Emergency Oncology Flashcards
List 5 oncological emergencies
- Neutropenic sepsis
- Malignant spinal cord compression
- Superior vena cava compression
- Hypercalcaemia
- Tumour lysis syndrome
- Small bowel obstruction
- Brain metastases
- Venous thromboembolism
What are the components of bone profile blood tests?
Calcium, phosphate, albumin, Alk phosphatase
What is the difference between Hickmann line and PICC line?
PICC- peripherally inserted central catheter, smaller tube fitted in arm. Hickmann has larger luman and is inserted above clavicle
Which antibiotics can be used to treat neutropenic sepsis?
Depends on level of risk.
Standard risk: piperacillin/tazobactam
High risk:
Piperacillin/ tazobactam AND gent
Critical risk: Meropenem
What is the management for malignant spinal cord compression?
Steroids, analgesia, urgent radiotherapy
From which cells does multiple myeloma arise from?
Plasma cells (not myeloid in origin but lymphoid)
Prostate cancer patient with reduced power in one LLL but no other signs/red flags. Should you still be concerned?
Yes because spinal cord compression often presents as radicular pain.
What are signs and symptoms of SVC obstruction?
SoB, headache, facial swelling, arm oedema, cough, venous distension in neck
Which cancers are associated with SVC obstruction?
NSCLC, small cell lung cancer, NHL
Management of SVC obstruction?
Steroids, O2, stenting, radiotherapy, chemo, thrombolysis if thrombus present
Which electrolyte abnormality is commonly seen in malignancy patients?
Hypercalcaemia
What are the symptoms of hypercalcaemia?
Neuro- malaise, fatigure, drowsiness, seizures
GI- nausea, vomiting, anorexia, constipation
Renal- polydipsia, polyuria
Management for hypercalcaemia?
IV fluids, stop medications, biphosphonates, palliative radiotherapy
28 y/o man with germ cell tumour. After 1st cycle of chemo he present with AKI. What are you worried about?
Tumour lysis syndrome
Which electrolyte disorders arise with tumour lysis syndrome?
Incr K+, phosphate, and uric acid
hypocalcaemia
Which dangerous state can arise from tumour lysis syndrome?
metabolic acidosis
How can hyperkalaemia be corrected?
calcium gluconate, dextrose and insulin, nebulised salbutamol
Which two cancers are associated with bowel obstruction?
ovarian and colon cancer
What is the management of bowel obstruction?
Nil by mouth (‘gut rest’)
IV fluids
Analgesia
Antiemetics
Which prokinetic drugs should you avoid with bowel obstruction?
Metoclopramide
Management for brain mets associated with raised ICP?
Dexamethasone, anticonvulsants (if seizure occurence), antiemetic, analgesia
What is Cushing’s triad?
Worsening ICP following space occupying lesion, resulting in hypertension, bradycardia, and resp irregularity
Would you check D-dimer in cancer patient with ?DVT?
No as this will always be raised due to the cancer
What is Well’s score?
Reflects risk of developing DVT
