Clinical Problems in Oncology	5
	Copyright	6
	Contents	7
	List of contributors	11
	Preface	13
	Acknowledgements	14
	List of abbreviations	15
	Chapter 1 Introduction to clinical problems in oncology	21
	General approach to the management of oncology patients	22
	Types of treatment	22
	Tumour types and extent of disease	22
	Other important tumour characteristics	23
	Decision making in cancer patients	23
	Assessing response to treatment	25
	References	25
	Performance status	26
	Tumour markers	26
	Overview	26
	Current uses of tumour markers	27
	Common tumour markers	27
	Other relevant sections of this book	32
	References	32
	Chapter 2 Oncological emergencies	33
	Anaphylaxis and hypersensitivity reactions	33
	Definition	33
	Causes	33
	Symptoms and signs	34
	Management	34
	Localised hypersensitivity reaction	34
	Anaphylaxis	34
	Observation a nd biphasic reactions	35
	Ongoing management and retreatment	35
	References	36
	Bleeding	36
	Overview	36
	Clinical presentation	36
	Clinical assessment	37
	Management	37
	Disseminated intravascular coagulopathy (DIC)	38
	End of life considerations/catastrophic bleed	39
	Other relevant sections of this book	39
	References	39
	Central airway obstruction and stridor	39
	Definition	39
	Causes	40
	Symptoms	41
	Investigation	41
	Management	41
	References	43
	Extravasation	43
	Definition	43
	Risk factors and prevention of extravasation	43
	Diagnosis	45
	Differential diagnoses	45
	Management	45
	Central venous device extravasation	47
	Recall injury	47
	Surgical referral	47
	References	48
	Febrile neutropenia	48
	Definition	48
	Background	48
	Assessment	49
	Management	49
	Future cancer management	50
	References	50
	Hypercalcaemia	50
	Symptoms/signs	51
	Causes	51
	Management	52
	References	53
	Non-neutropenic sepsis	54
	Definitions	54
	Presentation and management	54
	Other relevant sections of this book	56
	References	56
	Raised intracranial pressure and seizures	56
	Raised intracranial pressure (ICP)	56
	Seizures	58
	References	60
	Spinal cord compression	61
	Definition	61
	Presentation	61
	Risk factors	62
	Early detection of spinal metastases	63
	MSCC as an oncological emergency	63
	Treatment	64
	Management after definitive treatment	65
	References	65
	Superior vena cava obstruction	65
	Causes	65
	Presentation	66
	Investigations	66
	Treatment	66
	References	67
	Transfusion reactions	68
	Mild fever only	68
	Urticaria/mild allergic reaction only	68
	ABO incompatibility	68
	Severe allergic reaction	68
	Haemolytic reaction or bacterial infection of unit of transfusion	69
	Acute dyspnoea/hypotension	69
	Other relevant sections of this book	69
	References	70
	Tumour lysis syndrome	70
	Definition	70
	Classification	70
	Causes	71
	Risk assessment	71
	Management	72
	Other relevant sections of this book	72
	References	72
	Chapter 3 Side effects and complications of cancer and its treatment	73
	Overview of toxicity management	74
	Assessment and documentation of toxicities	74
	Advice to patients	74
	Principles of toxicity management	75
	Effects of dose reductions and/or delays on treatment efficacy	76
	References	76
	Abnormal liver function tests	77
	Abnormal liver function	77
	Assessment	77
	Causes of hepatitic liver dysfunction	78
	Causes of obstructive liver dysfunction	78
	Investigations	79
	Management	79
	Prescribing and liver function	79
	Other relevant sections of this book	79
	References	80
	Alopecia	80
	Symptoms and signs	80
	Causes	80
	Management	81
	References	82
	Anaemia	82
	Causes	83
	Symptoms and signs	84
	Investigations	84
	Management	84
	Refusal of blood products	85
	Palliative care	86
	Other relevant sections of this book	86
	References	86
	Anorexia and nutrition	86
	Anorexia	86
	Cachexia	87
	Causes of reduced calorific intake	87
	Management	87
	Other relevant sections of this book	88
	References	88
	Ascites	89
	Symptoms/signs and causes	89
	Management	90
	Other management approaches	90
	Other relevant sections of this book	91
	References	91
	Bone metastases and osteoporosis	91
	Bone metastases	91
	Osteoporosis	94
	Other relevant sections of this book	95
	References	95
	Bowel obstruction	95
	Symptoms	96
	Management	96
	References	97
	Breathlessness	97
	Symptoms and signs	98
	Causes	98
	Management	99
	Lymphangitis	99
	Pleural effusion	99
	Pneumonitis	100
	Other relevant sections of this book	100
	References	100
	Chest pain and other cardiac complications	101
	Chest pain	101
	Arrhythmias	102
	Pericardial effusions and pericarditis	104
	Pericarditis/myocarditis	104
	Heart failure	104
	Radiation-related cardiac injury	105
	Other cardiac complications	105
	References	105
	Confusion and decreased conscious level	106
	Delirium and confusion	106
	References	110
	Constipation	111
	Causes	111
	Symptoms	112
	Management	112
	References	113
	Dental disorders	113
	General dental advice	113
	Osteonecrosis of the jaw	113
	References	115
	Diarrhoea	115
	Symptoms and signs	115
	Differential diagnoses and their management	116
	Other relevant sections of this book	120
	References	120
	Dysphagia	120
	Symptoms and signs	120
	Causes	121
	Investigations	121
	Management	121
	Other techniques	123
	Other relevant sections of this book	123
	References	123
	Fatigue	124
	Overview	124
	Management	124
	Other relevant sections of this book	126
	References	126
	Fertility and pregnancy	126
	Fertility	126
	Factors influencing fertility post treatment	127
	Possible causes of reduced pre-treatment fertility in male cancer patients	127
	Possible cause of reduced fertility in female cancer patients	131
	Methods of fertility preservation	131
	Fertility preservation for men	131
	Fertility preservation for women	131
	Pregnancy following cancer treatment	132
	Cancer in pregnancy	132
	References	133
	Haematuria	133
	Causes	134
	Symptoms	134
	Investigations and management	134
	Haemorrhagic cystitis	135
	References	135
	Hearing loss	135
	Causes	135
	Risk factors	136
	Audiological testing	136
	References	137
	Hiccups	137
	Pathophysiology	137
	Causes	138
	Investigations	138
	Treatment	138
	References	139
	Hyperglycaemia and hypoglycaemia	139
	Hyperglycaemia	140
	Hypoglycaemia	141
	References	143
	Hypertension and hypotension	143
	Hypertension	143
	Hypotension	145
	References	146
	Lymphoedema	147
	Symptoms and signs	147
	Causes	147
	Factors which may increase the risk of lymphoedema	147
	Diagnosis	148
	General advice for lymphoedema prevention and management	148
	Treatment	148
	References	149
	Mucositis	149
	Mucositis	149
	Risk factors	149
	Symptoms and consequences of mucositis	150
	Signs	150
	General advice	151
	Prevention	151
	Suggested general principles of treatment	151
	Neutropenic ulcers	152
	Herpes simplex virus-1 (HSV -1) associated mucositis	152
	Oral candidiasis	152
	Other relevant sections of this book	153
	References	153
	Nausea and vomiting	153
	Symptoms and signs	153
	Causes	154
	Managment	155
	Other relevant sections	158
	References	158
	Neuropathy	158
	Symptoms and signs	158
	Causes	158
	Other causes	160
	Management	160
	Neuroprotective treatment	161
	Pharmacological treatment	161
	Neurostimulation	161
	References	162
	Neutropenia	162
	Causes	162
	Management	163
	Management of unexpected neutropenia	163
	GCSF	164
	Other relevant sections of this book	164
	References	164
	Proteinuria	165
	Causes	165
	Symptoms	165
	Investigations	165
	Management	166
	Bevacizumab-related proteinuria	166
	References	166
	Pruritus	166
	Assessment	167
	Causes	167
	Management	168
	Other relevant sections of this book	169
	References	169
	Psychiatric disorders	169
	Adjustment disorder, depression and suicidal ideation	169
	Anxiety	170
	Psychosis	172
	Mental Capacity Act ( 2005)	172
	Mental Health Act 1983	173
	Other relevant sections of this book	173
	References	174
	Rash	174
	General advice	174
	Hand-foot syndrome due to chemotherapy	175
	Hand-foot syndrome due to tyrosine kinase inhibitors (e.g. sorafenib, sunitinib)	177
	Acneiform rash	177
	Skin cracking and fissuring	179
	Nail changes	180
	Xerosis (dry skin)	181
	Hyper or hypopigmentation	181
	Radiation recall	181
	Other skin toxicities	182
	Other relevant sections of this book	182
	References	182
	Renal failure and hydronephrosis	183
	Hydronephrosis	185
	Other relevant sections of this book	186
	References	186
	Sexual dysfunction	186
	Sexual dysfunction	186
	Symptoms and signs	186
	Management	188
	Other relevant sections of this book	190
	References	190
	Thrombocytopenia	190
	Aetiology	190
	Symptoms	192
	Investigations	192
	Management	192
	Heparin induced thrombocytopenia (HIT)	192
	Other relevant sections of this book	193
	References	193
	Thromboembolism	193
	Arterial thromboembolism (ATE)	197
	References	197
	Vaccinations and immunoglobulin	198
	Vaccinations	198
	Exposure to chickenpox	199
	References	200
	Visual symptoms	200
	Eye disorders	200
	Ocular toxicity	200
	References	204
	Chapter 4 Introduction to radiotherapy	205
	Introduction to radiotherapy	205
	Indications for radiotherapy	205
	Radiotherapy dose and fractionation	205
	Efficacy of radiotherapy	206
	Methods of delivery of radiotherapy	206
	External beam radiotherapy	206
	Newer techniques using external beam radiotherapy	207
	Brachytherapy	208
	Radioisotopes	209
	Palliative radiotherapy	209
	Paediatric radiotherapy	210
	References	211
	Chapter 5 Radiotherapy side effects and their management	213
	Overview of radiotherapy toxicity	213
	Risk of second malignancies	214
	Causes of toxicity	214
	The effect of radiotherapy schedules on toxicity	214
	Overview of radical radiotherapy treatment and side effect management by anatomical treatment site	215
	Brain	215
	Head and neck	216
	Other relevant sections of this book	220
	Breast	220
	Thorax	220
	Management of early respiratory toxicity	223
	Other relevant sections of this book	224
	Abdomen	224
	Pelvis	225
	Other relevant sections of this book	231
	Skin toxicities	231
	Assessment of skin reactions	232
	Management of early skin toxicity	233
	Management of late skin toxicity	233
	Total body irradiation	234
	References	234
	Chapter 6 Endocrine therapy, immunotherapy and targeted therapies	235
	Endocrine therapy	235
	Breast cancer	235
	Prostate cancer	236
	Other relevant sections of this book	237
	References	237
	Immunotherapy	238
	Introduction	238
	Ipilumumab and CTLA-4	238
	Interleukin-2 (IL-2)	238
	Interferon- ? (IFN- ?)	239
	Intravesical immunotherapy	239
	Cancer vaccines	239
	Future treatments	239
	Other relevant sections of this book	240
	References	240
	Targeted therapies	240
	Types of targeted therapies	240
	Examples of targeted therapies	241
	Other relevant sections of this book	244
	References	244
	Chapter 7 Electrolyte abnormalities	245
	Hypocalcaemia	245
	Pseudohypocalcaemia	245
	Symptoms/signs	245
	Causes	245
	Management	246
	Other relevant sections of this book	247
	References	247
	Hyperkalaemia and hypokalaemia	247
	Hyperkalaemia	247
	Hypokalaemia	249
	References	250
	Hypermagnesaemia and hypomagnesaemia	251
	Hypermagnesaemia	251
	Hypomagnesaemia	252
	References	254
	Hypernatraemia and hyponatraemia	254
	Hypernatraemia	254
	Hyponatraemia	255
	Syndrome of inappropriate antidiuretic hormone secretion (SIADH)	256
	References	257
	Hyperphosphataemia and hypophosphataemia	257
	Hyperphosphataemia	257
	Hypophosphataemia	258
	References	260
	Chapter 8 Palliative care and pain management	261
	Pain management	261
	Overview of pain management	261
	Opioid prescribing in palliative care	265
	Opioid toxicity	271
	Syringe pumps	272
	End-of-life care	273
	Advance care planning and NHS Continuing Healthcare funding	273
	The Gold Standards Framework	274
	End-of-life care plans	274
	References	275
	Chapter 9 Oncology procedures and their complications	277
	Ascitic drains (paracentesis)	277
	Overview of paracentesis	277
	Paracentesis procedure	278
	Complications and side effects	278
	Permanent indwelling catheter (PleurX® drain)	278
	Other relevant sections of this book	279
	References	279
	Biliary drains and stents	279
	Overview of biliary stenting	279
	Types of biliary stenting	279
	Complications	280
	Other relevant sections of this book	281
	References	281
	Central venous access devices	281
	Overview of central lines	281
	Checking the position of a central venous line	281
	Complications of a central venous line and their management	283
	Obstruction of venous devices	284
	References	285
	Chemoembolisation	285
	Background	285
	Overview of chemoembolisation	285
	Procedure	285
	Complications	286
	References	286
	Chest drains and pleurodesis	286
	Overview of chest drainage	286
	Chest drain procedure	286
	Monitoring	287
	Chest drain removal	287
	Complications	287
	Pleurodesis	288
	Permanent indwelling catheter (PleurX® drain)	288
	Other relevant sections of this book	288
	References	289
	Enteral feeding tubes	289
	Overview of enteral feeding tubes	289
	Complications due to procedure	289
	Late complications	289
	Other relevant sections of this book	290
	Nephrostomies and ureteric stents	290
	Background	290
	Overview of ureteric decompression	290
	Percutaneous nephrostomy and anterograde ureteric stenting	290
	Retrograde ureteric stenting	291
	Complications of ureteric stents	291
	Other relevant sections of this book	291
	References	291
	Oesophageal stents and dilatation	292
	Overview of oesophageal stents	292
	Procedure	292
	Early complications	292
	Delayed complications	292
	Oesophageal dilatation	293
	Other relevant sections of this book	293
	References	293
	Radioembolisation (SIR-spheres®)	293
	Background	293
	Overview of radioembolisation	293
	Procedure	294
	Radiation safety	294
	Complications	294
	References	295
	Radiofrequency ablation (RFA)	295
	Procedure	295
	Complications following RFA to liver metastases	295
	Complications following RFA to lung metastases	296
	References	296
	Chapter 10 Cancer drug development and funding	297
	Clinical trials	297
	Trial terminology	298
	Safety reporting	299
	References	299
	Funding of cancer drugs	300
	National Institute for Health and Care Excellence (NICE)	300
	Cancer Drugs Fund (CDF)	300
	Individual funding requests (IFR)	300
	Private healthcare	301
	Co-payment	301
	Clinical trials and expanded access programmes	301
	References	302
	Personalised medicine	302
	Molecular tests that may currently influence patient management outside of clinical trials	302
	References	305
	Appendices	307
	Chemotherapy regimes	307
	References	307
	Drug toxicities	307
	References	316
	Useful resources	316
	Index	321