Oncologic Emergencies Flashcards
Superior Vena Cava Syndrome
Signs: Edema of head/neck/arms/upper chest/LARYNX/BRAIN, puffy face, Venous Hypertension w/ lots of collateral vessels superficially, SOB, head fullness, chest pain, CONFUSION, COMA
Etiology: Malignancy 70% (lung ca, and NHodgk lymphoma), Benign 30% (SVC stenosis/thrombosis DUE TO INTRAVASCULAR DEVICES, Fibrosing mediastinitis)
Dx: CXR, CT (TEST OF CHOICE), venography (IF FROM DEVICE) and mr not so much, Histologic dx if malignant
Normal WBC, Normal Hb/Hct, Normal platelets
Hyponatremia
CXR - Loss of clear borders, Lost peritracheal stripe, Lots of soft tissue ext into hilum, abnormal w/ lymphadenopathy
CT - Can see many collateral vessels, big lymph nodes, mass compressing the SVC (do both coronally and sagitally)
When SVC obstructed, venous collaterals form to shunt blood to the azygous and IVC
Tx: SVC stent to treat symptoms, Then tx underlying dz
- Malignant: Radiation, Chemo
Neutropenic Fever
Definition: Temp >38 degree C, for greater than one hr, Absolute Neutrophil Count (ANP) (bands and PMNs) less than 500 cells/microliter.
Syndromes:
- Microbiologically documented infection - Neutropenic fever AND pathogen
- Clinically documented infection - Neutropenic fever w/o pathogen
- Unexplained fever
THIS IS A MEDICAL EMERGENCY
Usually induced by antineoplastic therapy - kills rapidly dividing cells - including the GI mucosa. Bacteria infiltrate (normal flora) and fungi too
Other causes could be: obstruction from catheters, breeches in host defense
Pathogens: Gram + more than Gram -, Fungal (persistent fevers, from prolonged abx use, candida (central catheter) and aspergillus), Viral (HSV, EBV, CMV)
Epidemiology: 80% of infections from gut flora
Tx: Empiric antibiotics promptly (WITHIN 60 MIN) used in ALL pnts!, use antifungals if needed, REMOVE INFECTED DEVICES, granulocyte colony stim factors if needed
Need to inspect/history DAILY
Image - CXR
Pericardial Effusion
can lead to cardiac tamponade - where the fluid around the heart is causing the heart to not fill up.
Malignant: Lung Ca, Breast Ca, Leukemia, Lymphoma, Previous Chemo/Rad
Cause: Bleeding from tumor implants, lymphatic obstruction, altered vasc permeability in heart
Signs/Symptoms: cough, SOB, weak, tachycardia w/ Low BP, NECK VEIN DISTENSION, PULSUS PARADOXUS, ELECTRICAL ALTERNANS, friction rub, low pulse pressure
Dx: Echo is test of choice, CXR - water bottle heart, CT not necessary if have and Echo
Tx: Drain the fluid:
- Pericardiocentesis - tx of choice
- Pericardial Window - cut window to drain fluid into pleural space and get reabsorbed
Malignant Spinal Cord Compression (MSCC)
Extra dural tumor compressing the spinal cord or cauda equina
Can lead to ischemia - bad
Common CA to cause: Lung, Breast, Prostate, Multiple Myeloma
almost all in the vertebral column, thoracic most common
Signs: localized back pain, “Lhermittes sign” down spine, weakness, spasticity, low reflexes, Numbness, bowel and bladder dysfunction later.
Can cause cauda equina syndrome: Low back pain, low sensation over buttocks, thigh, perineum, Bowel/Bladder dysfunction, Decreased patellar/achilles reflex, Leg weakness
Dx: Prompt eval, Neuro evaluation, MRI IS TEST OF CHOICE, CT myelogram if cant do MRI due to pacemakers.
Tx: Goal is to decompress and maintain neural function
- mostly by sx intervention
- can also be via steroids, radiation, chemo, radioablat
Tumor Lysis Syndrome
Syndrome from rapid death/turnover of large volume of rapidly proliferating cells
Characterized by:
1. Hyperkalemia
2. Hyperuricemia
3. Hyperphosphatemia
4. Hypocalcemia
5. Metabolic Acidosis
6. Acute Kidney Injury
Look for this after tx with chemotherapy
Most common if pnt has hematologic malignancy
Nucleic acids broken down to uric acid, K and P released from dead cells
Hyperphosphatemia causes Hypocalcemia = tetany, dysrhythmia and seizure - may precipitate calcium phosphate crystals in various organs
Calcium phosphate crystals - cause dysrhythmias
Cytokines released - Multisystem organ failure
Uric acid crystals - damage kidneys
Usually need nephropathy first before tumor lysis syndrome, bc a healthy kidney secretes uric acid
Uric acid precipitates in presence of calcium phosphate and vice versa
CA with high potential for this: Lymphomas, Leukemias, Rapidly proliferating Tumor
Tx: HYDRATION - mainstay for prevention
ALLOPURINOL - blocks uric acid crystals
RASBURICASE - prophylactic
Dialysis if needed
Pulmonary Embolus
SIgns: Dyspnea at rest, Pleuritic chest pain, Cough, Calf or Thigh Pain or swelling
Most common signs: Tachypnea, Tachycardia, Rales, JVD
Dx: CXR - poor sensitivity, V/Q scan - reader dependent, CT - PULMONARY ANGIOGRAPHY very SENSITIVE,
Tx: Resusitation - resp and hemo support - O2 and tPa
- Dx studies when stable
- Initiate anticoag with LMWH if no contraindications
