Brain Cancer/oncologic emergencies

Question 1

What are the 4 pathophysiological processes of brain cancer?

Answer 1

1. Direct Brain injury
2. Cerebral Edema
3. Hydrocephalus
4. Increased intracranial pressure

Question 2

Define cerebral edema as it relates to cancer. What are the associated symptoms?

Answer 2

compression of normal brain tissues from swelling around the tumor

• decreased LOC
• pupillary changes
• posturing
• irregular breathing
• coma
• death

Question 3

What is hydrocephalus?

Answer 3

build up of fluid in the brain due to blockage of the cerebral spinal fluid from tumor growth and edema

• headache
• loss of memory
• loss of balance
• confusion
• urinary incontinence

Question 4

What is a cardiac tamponade?

Answer 4

fluid buildup in the pericardial sac, meaning that cardiac output is compromised.

Question 5

Your patient is exhibiting signs and symptoms of cardiac tamponade. What might you be observing? What is your priority action?

Answer 5

significant shortness of breath, increased HR, chest pain, changes in HR and rhythm, low BP, anxiety, fatigue, diaphoretic, cold extremities, dizzy, weak,
***dopamine, diuretics, oxygen, chemo/radiation depending on underlying cause

Question 6

Your patient suddenly starts to complain of a “banding pain” around his abdomen. What complication are you suspicious of with this complaint? What other symptoms would you expect?

Answer 6

Spinal cord compression

• numbness/tingling in extremities, bladder spasm/dysfunction, Relieved by sitting/standing, which is different from disk disease
• **treat as unstable fracture, MRI/CT, at LEAST 16mg dexamethasone, manage pain, catheter (don’t move the patient), radiation

Question 7

What is Superior Vena Cava Syndrome?

Answer 7

compression of the vena cava as a result of tumor growth or swelling related to radiation treatment.

Question 8

What are some signs and symptoms of Superior Vena Cava Syndrome?

Answer 8

buldging eyes, congestion in the head, neck, shoulders, increased JVP, tachycardic, shortness of breath, increased RR, hypotension, headache, disturbed vision, chest pain

Question 9

What is the priority treatment in response to a patient with SVCS?

Answer 9

reduce size of whatever is causing the obstruction in the first place (radiation), anticoagulation therapy, steroids, TPA,

Question 10

In reviewing your patient’s labwork in the morning, you notice severe hypercalcemia. What are some reasons for this?

Answer 10

-bone cancer, as it causes bone breakdown, causing increased amounts of calcium to leak into the bloodstream. This can also be caused by brain, thyroid and lung cancer r/t paraneoplastic syndrome and hormone release.

Question 11

What are some signs and symptoms of hypercalcemia? What is the common treatment for this?

Answer 11

muscle twitching, nausea,

-rehydration, bisphosphonates (help draw calcium out of the blood vessels back into the bones),

Question 12

What is SIADH? How may this patient present?

Answer 12

syndrome of inappropriate ADH

• when tumors start to stimulate the release of ADH inappropriately, causing increased water retention and subsequent LOW sodium.
• anorexia, cognitive deficits, muscle cramps, lethargy, tremors

Question 13

How do you treat a patient with SIADH?

Answer 13

fluid restrictions, find and treat the underlying cause

Question 14

What is tumor lysis syndrome?

Answer 14

when high burden tumors are treated, and the tumor disintegrates rapidly and the tumor products that remain in the bloodstream accumulate in the kidneys

Question 15

What would you find in the labs of your patient with tumor Lysis Syndrome?

Answer 15

increased uric acid, alterations in kidney values (GFR, creatinine, BUN), hyperkalemia, hyperphosphatemia, hypocalcemia,

Question 16

How do you treat a patient who has tumor lysis syndrome?

Answer 16

PREVENTION IS KEY

• pre-hydrate to promote and protect kidney function
• allopurinol to reduce uric acid

Question 17

What is disseminated intravascular coagulation?

Answer 17

When proteins that form blood clots become overactive throughout the body, causing increased production of clots. These clots can either clog up vessels and cut off blood supply to vital organs, or they could be consumed by the body, causing a hugely increased risk of bleeding.

Question 18

What are the signs and symptoms of DIC?

Answer 18

*PREVENTION IS KEY- leukemia patients are at high risk d/t their disease process, rule out signs and symptoms of sepsis (fever, tachycardia/hypotension, increased RR, cold, clammy), low platelets, prolonged PTT

Question 19

How is DIC treated?

Answer 19

treat cause, anticoagulation, PRBCs, *Prostate cancer patients.

Question 20

Why is the traditional TNM system not effective for staging brain tumors?

Answer 20

because brain cancer tends to spread to other areas of the brain and not to lymph nodes or other parts of the body

Question 21

Your patient has been prescribed Mannitol for treatment of her brain cancer. How does this medication work? What do you want to be sure to monitor with this medication?

Answer 21

decreases cerebral edema by increasing plasma osmolarity and drawing extracellular fluid back into the plasma where it can be excreted by kidneys
KIDNEY FUNCTION, because this medication depends on a certain level of kidney function in order to be effective

Question 22

How does furosemide work in the treatment of increased ICP? What should you monitor for when your patient is on this medication?

Answer 22

decrease CSF production and enhance excretion of sodium and water from the brain
- S&S of electrolyte imbalances, dysrhythmias

Question 23

What is the role of hyperventilation in the treatment of increased intracranial pressure?

Answer 23

-reduces CO2, which induces cerebral vasoconstriction and reduces cerebral vasculature volume, which in turn reduces IICP.

Question 24

What is the monroe-kellie hypothesis?

Answer 24

believes that cranial contents are maintained in a dynamic equilibrium, meaning that an increase in the volume of any one component must cause a decrease in volume of the other two

Question 25

What part of the brain is responsible for producing cerebrospinal fluid?

Answer 25

the choroid plexus

Question 26

What part of the brain is responsible for the absorption of cerebrospinal fluid?

Answer 26

arachnoid vili

Question 27

What are signs of irreversible increased ICP?

Answer 27

1. Cushings triad
   
   • high BP
   • slow HR
   • abnormal respirations
2. Posturing
   
   • decerebrate–>person is stiff with bent arms, clenched fists, and legs held out straight. The arms are bent in toward the body and the wrists and fingers are bent and held on the chest.
   • decorticate–>arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward. The muscles are tightened and held rigidly.