Oncologic Emergencies Flashcards
Oncologic emergencies are defined as potentially life-threatening events directly or indirectly related to a patient’s ___ or its ___
- Primarily an acute process, but can manifest as slow and insidious
An oncologic emergency can occur at any time during a malignancy, from the presenting symptom to end-stage disease
tumor
treatment
Tumor Lysis Syndrome
TLS is a constellation of ___ derangements resulting from the death of malignant cells
- Massive release of intracellular contents into the bloodstream that overwhelms the body’s homeostasis
- Mostly observed following treatment (generally after 1 - 5 days), but can occur spontaneously
- Usual homeostatic mechanisms can often compensate for
these shifts, if ___ function is good in patient
metabolic
kidney
TLS: Risk Factors
- Primary associated with aggressive ___ malignancies, but also seen in solid tumors
- Tumor specific risk factors: High tumor burden, high tumor grade
with rapid cell turnover, and treatment sensitive tumors - Patient specific risk factors: Age, preexisting renal impairment,
concomitant use of drug known to increase uric acid - Examples: Aspirin, alcohol, thiazide diuretics, caffeine
- hematologic
TLS Pathophysiology
hyper ___ , ___ , and ___
hypo ___
- hyperkalemia, hyperuricemia, hyperphosphatemia
- hypocalcemia
hyperuricemia and hyperphosphatemia cause AKI
TLS: Aggressive Hydration
Fluids and Hydration
- Improves intravascular volume, renal perfusion, and glomerular filtration
- Decreases risk of life-threatening hyperkalemia
- May require use of diuretics
Urine Output = ___ - ___ mL/m 2 /hr
80-100
TLS: Allopurinol Medical Management
Does NOT facilitate the breakdown of uric acid that has already been produced, prevents formation of
___ uric acid
* For use with intermediate risk of TLS
* Reduces incidence of obstructive uropathy
Duration of therapy
* Until normalization of uric acid and other lab values
* Tumor burden decreases to low-risk criteria
- new
Rasburicase
- Decreases uric acid levels, including already ___ uric acid, within 4 hours!
- use in patients who are not candidates for allopurinol, high-risk
- expensive
- Contraindicated in women pregnant or breast-feeding
- formed
Malignant Spinal Cord Compression (MSCC)
Caused by compression of the dural sac, spinal cord, or cauda equina by an extradural or intradural mass
All cancers can cause MSCC
- Most common: Breast, lung, ___
early diagnosis and treatment are
ESSENTIAL to prevent permanent
neurologic damage and possible ___
Magnetic resonance imaging
(MRI) of the WHOLE ___ is the
method of choice
- prostate
- paralysis
- spine
MSCC Symptoms
pain
motor deficit
sensory deficit
autonomic dysfunction
MSCC Treatment
if strong suspicion – start ___ IMMEDIATELY
___ and ___ are the only treatments that leads to immediate relief of MSCC
All patients should be evaluated urgently for a decompressive surgical procedure or radiotherapy
___ should be offered in patients with vertebral involvement to reduce the risk of vertebral fracture / collaps
steroids
surgery, radiotherapy
Bisphosphonates
Superior Vena Cava (SVC) Syndrome
SVC: Major blood vessel for venous blood flow from head, neck, upper extremities to heart & lungs to the heart
- Carries approximately 1/3 of
the total venous return to the
heart
Thin-walled SVC gradually compressed by tumors outside the vessel
- Impaired venous drainage
from the head, neck, and upper extremities
SVC Syndrome Treatment
- Most cases are not considered an oncologic emergency
- Patients with symptoms and signs concerning for cerebral and/or airway edema and circulatory instability need urgent initiation of therapy
Adjunctive therapies (alleviation of symptoms):
- Elevation of head to decrease hydrostatic pressure & edema
- Steroids are recommended only in patients with steroid sensitive
tumors & in patients undergoing radiation therapy
- Diuretics have been recommended to decrease arterial pressure to
affect venous pressure distal to the obstruction. If they do not alter
symptoms, do not continue
Malignant Pleural Effusion (MPE)
Most common cancers:
* Lung cancer
* Breast cancer
* Lymphoma
Uniformly fatal prognosis
* Life expectancy of 3 - 12 months
Effusions form when cancer cells spread to the pleural space increases the production and decreases ___ of the pleural fluid
absorption
MPE Management
___ : Needle aspiration of fluid from a pleural effusion
Pleurodesis
- Activates inflammatory cascade leading to ___ of pleural layers
- Useful for patients with life expectancy > 1 to 3 months
Agents:
* Talc
* Doxycycline
* Bleomycin
Pleural Catheters & Pleurectomy
Thoracentesis
adhesion
