Oncologic emergencies

Question 1

What are five oncologic emergencies?

Answer 1

(1) Febrile neutropenia
(2) Spinal cord compression
(3) Hypercalcemia
(4) Superior vena cava syndrome
(5) Hyperviscosity syndrome

Question 2

What is febrile neutropenia?

Answer 2

Fever occurring 10-14 days after chemotherapy due to low neutrophil count

Question 3

How is febrile neutropenia managed?

3

Answer 3

(1) Always evaluate fever after chemotherapy
(2) Start patient on broad spectrum antibiotics
(3) Identify infection by blood culture, then treat specific organism

Question 4

What is the mechanism spinal cord compression?

Answer 4

Spine metastases with expansion into the epidural space

Question 5

What is the progression of symptoms in spinal cord compression?

Answer 5

(1) Pain
(2) Weakness
(3) Sensory deficits
(4) Paraplegia

Question 6

What cancers typically cause spinal cord compression?

Answer 6

Common cancers (nasopharyngeal, breast, lung, lymphoma, multiple myeloma)
Adenocarcinoma
Neuroblastoma, Ewing’s sarcoma

Question 7

What is the treatment for spinal cord compression?

Answer 7

(1) Steroids to decrease cord edema
(2) External beam irradiation
(3) Surgical decompression

Question 8

What causes hypercalcemia?

Answer 8

(1) Paraneoplastic tumor produces factors that cause bone resorption or tubular calcium reabsorption
(2) Osteoclast-mediated upregulation of osteoclast-activating factors

Question 9

How is hypercalcemia treated?

Answer 9

(1) Rapid rehydration to replace intravascular contraction and prevent renal calcium reabsorption
(2) Bisphosphonates - inhibit bone resorption

Question 10

What causes superior vena cava syndrome?

Answer 10

Compression of SVC by malignancies in superior mediastinum

Question 11

What are the symptoms of SVC syndrome?

Answer 11

(1) Dyspnea
(2) Facial swelling
(3) Distension of neck and chest wall

Question 12

How is SVC syndrome treated?

Answer 12

(1) Radiation therapy
(2) Endovascular stenting
(3) Angioplasty
(4) Thrombolytic therapy
(5) Surgery

Question 13

What are the causes of hyperviscosity syndrome?

Answer 13

(1) IgM in Waldenstrom’s macroglobulinemia

(2) IgA or IgG in multiple myeloma

Question 14

What are signs of hyperviscosity syndrome?

Answer 14

(1) Changing mental status
(2) Pulmonary distress
(3) Renal failure

Question 15

How is hyperviscosity syndrome treated?

Answer 15

Prompt plasmapheresis to remove immunoglobulin