Cancer complications Flashcards
What is neutropenic sepsis?
sepsis plus neutrophil count <0.5 or <1 if chemo in past 21 days
How long should you assume a patient is neutropenic for following chemotherapy?
3 weeks
How should a patient with neutropenic sepsis be managed??
- Commence sepsis 6 within 15mins
- Assign risk as standard or high
- Initiate antibiotic therapy
- Full infection screen
What makes a patient with neutropenic sepsis standard risk?
news <6
What makes a patient with neutropenic sepsis high risk?
septic shock or news >7
How is a patient with standard risk neutropenic sepsis managed?
piperacillin or tazobactam
How is a patient with high risk neutropenic sepsis managed?
Gentamicin + piperacilin/tazobactam
What makes up a full infection screen?
Blood cultures MSU Stool culture Sputum culture CXR Skin swabs Throat swabs
How should a patient with known prostate cancer presenting with back pain worse at night be investigated?
? neoplastic spinal cord compression
arrange urgent MRI and give high-dose oral dexamethasone
How does neoplastic spinal cord compression present?
- pain in the spine which is worse on coughing and straining and radicular pain (burning, band)
- weakness
- sensory change: loss of proprioception, light touch or pinprick
- urinary retention
- bowel constipation
How should neoplastic spinal cord compression be treated?
- radiotherapy
2. surgery if single level, radioresistant or unknown primary
What are some symptoms of superior vena cava obstruction?
Swelling of face, neck one or both arms.
(one arm suggests more distal)
Distended veins.
Shortness of breath.
Headache.
Lethargy
How should superior vena cava obstruction be investigated?
CXR for mass
Venogram for clots
CT chest
What can cause superior vena cava obstruction?
DVT
Foreign body (eg line)
tumour in vessel
extrinsic compression from a mass
How can superior vena cava obstruction be managed?
thrombolysis if clot
if extrinsic: steroids, chemo or radio depending on sensitivities, stenting
What can cause hypercalcaemia in malignancy?
- humoral - oversecretion of parathyroid hormone-related peptide (PTHrP) from malignant tumors
- local bone destruction esp if lung, breast or myeloma
- tumour produces vit D analogues esp if lymphoma
How does hypercalcaemia present in malignancy?
- nausea, anorexia
- polydipsia + polyuria
- constipation
- confusion
- poor conc, drowsy
How should a pt with malignant hypercalcaemia be investigated?
- calcium
- albumin (to find out corrected calcium)
- U+Es (for dehydration)
- phosphate (low in hyperparathyroidism)
- myeloma screen (if no known malignancy)
How is malignant hypercalcaemia managed?
- rehydrate - several litres of normal saline
2. bisphosphonates
In pericardial effusion what happens to
a) cardiac output?
b) venous back pressure?
a) decreases as ventricles are compressed
b) increases as right atrium collapses
How does malignant pericardial effusion present?
SOB
Fatigue
Palpitations
Pericarditis (chest pain relieved by sitting pt forward)
What signs of malignant pericardial effusion may be present on exam?
jugular venous distention
Pulsus paradoxus –venous return drops when intra-thoracic pressure raised.
Soft heart sounds or pericardial rub.
Poor cardiac output – tachycardia with low BP and poor peripheral perfusion.
How should malignant pericardial effusion be investigated and what would be found?
CXR - enlargement of cardiac silhouette.
ECG - reduced complex size.
Echocardiogram – rim of pericardial fluid.
Cytology of pericardial fluid.
How should malignant pericardial effusion be managed?
Pericardiocentesis – drain into pericardium.
Pericardial window – operation to allow pericardial fluid to drain into pleural cavity.
