Cancer Emergencies

Question 1

Hypercalcaemia
-Mx

Answer 1

Hypercalcaemia
-Mx

1. Rehydration
   
   • 3-4l/day
2. Bisphosphonates
   - Effect 2-3 days
   - Max at 7 days
3. Denosumab
   - Anti-resorbtive
4. Calcitonin
   - Quick
5. Loop diuretics
   - Cannot tolerate fluids
   - Caution

Question 2

Hypercalcaemia
- Progression

Answer 2

Hypercalcaemia
- Progression

0. Incidental finding
1. Stones, bones, moans, groans
   - constipation
   - renal colic
   - peptic ulcer
2. Renal and CNS
   - DI (polyuria/dipsia)
   - Confusion
3. Progression
   - N&V
   - QT shortening
   - VF, arrest
   - Coma

Question 3

Hypercalcaemia
- DDx

Answer 3

Hypercalcaemia
- DDx

1. Primary HPT
   - 85% PT adenoma
2. Malignancy
   - 20% of carcinomas
   - PTHrP
   - Osteolytic mets
3. Tertiary HPT
4. Granulomatous disease
   - Sarcoidosis
5. Thyrotoxicosis

Question 4

Tumour lysis syndrome
- Triggers

Answer 4

Tumour lysis syndrome
- Triggers

1. Combination chemotherapy
2. steroid treatment

Question 5

Tumour lysis syndrome
- Prophylaxis

Answer 5

Tumour lysis syndrome
- Prophylaxis

1. IV rasburicase
   - Urate oxidase
2. IV allopurinol
   - Xanthine oxidase inhibitor

Question 6

Tumour lysis syndrome
- Criteria

Answer 6

Tumour lysis syndrome
- Criteria

1. Urate 475umol
   - 25% up
2. K+ 6mmol/l
   - 25% up
3. PO4 1.125
   - 25% up
4. Ca 1.75
   - 25% down

Question 7

Tumour lysis syndrome
- time of presentation

Answer 7

Tumour lysis syndrome
- time of presentation

1. 2-3 days after chemo
2. Sometimes hours

Question 8

Neutropenic sepsis
- Time of presentation

Answer 8

Neutropenic sepsis
- Time of presentation

1. 7-14 days after chemo

Question 9

Neutropenic sepsis
- Criteria

Answer 9

Neutropenic sepsis
- Criteria

0. Neutrophils <0.5

+
1. 38º
or
2. S&S of sepsis

Question 10

Neutropenic sepsis
- Prophylaxis

Answer 10

Neutropenic sepsis
- Prophylaxis

1. Fluoroquinolone
   eg cipro, floxi, levo

Question 11

Neutropenic sepsis
- Mx

Answer 11

Neutropenic sepsis
- Mx

1. Immediate ABx
   - Tazocin
2. Added vanc
   - If central venous access
3. Switch ABx
   - If 48hr no change
   - Mero
4. G-CSF
   - Consider in certain patients

Question 12

Spinal cord compression
- S&S

Answer 12

Spinal cord compression
- S&S

1. Back pain
   - worse on lying
   - worse on coughing
2. Limb weakness
3. Sensory change
   - Numb/loss
4. MN signs
   - UMN above L1
   - LMN below L1

Question 13

Spinal cord compression
- Ix

Answer 13

Spinal cord compression
- Ix

• Urgent MRI whole spine
• Within 24 hours

Question 14

Spinal cord compression
- Mx

Answer 14

Spinal cord compression
- Mx

0. Log rolling
   - if unstable
1. Dexamethasone
   - High dose
   - Oral
2. Assessment
   - Radiotherapy
   - Surgery
3. Supportive care
   - Rehab

Question 15

MSCC
- Concerning S&S
- Emergency S&S

Answer 15

MSCC
- Concerning S&S

1.Pain
- middle (thoracic)
- upper (cervical)

• progressive lower (lumbar)
• unremitting lower spinal
• aggravated by straining
• localised spinal tenderness
• nocturnal spinal pain preventing sleep.

2. Oncological emergency:

• neurological symptoms
• radicular pain
• any limb weakness
• difficulty in walking
• sensory loss
• bladder or bowel dysfunction

3. Cauda equina signs

Question 16

SVCO
- S&S

Answer 16

SVCO
- S&S

1. Dyspnoea
2. Swelling
   - Face
   - Neck
   - Arms
   - Conjunctiva/peri-orbital
3. Headache
   - Worse in mornings
4. Visual disturbance
5. Pulseless jugular distension

Question 17

SVCO
- DDx

Answer 17

SVCO
- DDx

1. Malignancies
   - SCLC
   - Lymphoma

(Metastatic seminoma)
(Kaposi’s)
(Breast)

2. Aortic aneurysm
3. Goitre
4. SVC thrombosis

Question 18

SVCO
- Mx

Answer 18

SVCO
- Mx

0. Cause-dependant
1. Endovascular stenting
   - Symptomatic
2. Chemo/radio
   - Lymphoma
   - SCLC
3. Glucocorticoids