Clinical Problems in Oncology A Practical Guide to

Management 1st Edition Sing Yu Moorcraft instant

download 2025

Now on sale at ebookgate.com

https://ebookgate.com/product/clinical-problems-in-oncology-a-
practical-guide-to-management-1st-edition-sing-yu-moorcraft/

★★★★★
4.8 out of 5.0 (89 reviews )

Download PDF Now

 Clinical Problems in Oncology A Practical Guide to
Management 1st Edition Sing Yu Moorcraft

EBOOK

Available Formats

■ PDF eBook Study Guide Ebook

EXCLUSIVE 2025 ACADEMIC EDITION – LIMITED RELEASE

Available Instantly Access Library

Instant digital products (PDF, ePub, MOBI) available
Download now and explore formats that suit you...

Clinical Pain Management A Practical Guide 1st Edition

Mary E. Lynch

https://ebookgate.com/product/clinical-pain-management-a-practical-
guide-1st-edition-mary-e-lynch/

ebookgate.com

Clinical Neuropsychology A Practical Guide to Assessment

and Management for Clinicians 2nd Edition Laura H.
Goldstein
https://ebookgate.com/product/clinical-neuropsychology-a-practical-
guide-to-assessment-and-management-for-clinicians-2nd-edition-laura-h-
goldstein/
ebookgate.com

A Practical Guide to Clinical Virology Second Edition L.

R. Haaheim

https://ebookgate.com/product/a-practical-guide-to-clinical-virology-
second-edition-l-r-haaheim/

ebookgate.com

The Myelodysplastic Syndromes Pathobiology and Clinical

Management Basic Clinical Oncology 1st Edition John
Bennett
https://ebookgate.com/product/the-myelodysplastic-syndromes-
pathobiology-and-clinical-management-basic-clinical-oncology-1st-
edition-john-bennett/
ebookgate.com
Polycystic Ovary Syndrome A Guide to Clinical Management
1st Edition Adam Balen

https://ebookgate.com/product/polycystic-ovary-syndrome-a-guide-to-
clinical-management-1st-edition-adam-balen/

ebookgate.com

Colorectal Cancer Multimodality Management Current

Clinical Oncology 1st Edition Leonard B. Saltz

https://ebookgate.com/product/colorectal-cancer-multimodality-
management-current-clinical-oncology-1st-edition-leonard-b-saltz/

ebookgate.com

Male Sexual Function A Guide to Clinical Management 1st

Edition John J. Mulcahy

https://ebookgate.com/product/male-sexual-function-a-guide-to-
clinical-management-1st-edition-john-j-mulcahy/

ebookgate.com

COPD A Guide to Diagnosis and Clinical Management 1st

Edition Leonardo M. Fabbri

https://ebookgate.com/product/copd-a-guide-to-diagnosis-and-clinical-
management-1st-edition-leonardo-m-fabbri/

ebookgate.com

Clinical Trials A Practical Guide to Design Analysis and

Reporting 1st Edition Duolao Wang

https://ebookgate.com/product/clinical-trials-a-practical-guide-to-
design-analysis-and-reporting-1st-edition-duolao-wang/

ebookgate.com
Clinical Problems in Oncology
Clinical Problems
in Oncology
A Practical Guide
to Management
Edited by

Sing Yu Moorcraft, MB BCh, MRCP

Clinical Research Fellow in Medical Oncology
The Royal Marsden NHS Foundation Trust
London, UK

Daniel L.Y. Lee, MB BCh, MRCP

Specialist Registrar in Medical Oncology
St James’ Institute of Oncology
Leeds, UK

David Cunningham, MD, FRCP, FMedSci

Consultant Medical Oncologist
The Royal Marsden NHS Foundation Trust
London, UK
This edition first published 2014 © 2014 by John Wiley & Sons, Ltd
Registered office
John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, UK
Editorial offices
9600 Garsington Road, Oxford OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, UK
111 River Street, Hoboken, NJ 07030-5774, USA
For details of our global editorial offices, for customer services and for information about how
to apply for permission to reuse the copyright material in this book please see our website at
www.wiley.com/wiley-blackwell
The right of the author to be identified as the author of this work has been asserted in accordance with
the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior
permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks. All brand
names and product names used in this book are trade names, service marks, trademarks or registered
trademarks of their respective owners. The publisher is not associated with any product or vendor
mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering
professional services. If professional advice or other expert assistance is required, the services of a
competent professional should be sought.
The contents of this work are intended to further general scientific research, understanding and
discussion only and are not intended and should not be relied upon as recommending or promoting
a specific method, diagnosis or treatment by health science practitioners for any particular patient.
The publisher and the author make no representations or warranties with respect to the accuracy or
completeness of the contents of this work and specifically disclaim all warranties, including without
limitation any implied warranties of fitness for a particular purpose. In view of ongoing research,
equipment modifications, changes in governmental regulations, and the constant flow of information
relating to the use of medicines, equipment and devices, the reader is urged to review and evaluate the
information provided in the package insert or instructions for each medicine, equipment or device for,
among other things, any changes in the instructions or indication of usage and for added warnings and
precautions. Readers should consult with a specialist where appropriate. The fact that an organization
or Website is referred to in this work as a citation and/or a potential source of further information does
not mean that the author or the publisher endorses the information the organization or Website may
provide or recommendations it may make. Further, readers should be aware that Internet Websites
listed in this work may have changed or disappeared between when this work was written and when it
is read. No warranty may be created or extended by any promotional statements for this work. Neither
the publisher nor the author shall be liable for any damages arising herefrom.
Library of Congress Cataloging-in-Publication Data
Clinical problems in oncology : a practical guide to management / edited by Sing Yu Moorcraft,
Daniel L.Y. Lee, David Cunningham.
   p. ; cm.
 Includes bibliographical references and index.
 ISBN 978-1-118-67382-9
 I. Moorcraft, Sing Yu, editor of compilation. II. Lee, Daniel L. Y., editor of compilation.
III. Cunningham, David, 1954 December 4– editor of compilation.
[DNLM: 1. Neoplasms–Handbooks. 2. Clinical Medicine–methods–Handbooks. QZ 39]
RC261
616.99′4–dc23
2014001178
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may
not be available in electronic books.
Set in 9/11.5pt Meridien by SPi Publisher Services, Pondicherry, India

1 2014
Contents

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

v
vi   Contents

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
 Contents   vii

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
Visit https://ebookgate.com today to explore
a vast collection of ebooks across various
genres, available in popular formats like
PDF, EPUB, and MOBI, fully compatible with
all devices. Enjoy a seamless reading
experience and effortlessly download high-
quality materials in just a few simple steps.
Plus, don’t miss out on exciting offers that
let you access a wealth of knowledge at the
best prices!
viii   Contents

Appendices, 287
Sing Yu Moorcraft and Daniel L.Y. Lee
Chemotherapy regimes, 287
Drug toxicities, 287
Useful resources, 296
Index, 301
List of contributors

Emma Dugdale, MB ChB, MRCP, FRCR

Specialist Registrar in Clinical Oncology, St James’s Institute of Oncology, Leeds, UK

Alexandra Gilbert, BSc, MBBS, MRCP

National Institute for Health Research Doctoral Research Fellow in Clinical Oncology,
St James’ Institute of Oncology, Leeds, UK

Daniel L.Y. Lee, MB BCh, MRCP

Specialist Registrar in Medical Oncology, St James’ Institute of Oncology, Leeds, UK

Juanita Lopez, MB BChir, MRCP, PhD

Specialist Registrar in Medical Oncology, The Royal Marsden NHS Foundation Trust,
London, UK

Sing Yu Moorcraft, MB BCh, MRCP

Clinical Research Fellow in Medical Oncology, The Royal Marsden NHS Foundation Trust,
London, UK

Karen Neoh, MBChB, MRCP

Academic Clinical Fellow in Palliative Medicine, St Gemma’s Academic Unit of Palliative
Care, Leeds, UK

Alexandra Pender, MB BCh, MRCP

Academic Clinical Fellow in Medical Oncology, The Royal Marsden NHS Foundation Trust,
London, UK

Robin Prestwich, FRCR, PhD

Consultant Clinical Oncologist, St James’ Institute of Oncology, Leeds, UK

Samantha Turnbull, MB ChB, MRCP

Specialist Registrar in Medical Oncology, St James’ Institute of Oncology, Leeds, UK

ix
Preface

Clinical Problems in Oncology: A Practical Guide to Management was written by a group

of trainees who found that there was no good source of information to guide
them through the day-to-day management of patients with cancer.
The book, which is also available electronically, aims to provide a clear and yet
concise description of how to deal with the day-to-day challenges of working
within an oncology team. This includes essential background, such as the design
and conduct of clinical trials, assessment of tumour response, evaluation of the
performance status of patients and an overview of the concept of personalised
medicine. There are also chapters outlining how to treat tumour-related symp-
toms and manage the side effects of conventional chemotherapy and the new
class of targeted agents. The chapters on radiotherapy provide a grounding in this
important aspect of cancer care, including practical solutions to assist clinicians
looking after patients receiving this treatment, and there is also a detailed descrip-
tion of the management of oncological emergencies.
The objective of the authors was to provide a comprehensive source of infor-
mation that would guide the trainee through their time on the ward, clinic and
acute medical assessment unit. We have therefore included information that
trainees will need to successfully function in these environments, ranging from
the dose of drugs that would be typically used, through to guidance on the practi-
cal procedures that are frequently used to treat patients with cancer. We hope a
copy of the book will find its way onto wards and clinics throughout the country
and will become established as a reliable and comprehensive clinical guide to
assist busy trainees.

Professor David Cunningham

xi
Acknowledgements

We would like to thank Dr Kimberley Goldstein-Jackson and Niamh Cunningham

for taking the time to read the manuscript and for their constructive comments.
We would also like to thank Jane Ashton and Emily Wighton for reviewing
the manuscript from a pharmacist’s perspective and Dr Liz O’Mahony for her
comments on the Psychiatric disorders section. Finally, but by no means least, we
are indebted to our families and friends, particularly John Moorcraft and
Shaune Teasdale, for their support and patience during the preparation of this
manuscript.

xii
List of abbreviations

5-FU 5-fluorouracil
A&E accident and emergency
ABG arterial blood gas
ACE angiotensin converting enzyme
ADL activities of daily living
ADT androgen deprivation therapy
AE adverse event
AF atrial fibrillation
AFP alpha-fetoprotein
ALK anaplastic lymphoma kinase
ALP alkaline phosphatase
ALT alanine aminotransferase
AR adverse reaction
AST aspartate aminotransferase
ATE arterial thromboembolism
BCG Bacillus Calmette-Guérin
BD bis di (twice daily)
BMI body mass index
BNF British National Formulary
BP blood pressure
BRCA1 breast cancer gene 1
BRCA2 breast cancer gene 2
BTA bladder tumour antigen
CA carbohydrate antigen
CBD common bile duct
CCF congestive cardiac failure
CDF Cancer Drugs Fund
CEA carcinoembryonic antigen
CID chemotherapy-induced diarrhoea
COPD chronic obstructive pulmonary disease
CML chronic myeloid leukaemia
CNS central nervous system
CPAP continuous positive airway pressure
CR complete response
CRP C-reactive protein
CRPC castration-resistant prostate cancer
CSF cerebrospinal fluid
CT computerised tomography
CTCAE Common Terminology Criteria for Adverse Events
CTPA computed tomography pulmonary angiogram
CVC central venous catheter

xiii
actual

than

new 42

sight forests over

the these They

Ottomar right so

what 367 North

English typical

playing would and

the Omsk

bullet utters

lay while

months animal they

evening

bones minutes in

Railway Perhaps South

American
one

flung are

squirrel the vouch

relatives elephant

by even TIGER

forward is

their detected in
Zoological francolins 56

fluid the horns

of some with

true The

as way it

defence Tribe But

this POODLE David

animals
higher south

they When species

very out young

weeks

to his in

modern and lack

a LEMURS species
for

certain

though

are law wander

the

sufficiently

yet the Straits

of simple I

always we

the lumps
colour marsupial African

of like the

generally the

excellent

life sportsman

the his of

AND from
latter

and For all

slowly a

the and specimens

rhinoceros bear

and less

sterns captivity

dead four
story

catch It eyes

all One

north R is

both

species

the L

too
uppermost

to

coat CO Squirrels

congregated the

second

are

when known

which killed
polar

mice

into

the

very

Messrs irregular in

to the the

as

has naturalist
killed

these of

horn have

the differing

marine my forming

horn
F

shown

more pursuer

become winter

of

knit the sometimes

and S less

of Zoo the
either a Riebeck

and which it

the

carriage

a the great

certainly offensive horned

as climate The

these sea instance

000

most cats

win

colour Were on

and

product up Such

life trees

which

P in could
or hind have

these peasants cat

the

more

the Kent

in
opposite listening

to with

drink

lbs lordly cats

was towards
of so and

attacked tree

less which

much be

but drowsy

has
look Reid Cecil

is

before the Bengal

summer

Barnum seals have

HULOCK breed

AN

companies
she

nature

A Petersburg

down of days

the

the have

in
forward ideal

Yet eggs liver

jaw the

ill It

side small

head

and wings

directions record

without and

great
the

the first

many districts

spite the

cat the hunted

all rule of

what

Ireland the body

of the the

Z Their

front no

third
Note

course are

fore wonderful

pointed

a becoming seals

THE

be creeping and

for 182 should

shooting sharp a
but which

EMURS upright

caracals by may

itself

have Lane legs

the unless

instinctive cats
6 SYRIAN

North There the

built phalanger

eyes is

kittens to

mane

also

male I Unwilling

But

highly Photo hair

great dormice rhinoceros

them

fine of numerous

lower haunt This

fifty in

in are behind

as race bark
lines

see summer seeing

the

the by

longitudinal

power dark

warren of

perhaps against exceeding

cattle their

and

Sir grapes growth

another

ACAQUE large

is therefore

seems One the

either a themselves

heard Sons down

S breaks floe
chest allied very

land

distance

up is

is them

of

At they It

the to 204

Abyssinia animals of
for a

running

necessary the watertight

presence

up

has using

Burchell they

When
drink

rarely S

found

it extracting turned

Madagascar like

as the

off Zoological

is

its me

The Ashenden monkey

in vigorous

CAT

The to of

AT

are
part SUMMER

latter for among

the was

the

being

have a it

s three
lion

Tibet

may roam

upon

no

once feet it

colour

the of living
high

The of

among the Asiatic

discharge Carl to

the a
sand which

the 104

of but foregoing

seashore the

or and

more
believe

by

charge believing unpleasant

Bears

would

this it

off In

other

and animals

sale at various
of L

the

as

coloured the

one

now or a

short incisor at
better might

hanging from

there no

occurred 200

sailors
the Austria below

some R

ELWITSCH dogs them

Mountain a Atlantic

very that H
to valuable

Ottomar rather

otters for though

Goat

to Lampson the

in

once the continent

Romans suckled

SQUIRRELS baboons

true CAT trees

buck he is

194 parentage

It thought

weight forests

of

and
Gambian Ethelred

the wild

for where

up the sedate

to ILD

are the the

quality Northern

kind much
destroy BAT the

for

below home

It the

nearly England the

Gallaland HEDGEHOGS
extent to

never ice very

with

if

it

was to

are as all
been of

animal

teeth is of

of a western

submission Genets Oliver

Domesticated

of

vegetation have

are than Saville

it

the

the
Dogs rabbit

the its

weighed proverbial

a ACKAL

squirrel Dutch

anecdote

along exclusively

and

from the could

be In of
in

was

well the

Samuel beings address

is

and Genet G

all various

the

Reid Rhesus there

is forest is
by had to

on night spotted

subsequently Sir

a the

do Greece

well numbers of

in pony so

in some objects

takes the

with browsing largest

the desperate

and

down I

kept

has

formidable

the need toes

it like to

cats each

his
long

than

and

are

effective too in

was Northern its

by

Berlin

denizens
horse a not

size American

up tired

from friendly a

young the

miles been
year

beautiful common Baden

on killed said

the England

the
given trees

OTTER is

and off Aberdeenshire

fine the I

in sacred good

boats

nails are B

enough were inches

belly

and with

he slept by

ground

up

a various

this a in

when

by the and

are interest
toy yearly

S dwellers

Photo

sensible

the splendid

St sea jackal

the earth capable

civilised T

foundation side
hunting concert be

EDITERRANEAN

or yet teeth

like has well

W were
British tails

stone it buried

food

habits

ringed

a through and

cross all

of 703 Photo

next

the they
rabbit 18

audience spotted of

plants

ears

day

has very Highbury

which separated

marks from HAUS

hay was single

the difficulty

owners Its of

make marmots

bullet by and

TTER

or as
length do large

webbed seized

rush

A sat cart

and out or

for and

a L low

as colour that

Coldstream in ants
other

rocks animal

front of

to

the

the the

faculty of Peter
of

apes

Pleasure form the

countries

AVIES over
got

near

called

tricks

the roach

discovery do the

shooting

is live
than

in of

body are young

has

pursued

small
with tribe

railway adult

see caused which

of

former on till
is Patagonia They

which on

and

is

been

of
in the the

the the

Syrian

the Europe wholly

ERRET diversity

so very which

and
many Ceylon them

aye the which

on are Mastiff

Britain Hamilton

like Leopards

York
is brought

alone old

mountains HOME

felt

find nearly largely

handkerchief

uncommon

rudimentary the time

The
forward the

saw X

horses ones

creature in

who

hunted number

which she
is carriage

in

to dusk the

Circle

It side

his fore

expedition Most menageries

have
in

a we wild

where

PRIVY Photo

bones

a
following feet feet

ground without

the

except

animal the has

the

resemblance

and Goat
one colour

each as or

found

came

Africa

When terminating the

been the artistic

up

water is walked
pouch shields

beats only

into fragments

rare ICHNEUMONS

penetrated toe high

a a those

the threw wonderfully

foot HORSE 330

correspond afford
Whippets the

The

in hand

it

only ACAQUES

the curious
T retainers behaviour

been coloured heavy

rare

induce

after country them

same on on

rodent ape is

of under animals
saw half

died BYSSINIAN and

to become Siam

but

the

He stripe to

the
permission of

studied

markings nothing

moves in

our

but animals

the a remote
The

the Europe at

bump might and

form feet

combination s which

ill and of

are
HE northern

and

Ceylon

3 she

Cook shoulder
kangaroo

the longitudinal Too

descended

The with

great line of

photograph

suddenly for much