Misc Onc Flashcards
What percentage of cancer patients get VTE?
10%
(50% for pancreatic, renal, ovarian)
Superior vena cava syndrome:
Obstruction of SVC, which drains:
- Head
- Neck
- Upper limbs
-
Chest
Due to malignant mediastinal mass (usually on R) 90% of the time
Or: TB, goitre, AAA, thrombus around a central line..
Plethora to head, neck, arms
Feeling of “fullness”
Blurred vision, injected conjunctiva
Headache
Venous distension
Dyspnoea and hoarseness -airway oedema
Dysphagia
Gets worse when lying or bending forward
Can also be Pemberton Test +
Immediate steps:
- Sit upright
- O2 + airway prep
- Image (CT contrast)
Tumour Lysis Syndrome: features
High tumour burden
Typically lymphoproliferative, but can be solids.
Usually related to treatment- eg. 1-4 days after CTx/RTx/steroids- but not always.
URIC ACID
HYPERPHOSPHATAEMIA
LDH
HyperK
HYPOCalcaemia
Metabolic acidosis
—> Renal failure (urate nephropathy)
Tumour Lysis Syndrome: management I
Prevent renal failure secondary to urate nephropathy:
URIC ACID
Aggressive hydration and diuresis
Eg.
—> N. saline 2-4L/day. Aim 2-3ml/kg/hr urine output
—> IV frusemide 20-100mg IV
- ALLOPURINOL up to 800mg/day
- RASBURICASE 0.2mg/kg daily
+ consider dialysis
__________
HYPERK
- Usual BUT NOT CALCIUM gluc (unless in immediate danger) —> CaPO4 precipitates.
HYPERPHOSPH
- Phosphate binders (eg.aluminium hydroxide)- no acute benefit
HYPOCALCAEMIA
- As above, avoid replacement if possible.
What is a Pancoast tumour?
Tumour in lung apex
Usually NSCLCs
Can cause:
-Horners syndrome
-Pancoast syndrome
What is Pancoast syndrome?
1- Scapular pain
2- Ulnar distribution pain/atrophy
Axilla, lateral arm, lateral hand
3- Horner Syndrome
—> Ptosis, Miosis, Anhydrosis
Compression of BRACHIAL PLEXUS and SYMPATHETIC CHAIN
Secondary to Pancoast tumour (apical)
DONT FORGET LUNG Ca AS DDX IN SHOULDER/ARM PAIN
Which cancers are most commonly associated with Hypercalcaemia?
Bony mets:
-Breast
-Lung
-Prostate
Lymphoma
Multiple myeloma
Renal cell
…30 day mortality is 50%!
Same ones also associated with bony mets/ cord compression (ie. bony Cx)
Paraneoplastic Syndromes:
A zillion. Refresh.
(Common with LUNG Ca)
https://en.m.wikipedia.org/wiki/Paraneoplastic_syndrome
Dose of steroid in malignant cord compression?
Dexamethasone 10mg IV
Then, 4mg QID.
Most common mechanism and location of malignant cord compression:
Epidural extension of a vertebral metastasis > bony fragment from pathological #
Thoracic > lumbar > cervical
Hyperviscosity syndrome:
Due to high WBCs or proteins
Ie.
Multiple myeloma
Leukaemia (hyperleukocytosis)
Waldenstrom’s macroglobinaemia
Causes microcirculatory insufficiency and bleed (from raised capillary pressures)
Classically:
1- Mucosal bleeding
2- Visual disturbance
3- Neuro deficit
Check viscosity directly
Blast count for leukaemia
TREATMENT
Hydrate
Avoid ‘thickeners’: eg. diuretics, transfusions
Urgent plasmapheresis/ leukophoresis
If emergent, take off blood (eg. 500ml)
Causes of altered mental status in cancer patient:
IN BRAIN:
Cerebral mets
Cerebral haemorrhage- tumour, met, thrombocytopaenia, DIC
Hyperviscosity
Ischaemic stroke -DIC, myeloprolif thrombocytosis, hyper viscosity
CNS infection
Post ichtal bleed, SOL, metabolic
METABOLIC
Hyponatraemia - paraneoplastic SIADH
Hypercalcaemia
Tumour lysis- hypocalcaemia
Sepsis
Hypoxia - pleural effusion, PE
ORGAN-RELATED
Uraemic renal failure
Hepatic encephalopathy
OTHER
Opioid withdrawal
Causes of fever in cancer patient:
Infection
Tumour lysis
Thrombosis (eg. PE)
Carcinoid syndrome (PN)
Direct paraneoplastic fever
Transfusion
Chemo/ biologic drugs
Causes of respiratory distress in cancer patient:
PE
Pericardial effusion/ tamponade
Pleural effusion
SVC syndrome
Compression of airways/ mediastinum
Fistulae
Pulmonary haemorrhage (DIC, thrombocytop)
Pulmonary tumour burden
Causes of renal failure in cancer patient:
PRERENAL
- Hypovolaemia (eg. Anorexia)
RENAL
- Tumour
- Met
- Nephrotoxic drugs/ chemo
- Tumour lysis (uric acid)
POST RENAL
- Obstructive pelvic mass
