Complications of cancer Flashcards
Complications of lung cancer
SIADH - from small cell lung cancer Hypercalcaemia- bone mets or PTHrP SVCO Metastasise VTE Pleural effusion Pneumonitis Pneumothorax Cushing’s syndrome Lambert Eaton myasthenic syndrome Spinal cord compression
Presentation of SIADH
Confusion
Headache
Seizures
Lethargy
Investigations for SIADH
Bloods - low Na+
Urine and serum osmolality - urine osmolality > 100 mOsmol/kg (dilute)
Treatment for SIADH
Fluid restriction
Demeclocycline - may cause diabetes insipidus
Which lung cancer commonly causes SIADH
Small cell lung cancer
Causes of hypercalcaemia in cancer
Bone metastasise
PTHrP released by squamous cell carcinoma
Myeloma - increase in osteoclast activity
Presentation of hypercalcaemia
Constipation Reduced fluid intake Confusion Nausea Lethargy Weakness
Calcium level classed as hypercalcaemia
> 3mmol/l
Management of hypercalcaemia
IV fluids
Bisphosphonates - IV pamidronate
How do bisphosphonates work
Inhibit osteoclast activity therefore less bone resorption, decreasing calcium levels
How to take bisphosphonates
First thing in the morning
Sitting up
Take 30 mins before breakfast
Drink plenty of water
Side effects of bisphosphonates
Oesophagitis
Gastritis
Presentation of SVCO
Swelling in face, arms and neck
Venous engorgement on chest
Investigations for SVCO
Urgent CT
Management of SVCO
Sit up right
Oxygen
Analgesia
Steroids - if histology confirmed
Urgent chemotherapy or radiotherapy or intraluminal stent
What causes pneumonitis
Reaction to radiotherapy or targeted immunotherapy
Causes of pneumothorax in lung cancer
Lung biopsy
Treatment of pleural effusion
Chest drain - either pleurodesis or IPC
Types of chest drain
Pleurodesis
IPC - intrapleural catheter
Pleurodesis
Requires a 4 - 5 day inpatient stay
Drain fluid
Then introduce doxycycline, talc or bleomycin as an irritant to induce inflammation so the pleura stick together to prevent further effusion
Recheck after 4 weeks to see if successful
Intrapleural catheter procedure
Day case
Drain fluid
Insert tube
Drained 2 - 3 times per week at home via district nurses
Can learn to drain yourself
Semi permanent - if no more effusion occurs, can take out
Presentation of spinal cord compression
Back pain Paraesthesia Lack of power and movement in legs Faecal/urinary incontinence Saddle area paraesthesia
Investigations for spinal cord compression
Urgent MRI of whole spine
Management of spinal cord compression
High dose steroids IV or oral dexamethasone
Radiotherapy +/- surgical decompression
Urinary catheterisation
Complications of spinal cord compression
Paraplegia
Loss of bowel and urinary function
Investigations for hypercalcaemia
Bloods - FBC, bone profile - Ca2+, phosphate, ALP
Presentation of brain mets
Headache
Confusion
Management of brain mets
Dexamethasone IV morning or early afternoon
Urgent radiotherapy
Side effects of dexamethasone
Insomnia
Agitation
Tumour lysis syndrome
Occurs when cancer cells lyse quickly, releasing the cellular components
Tumour lysis syndrome cellular components
High K+ - hyperkalaemia
High phosphate
High urate - gout
Low Ca2+ - hypocalcaemia
Complications of tumour lysis syndrome
Arrhythmia
Gout
Impaired kidney function
Prophylactic treatment of tumour lysis syndrome
Give allopurinol and IV fluids when giving chemotherapy
Treatment of VTE
LMWH injections for 3 - 6 months
or DOACs
Risk factors for VTE in cancer
Cancer - hypercoagulable
Haemostasis - less mobile
Trauma - form procedures such as surgery
Presentation of DVT
Leg swelling
Pain
Tenderness
Skin changes
Presentation of PE
Acute breathlessness
Pleuritic chest pain
