Oncologic Emergencies Flashcards
What do the following have in common: Neutropenic fever, tamponade, cord compression, CNS metastases with symptoms?
need to be treated immediately
What do the following have in common: coagulopathies, tumor lysis, leukostasis, hyperviscosity, severe thrombocytopenia, INR over 9?
need to be treated same day
What do the following have in common: SVC Syndrome, most hypercalcemia, most CNS mets without edema, INR 5-9?
need to be treated same day or the next day
Presents as back pain, inflammation, and paresthesias. Usually occurs in diseases with vertebral body mets, not hematogenous dural mets
spinal cord compression
What comes first in cord compression, autonomic dysfxn or motor/sensory?
motor/sensory dysfxn
Imaging needed for cord compression
MRI / CT [+/- myelogram] of the WHOLE spine
Medication that can be helpful for cord compression, brain metastases
Decadron
Presentation includes: headache, seizures, altered mental status, or focal deficits
brain metastases
Most commonly from lung or breast cancer if no prior known primary
brain metastases
Pharmacological therapy for brain metastases
decadron to reduce edema and dilantin if seizure suspected
Presentation includes nonspecific sx’s: somnolence, headache, blurry vision, dizziness
hyperviscosity/leukostasis
commonly occurs with Waldenstrom’s. less commonly with multiple myeloma or polycythemia Vera, essential thrombocytosis
hyperviscosity
Tx for hyperviscosity
hydration, apheresis for IgM, plus chemotherapy. Hydroxyurea/aspirin for ET
Most commonly in AML
leukostasis (blast crisis)
Sx include altered mental status, coma common, but other organs also involved.
Hypoxia, renal insufficiency
leukostasis (blast crisis)
Cancers that commonly cause cardiac tamponade
lung and breast cancers
Presentation includes left or right sided failure, pulsus paradoxus, big heart on CXR
cardiac tamponade
Surgical therapy for cardiac tamponade
subxiphoid pericardial window or balloon pericardiotomy
collection of three medical signs associated with acute cardiac tamponade. The signs are low arterial blood pressure, distended neck veins, and distant, muffled heart sounds
Beck’s triad
abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration
pulsus paradoxus
Usually from bronchogenic carcinomas. Presents with facial edema, symmetric or asymmetric upper extremity edema, SOB common, but not hypoxic
SVC syndrome
Tumor of pulmonary apex. Presents with progressively enlarging veins over the anterior chest wall
Pancoast tumor
Tx for SVC
radiatin of tumor, heparin or corticosteroids.
Occurs in tumors with high body burden and high chemosensitivity. Usually high-grade lymphomas or leukemias (Burkitt’s, ALL)
tumor lysis syndrome
Few clinical symptoms other than being ill with obvious lab abnormalities due to renal failure
tumor lysis syndrome
Metabolic abnormalities associated with tumor lysis syndrome due to rapid turnover of tumor cells
hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia
Metabolic levels that kill
high K+ and low Ca++
What should you do if phosphate level is greater than 7?
switch NaHCO3 to NS to prevent Ca-PO4 deposits in kidney
Cancers most commonly associated with hypercalcemia
breast, lung, multiple myeloma
Presentation includes: Fatigue, N/V, constipation, anorexia, apathy, decreased consciousness most common
hypercalcemia
Why are patients volume depleted with hypercalcemia?
due to calcium-induced renal tubular defects
Tx of hypercalcemia
volume repletion, furosemide, IV pamidronate (Aredia)
Predicts short survival
hypercalcemia
Cancer that commonly causes SIADH
small cell lung cancer
Labs include decreased BUN/serum osmolarity and increased urine osmolarity and sodium levels
SIADH
Presentation includes: anorexia, irritability, N/V, constipation, muscle weakness, myalgia, abnormal reflexes, papilledema
SIADH
Tx for SIADH
limit fluid intake to 500-1000ml/day, furosemide, Na+ replacement if neuro sx
May initially be very subtle, then rapid development of hypotension, dyspnea, sepsis
neutropenic fever
When does most neutorpenia occur?
10-15 days after chemotherapy is given
Antibiotic tx for neutropenic fever without a suspected source
Cefipime, Moxifloxacin, Pip/Gent, Aztreonam
Sx include: Mucosal bleeding most common epistaxis, gingival bleeding, bullous hemorrhages. Cutaneous bleeding, petechiae, ecchymoses, Menorrhagia
thrombocytopenia
Tx for thrombocytopenia
Prednisone if patient is well. IV-IG if patient ill
Tx for overanticoagulation due to warfarin
2 units FFP and 5 mg IV vitamin K
Tx for overanticoagulation due to heparin or LMWH
protamine sulfate
Tx for overanticoagulation due to fondaparinux (Arixtra)
Factor VII
