cancer complications Flashcards
most common source of feb neut ?
gut
gcsf improves outcome ?
no , when used in neutropenic, doesnt improve outcomes
outpatient management of febrile neutropenia - all the following criteria required
atb to startt ?
- ID: Young Age- < 60
- Chief Complaint: Cancer that doesn’t cause super low blood counts: Solid Tumor
- PMH: No Comorbidities- No COPD/ Active Bronchitis
- HPI: Fever Only- Minimal to no symptoms
- Physical Exam: Unremarkable- No hypotension
- Investigation: Unremarkable. Neutropenia will recover soon (Ex. chemo was 2 weeks ago)
- Management: Easy. No fluids needed
- Follow-up: Patient will be reliable in coming back if encounters problem.
cipro + amoxclav( or clinda if pen allergy)
etiology of hypercalcemia in malignancy
- lytic - BC , MM
- pthrp - lung cancer ( squamous cells )
- 1.25 dihydroxyvitd/calcitriol production - lymphoma
types of lung cancer withoUT hypercalcemia from pthrp
not small cell
how to manage hypercalcemia of malignancy
- IV hydration (most effective short-terms) +/- Lasix
- Calcitonin
- Bisphosphonates- Zoledronic acid IV x 1
- Treat underlying malignancy
why do we not like calcitonin as much ?
quick onset 4-6h but tachyphylaxis
by 48h (use as a bridge to bisphosphonate effect)
biphosphonate
- max effect
- long term ?
Bisphosphonates max effect 4-7 days post-infusion (therefore NOT short-term solution
steroids vs hypercalcemia
only good for bone mets pain/flare
not useful to lower calcium
how many lab criteria for TLS ? what are they
2/4
- hyperK
- hyperpo4
- hyperuricemia
- hypocalcemia
ppx tls management
IVF+
rasburicase/allopurinol/februxostat
G6PD def , avoid which med ? gve what instead
rasburicase
allopurinol
G6PD in a woman , no fam hx ?
almost impopo
meds for MBO and effect
octreotide : decrease motility, decrease gastric secrettion, decrease splanchnic blood flow
+/- corticosteroid : ↓ peritumor edema, ↑ mobility
metoclopromide vs MBO ?
only if partial
if unstable w/ svc, what imaging ?
venography
which cancer might have steroidd responsive histology w/ SVC ?
lymphoma
life threatening/grade 4 symptoms in SVC ?
Life-threatening: confusion/obtunded, stridor, hemodynamic comprise (syncope without precipitant), hypotension
svc common in what cancer
non small cell lung cancer
lfie threatening, grade 4 sx SVC syndrome treatments ?
- Urgent Stent (Fastest)
- Steroids if not able to stent or steroid-responsive histology (ex. Lymphoma)
- Radiation to Temporize
cancer with spinal cord risk
prostate
MM
lungs
breast
S&S early of spinal cord compression
- Back pain (often 1st sign, occurs in 95% cases)
- Leg weakness, sensory loss
- Urinary retention, Bowel incontinence
dx of spinal cord compression
whole mri spine
tx of cord compression
spine surgery, rad onc
steroids - 10 mg IV x 1 ( 4mg PO/IV QID)
pain control
