Oncologic emergencies Flashcards
Tumor Lysis Sydrome
Metabolic derangement resulting from the death of malignant cells
What?–> massive release of intracellular contents into blood overwhelm body’s hemostasis
When?–>1-5 days following treatment
Where?–> Lymphoma and leukemia
Risk factors
High tumor burden, high tumor grade with rapid tumor turnover, treatment sensitive to tumors
Age, preexisting renal impairment, medications (ASA, alcohol, caffeine, thiazide)
Hyperkalemia
Immediate (6-72 hours after therapy)
Exacerbated by AKI
Effects: arrhythmia’s, EKG abnormalities
Hyperuricemia
Immediate (24-48 hours after therapy)
Purine catabolism–>hypoxanthine–>xanthine–>xanthine oxidase–>uric acid–>urate oxidase–>allantoin
Effect: AKI
Hyperphosphatemia
Immediate (24-48 hours after therapy)
Calcification with calcium
Effect: AKI
Hypocalcemia
Immediate (24-48 hours after therapy)
Acute renal failure
Delayed (48-72 hours after therapy)
Fluid overload, edema, CHF, seizures
Treatment
Identify high risk patients
Monitor electrolytes
Hyperkalemia: > 6 mEq/L–> CA BIG K DROP
Hyperphosphatemia: Sevelamer TID with meals
Hypocalcemia: symptomatic–>calcium gluconate
Aggressive hydration:
D5W + 1/2 NS +/- diuretics
Maintain urine output of 80-100 mL/m^2/hr
Hyperuricemia low risk
Baseline uric acid: < 7.5 mg/dL
Baseline WBC: < 25,000
Baseline LDH: <2X UNL
Prophylaxis: Monitoring + hydration +/- allopurinol
Hyperuricemia intermediate risk
Baseline uric acid: <7.5 mg/dL
Baseline WBC: 25,000-100,000
Baseline LDH: >2X UNL
Prophylaxis: monitoring + hydration + allopurinol
Hyperuricemia high risk
Baseline uric acid: > 7.5 mg/dL
Baseline WBC: >100,000
Baseline LDH:> 2x UNL
Prophylaxis: monitoring +hydration + rasburicase
Monitoring prior to chemo
potassium
calcium
phosphate
uric acid
SCr
urine output
LDH
Monitoring during first 72 hours
Potassium
calcium
phosphate
uric acid
SCr every 8 hours
Rasburicase: uric acid 4-8 hours
Malignant spinal cord compression
EMERGENCY
What?–> compression of the dural sac, spinal cord, or cauda equina by extradural or intradural mass and edema and cytokines that can lead to irreversible neurologic damage
Where?–> prostate, breast, lung
Symptoms of Malignant spinal cord compression
Pain
Limb weakness, unsteady gait, difficulty walking, standing, transferring
Decreased sensation and numbness of toes/fingers
Urinary retention, incontinence, constipation
Diagnosis
MRI of whole spine
Treatment
If strong suspicion:
DEXAMETHASONE ONLY
STAT MRI
Radiation +/- surgery
Surgery indications: spinal instability, previous radiation, disease progression despite radioresistant tumor, paralegia < 48 hours
Laminectomy: surgical removal of tumor mass
Vertebroplasty: bone cement injected
Kyphoplastly: balloon insertion
Bisphosphonates
SVC syndrome
Thin-walled SVC gradually compressed by tumors outside of vessel
Impaired venous drainage from head, neck, and upper extremities
Occurs in the setting of an extrinsic compression
Signs/symptoms of SVC
Distention of superficial neck and chest wall veins
Hypotension
Dyspnea at rest
cough
stridor
facial and arm edema
SVC treatment
Goal is to alleviate symptoms and treat underlying disease
Biopsy and staging of cancer
Resection, radiation, stenting, chemo, anticoagulation
SVC adjunctive therpies
Elevation of head
Steroids
Diuretics
Malignant Pleural Effusion
Commonly encountered complication of advanced malignancy
Most common cancer: lung, breast, lymphoma
Fatal prognosis: 3-12 months
Pleural effusions=accumulation of fluid within the pleural space
MPE Symptoms
Dyspnea
Pleuritic chest pain
MRE diagnosis
Chest x-ray, ultrasound, CT
MPE management
Thoracentesis–>drain fluid
Pleural Fluid Analysis
