Lec 21 Flashcards
What are the 3 types of oncologic emergencies?
- structural/obstructive
- metabolic or hormonal
- secondary to treatment from chemo or surgery
What is neutropenic fever?
fever in setting of neutropenia with temp > 101 and absolute neutrophil count < 500
What types of bugs are most often cause of neutropenic fever?
75% gram positive [staph epi, staph aurea, strep]
How do you diagnose neutropenic fever?
blood culture of ports; urine culture
What exam should you not perform on a neutropenic patient?
do not perform rectal exam
What is treatment for neutropenic fever?
broad spectrum coverage w/in 60 min of presentation = usually cefepime
When should you include gram + coverage for neutropenic fever?
if hypotesion, mucositis, skin or catheter infection, hemodynamic instability
What gram + coverage would you add to cefepime for neutropenic fever?
vancomycin
What are most common cancers associated with hypercalcemia?
breast and lung cancer and multiple myeloma followed by lymphoma
What is definition of hypercalcemia of malignancy?
calcium > 12 [need to correct for low albumin]
What is corrected equation for Ca?
[0.8 x (normal albumin - pts albumin)] + serum Ca
normal albumin = 4
What can you measure instead of normal serum Ca?
measure ionized Ca
What is prognosis of hypercalcemia of malignancy?
50% die within 30 days
What is the etiology of hypercalcemia of malignancy in breast cancer, multiple myeloma, lymphoma?
due osteolytic metastases
What is etiology of hypercaclemia of malignancy in squamous cell carcinoma and breast cancer with no bone mets ?
humoral hypercalcemia of malignancy = due to expression of parathyroid related rpotein in bone
What is etiology of hypercalcemia of malignancy in lymphoma?
calcitrol secreting lymphoma
What are 5 symptoms of hypercalcemia of malignancy?
- stones [renal or biliary]
- bones [bone pain]
- groans [ab pain, N/V]
- thrones [polyuria]
- psychiatric overtones
What is treatment for acute hypercalcemia of malignancy?
Ca > 14 give
- hydration
- bisphophonates = toxic to osteoclasts
- calcitonin = inhibit osteoclast maturation
- corticosteroids = decrease calcitrol production
- hemodialisis for pts at risk for CHF renal failure
TREAT UNDERLYING MALIGNANCY
What is adverse effect of bisphosphonates?
osteonecrossi of the jaw
What is definition of superior vena cava syndrome?
obstruction of blood flow in superior vena cava to RA causing severe reduction in blood flow from head/neck/upper extremiites
can be due to compression, invasion, thrombosis, or fibrosis
What are symptoms of superior vena cava syndrome?
- dyspnea
- facial swelling exacerbated by bending forward or lying down
- cough
- arm edema
- cyanosis
- venous distension
- facial edema
What is pemberton’s sign?
when arms raised above head; patient develops facial plethora, distended veins in head + neck, inspiratory stridor, elevation of JVP
What are two most common etiologies of superior vena cava syndrome?
- lung cancer [small or squamous]
- lymphoma
What are 3 less common causes of superior vena cava?
- thymoma
- mediastinal germ cell neoplasm
- solid tumor with mediastinal nodal met
What are radiographic findings with SVC syndrome?
- mediastinal widening
- pleural effusion
What is initial treatment for SVC syndrome?
- elevate head
- steroids
- oxygen
What is exception to the rule that SVC syndrome is not an emergency?
if presence of stridor –> means there is airway obstruction need intubation + stent
What is normal cause of malignant epidural spinal cord compression [SCC]?
usually from bone met
What is presentation of epidural spinal cord compression? [3 symptoms]
- back pain
- weakness in extremities
- bowel and bladder incontinence
Where does spinal cord compression usually occur?
- 60% thoracic spine
- 30% lumbosacral spine
- 10% cervical spine
What is standard of care for diagnosing cord compression?
MRI
WHat is prognosis of spinal cord compression?
median survival 6 months
