivity reactions 13

Bleeding 16

Central airway obstruction and stridor 19

Extravasation 23

Febrile neutropenia 28

Hypercalcaemia 30

Non-neutropenic sepsis 34

Raised intracranial pressure and seizures 36

Spinal cord compression 41

Superior vena cava obstruction 45

Transfusion reactions 48

Tumour lysis syndrome 50

3 Side effects and complications of cancer and its treatment 53
Alexandra Pender, Sing Yu Moorcraft and Daniel L.Y. Lee

Overview of toxicity management 54

Abnormal liver function tests 57

Alopecia 60

Anaemia 62

Anorexia and nutrition 66

Ascites 69

Bone metastases and osteoporosis 71

Bowel obstruction 75

Breathlessness 77

Chest pain and other cardiac complications 81

Confusion and decreased conscious level 86

Constipation 91

Dental disorders 93

Diarrhoea 95

Dysphagia 100

Fatigue 104

Fertility and pregnancy 106

Haematuria 113

Hearing loss 115

Hiccups 117

Hyperglycaemia and hypoglycaemia 119

Hypertension and hypotension 123

Lymphoedema 127

Mucositis 129

Nausea and vomiting 133

Neuropathy 138

Neutropenia 142

Proteinuria 145

Pruritus 146

Psychiatric disorders 149

Rash 154

Renal failure and hydronephrosis 163

Sexual dysfunction 166

Thrombocytopenia 170

Thromboembolism 173

Vaccinations and immunoglobulin 178

Visual symptoms 180

4 Introduction to radiotherapy 185
Emma Dugdale, Alexandra Gilbert and Robin Prestwich

Introduction to radiotherapy 185

Methods of delivery of radiotherapy 186

5 Radiotherapy side effects and their management 193
Alexandra Gilbert, Emma Dugdale and Robin Prestwich

Overview of radiotherapy toxicity 193

Overview of radical radiotherapy treatment and side effect management by anatomical treatment site 195

Brain 195

Head and neck 196

Breast 200

Thorax 200

Abdomen 204

Pelvis 205

Skin toxicities 211

Total body irradiation 214

6 Endocrine therapy, immunotherapy and targeted therapies 215
Samantha Turnbull

Endocrine therapy 215

Immunotherapy 218

Targeted therapies 220

7 Electrolyte abnormalities 225
Sing Yu Moorcraft

Hypocalcaemia 225

Hyperkalaemia and hypokalaemia 227

Hypermagnesaemia and hypomagnesaemia 231

Hypernatraemia and hyponatraemia 234

Hyperphosphataemia and hypophosphataemia 237

8 Palliative care and pain management 241
Karen Neoh

Pain management 241

Overview of pain management 241

Opioid prescribing in palliative care 245

Opioid toxicity 251

Syringe pumps 252

End-of-life care 253

9 Oncology procedures and their complications 257
Juanita Lopez

Ascitic drains (paracentesis) 257

Biliary drains and stents 259

Central venous access devices 261

Chemoembolisation 265

Chest drains and pleurodesis 266

Enteral feeding tubes 269

Nephrostomies and ureteric stents 270

Oesophageal stents and dilatation 272

Radioembolisation (SIR-spheres®) 273

Radiofrequency ablation (RFA) 275

10 Cancer drug development and funding 277
Sing Yu Moorcraft

Clinical trials 277

Funding of cancer drugs 280

Personalised medicine 282

Appendices 287
Sing Yu Moorcraft and Daniel L.Y. Lee

Chemotherapy regimes 287

Drug toxicities 287

Useful resources 296

Index 301

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.