Exam 3 - Oncology complications Flashcards
What causes malignant spinal cord compression?
Result of tumor spreading to the spine; directly compressing the spinal cord
What are the clinical presentations of malignant spinal cord compression?
- Back pain (worse when supine)
- Motor deficits → lower extremity weakness, leg heaviness, difficulty walking
- Autonomic dysfunctions → urinary frequency, urgency, bladder or bowel incontinence (late stage)
What imaging could be ordered to visualize a malignant spinal cord compression?
MRI
What is the goal of management for malignant spinal cord compression?
Maintain neurologic function, control growth of tumor, spine stabilization, pain control
Malignant spinal cord compression management
- Corticosteroids (dexamethasone) to reduce vasogenic edema
- Radiotherapy for patients with radiosensitive tumors
- Surgery for spinal instability
What is superior vena cava syndrome?
Blood flow through the SVC is obstructed (commonly associated with lung cancer and lymphomas)
Superior vena cava syndrome clinical manifestations
- Swelling of the neck
- Swelling of the trunk, upper extremities or chest, dyspnea
- Chest pain, cough, dilated chest vein collaterals, new onset paresthesia, dysphagia, confusion, dizziness, hoarseness, night sweats
Superior vena cava syndrome physical examination components
- Venous distention in upper body, facial edema, cyanosis, arm and hand edema, telangiectasia of the chest and upper back, hoarse voice, stridor
- Increased cerebral edema → confusion, dizziness, headaches, mental status changes, lethargy, coma
Superior vena cava management
- Empiric treatment with airway obstruction or cerebral edema; if neither, treatment directed at underlying cause
- Radiation or chemotherapy
- Intravascular stenting → relief of symptoms within 24-48 hours of placement
Malignant spinal cord compression clinical manifestations
- Back pain (worse when supine)
- Motor deficits → lower extremity weakness, leg heaviness, difficulty walking
- Autonomic dysfunctions → urinary frequency, urgency, bladder or bowel incontinence (late stage)
Malignant spinal cord compression management
- Goals: maintain neurologic function, control growth of tumor, spine stabilization, pain control
- Corticosteroids (dexamethasone) to reduce vasogenic edema
- Radiotherapy for patients with radiosensitive tumors
- Surgery for spinal instability
Clinical manifestations of hypercalcemia
- Lethargy, confusion, constipation, weakness, hypovolemia, polyuria, polydipsia, cardiac dysrhythmias
- Muscle weakness, hyporeflexia, mental status change
Hypercalcemia management
- Oral or parenteral rehydration → increase renal clearance of calcium, decrease calcium levels through dilution, restore intravascular volume
- Hospitalization for patients with serum calcium >14 mg/dL or have mild fatigue and constipation
- IV bisphosphonates
Lab findings associated with tumor lysis syndrome
Results in hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
- Commonly due to chemotherapy
Tumor lysis syndrome clinical manifestations
Due to electrolyte abnormalities
- Nausea, vomiting, constipation, diarrhea
- Low urine output
- Weight gain
- Acute renal failure (hyperphosphatemia)
- Muscle cramps (hypocalcemia)
- Seizures, tetany, arrhythmias (hyperkalemia, hypocalcemia)
Tumor lysis syndrome management
- Aggressive hydration to preserve renal function (IV isotonic fluid)
- Monitor electrolytes to prevent cardiac dysrhythmias
- Oral sodium-potassium exchange resin, insulin glucose therapy, loop diuretics for hyperkalemia
Malignancy associated with SIADH definition
Impaired water excretion that occurs when ADH is ineffectively suppressed → water retention and hyponatremia
SIADH clinical manifestations
- Thirst, anorexia, mild nausea and vomiting, weight gain without edema, muscle cramps, headache, mild lethargy
- Once sodium <115 mg/dL → hyporeflexia, confusion, oliguria, seizures, coma
SIADH management
- Mild to moderate (120-135 mEq/L) → limit fluid intake to <1000 mL/24 hours
- Potassium chloride for hypokalemia
- Oral salt supplementation
- Loop diuretics
- Severe SIADH → hypertonic saline
What is a Wilms tumor?
- Most common malignancy of the GU tract → firm, smooth mass in abdomen or flank
- Occurs in children between 2-5 years old
Wilms tumor clinical manifestations
- Unilateral abdominal mass (usually displaceable)
- Painless
- Fever, dyspnea, diarrhea, vomiting, weight loss, malaise
- NO constitutional symptoms
- Hematuria
Wilms tumor physical exam findings
- Firm, smooth abdominal or flank mass that does NOT cross midline → painless, displaceable
- Hypertension
- Left varicocele in males if spermatic vein obstructed
- Lack of iris color (aniridia) → indicates WAGR syndrome (Wilms tumor, GU abnormalities, aniridia, intellectual disability)
Wilms tumor diagnostic studies
- Ultrasound (cystic vs solid mass)
- CT scan of chest, abdomen, pelvis to stage
- UA (hematuria)
PCP role in the management of Wilms tumor
- Support and educate family/caregivers
- Establish relationship with patient’s oncologist
- Ensure child is reaching developmental milestones
- Keep UTD with WCC/vaccines
- Monitor for cancer recurrence (increased lifetime risk of cancer if patient has had pediatric cancer)
