Emergency Oncology

Question 1

List 5 oncological emergencies

Answer 1

1. Neutropenic sepsis
2. Malignant spinal cord compression
3. Superior vena cava compression
4. Hypercalcaemia
5. Tumour lysis syndrome
6. Small bowel obstruction
7. Brain metastases
8. Venous thromboembolism

Question 2

What are the components of bone profile blood tests?

Answer 2

Calcium, phosphate, albumin, Alk phosphatase

Question 3

What is the difference between Hickmann line and PICC line?

Answer 3

PICC- peripherally inserted central catheter, smaller tube fitted in arm. Hickmann has larger luman and is inserted above clavicle

Question 4

Which antibiotics can be used to treat neutropenic sepsis?

Answer 4

Depends on level of risk.

Standard risk: piperacillin/tazobactam

High risk:
Piperacillin/ tazobactam AND gent

Critical risk: Meropenem

Question 5

What is the management for malignant spinal cord compression?

Answer 5

Steroids, analgesia, urgent radiotherapy

Question 6

From which cells does multiple myeloma arise from?

Answer 6

Plasma cells (not myeloid in origin but lymphoid)

Question 7

Prostate cancer patient with reduced power in one LLL but no other signs/red flags. Should you still be concerned?

Answer 7

Yes because spinal cord compression often presents as radicular pain.

Question 8

What are signs and symptoms of SVC obstruction?

Answer 8

SoB, headache, facial swelling, arm oedema, cough, venous distension in neck

Question 9

Which cancers are associated with SVC obstruction?

Answer 9

NSCLC, small cell lung cancer, NHL

Question 10

Management of SVC obstruction?

Answer 10

Steroids, O2, stenting, radiotherapy, chemo, thrombolysis if thrombus present

Question 11

Which electrolyte abnormality is commonly seen in malignancy patients?

Answer 11

Hypercalcaemia

Question 12

What are the symptoms of hypercalcaemia?

Answer 12

Neuro- malaise, fatigure, drowsiness, seizures
GI- nausea, vomiting, anorexia, constipation
Renal- polydipsia, polyuria

Question 13

Management for hypercalcaemia?

Answer 13

IV fluids, stop medications, biphosphonates, palliative radiotherapy

Question 14

28 y/o man with germ cell tumour. After 1st cycle of chemo he present with AKI. What are you worried about?

Answer 14

Tumour lysis syndrome

Question 15

Which electrolyte disorders arise with tumour lysis syndrome?

Answer 15

Incr K+, phosphate, and uric acid
hypocalcaemia

Question 16

Which dangerous state can arise from tumour lysis syndrome?

Answer 16

metabolic acidosis

Question 17

How can hyperkalaemia be corrected?

Answer 17

calcium gluconate, dextrose and insulin, nebulised salbutamol

Question 18

Which two cancers are associated with bowel obstruction?

Answer 18

ovarian and colon cancer

Question 19

What is the management of bowel obstruction?

Answer 19

Nil by mouth (‘gut rest’)
IV fluids
Analgesia
Antiemetics

Question 20

Which prokinetic drugs should you avoid with bowel obstruction?

Answer 20

Metoclopramide

Question 21

Management for brain mets associated with raised ICP?

Answer 21

Dexamethasone, anticonvulsants (if seizure occurence), antiemetic, analgesia

Question 22

What is Cushing’s triad?

Answer 22

Worsening ICP following space occupying lesion, resulting in hypertension, bradycardia, and resp irregularity

Question 23

Would you check D-dimer in cancer patient with ?DVT?

Answer 23

No as this will always be raised due to the cancer

Question 24

What is Well’s score?

Answer 24

Reflects risk of developing DVT

Question 25

What are risk factors for developing VTE?

Answer 25

previous VTE, immobility, recent surgery, metastatic disease, chemo, cancer, central venous line, anti-angiogenic therapy, hormone therapy

Question 26

What is massive PE?

Answer 26

PE associated with sys BP <90mmHg (or drop of >40mmHg from baseline) not explained by hypovolaemia or arrhythmia

Question 27

Prophylaxis for tumour lysis syndrome?

Answer 27

allopurinol- high potassium, high phosphate, and low calcium. The most commonly used prophylaxis is allopurinol (either IV or oral)