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Heme/Onc > Oncologic Emergencies > Flashcards

Oncologic Emergencies Flashcards

1
Q

What are metabolic/hormonal cancer related complications?

A

Tumor lysis syndrome
Hyperglycemia of malignancy
SIADH
Paraneoplastic syndrom

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2
Q

What are structural cancer related complications?

A

Superior vena cava syndrome
Pleural or pericardial effusion
Spinal cord compression

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3
Q

What are chemotherapy-related cancer related complications?

A

Extravasation

Diarrhea/Constipation

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4
Q

What are hematologic cancer-related complications?

A

Febrile neutropenia
Hyperviscosity syndrome
Thromboembolic risk associated with cancer

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5
Q

What is TLS?

A

Tumor lysis syndrome

Metabolic complications resulting from abrupt release of cellular components into the blood

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6
Q

What may TLS result in?

A

Acute renal failure

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7
Q

What are the typical electrolyte abnormalities of TLS?

A

Hyperphosphatemia
Hyperkalemia
Hypocalcemia

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8
Q

What is the pathophysiology of TLS?

A

Release of nucleic acids –>
Hyperuricemia–>
Uric acid crystal ppt in renal tubules –> –>
Acute obstructive nephropathy

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9
Q

What are the tumor related toxicities of TLS?

A

Type of malignancy - more common with acute hematologic malignancies
High tumor burden
Chemotherapy-sensitive disease

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10
Q

What are the patient related risk factors of TLS?

A

Pre-existing renal dysfunction
Elevated uric acid, WBC, serum LDH
Dehydration

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11
Q

What is the cairo-bishop classification?

A

2 or more lab changes up to 7 days after chemotherapy

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12
Q

What is an elevated uric acid level per cairo-bishop classification?

A

8.0+

25%+ increase from baseline

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13
Q

What is an elevated potassium level per cairo-bishop classification?

A

6.0+

25%+ increase from baseline

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14
Q

What is an elevated phosphorous level per cairo-bishop classification?

A

6.5+ (children)
4.5+ (adults)
25% + increase from baseline

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15
Q

What is an elevated calcium level per cairo-bishop classification?

A

Less than 7.0

25% decrease from baseline

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16
Q

What are the clinical presentations of TLS?

A 
Non-specific complaints**
Acute renal failure
Arrhythmias
Neuromuscular weakness
Tetany
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17
Q

What is the treatment outline for TLS?

A 
Aggressive emergency care
Fluids and hydration
Management of hyperuricemia
Management of electrolytes
Monitor and follow-up
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18
Q

How do we manage hyperuricemia in TLS?

A

Allopurinol (to prevent remission)

Rasburicase (treatment)

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19
Q

How is Allopurinol administered?

A

IV

PO

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20
Q

How must allopurinol be adjusted?

A

Renal dysfunction

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21
Q

Does allopurinol affect uric acid produced prior to initiation?

A

No

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22
Q

What are the AEs of allopurinol?

A

N/V
Precipitate gout flare
Increased LFTs

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23
Q

What is the indication for Rasburicase?

A

Patients with hyperuricemia secondary to leukemia, lymphoma or solid tumor malignancies; indicated for a single course of treatment

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24
Q

How is rasburicase administered?

A

IV

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25
Q

What is the BBW of rasburicase?

A

Anaphylaxis
Hemolysis
Methemoglobinemia

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26
Q

What are monitoring issues with rasburicase?

A

Collect blood in prechilled heparinized tubes
Immerse in ice water
Analyze samples w/in 4 hours

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27
Q

What is the management of hyperkalemia?

A

Insulin and glucose
Albuterol
Diuretics/dialysis
Bicarbonate

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28
Q

What is the treatment of hyperphosphatemia?

A

Phosphate binds
IV fluids
Dialysis

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29
Q

What is the treatment of hypocalcemia?

A

Treat phosphorous levels

30
Q

How do we monitor pts with TLS?

A 
Renal function
I&Os
SCr
Electrolytes
EKG
31
Q

What range is severe hypercalcemia?

A

14+

32
Q

What is the corrected calcium equation?

A

Observed Ca + 0.8 (4 - albumin)

33
Q

What is the pathophysiology of hypercalcemia of malignancy?

A

Increased bone resorption

Enhanced renal tubular and intestinal reabsorption

34
Q

What medications may cause hypercalcemia?

A

Calcium supplements
HCTZ
Lithium

35
Q

What are the clinical presentations of hypercalcemia of malignancy?

A 
"Stones, bones, ab groans, psychiatric moans"
Renal
GI
Neurologic
CV
36
Q

What are the renal presentations of hypercalcemia of malignancy?

A 
Kidney stones
Polyuria
Polydipsia
Dehydration
Decreased GFR
37
Q

What are the GI presentations of hypercalcemia of malignancy?

A

Constipation
N/V
Anorexia

38
Q

What are therapies for hypercalcemia of malignancy?

A

D/c exogenous sources of calcium
Hydration (watch CV status)
Diuresis (after establishing rehydration)
Bisphosphonate therapy

39
Q

What is a follow up therapy if bisphosphonates do not fix calcium after the second dose?

A

Calcitonin
Denosumab (if refractory to zolendronic acid)
Glucocorticoids (in steroid responsive diseases)
Mithramycin (chemo)
Gallium nitrate (chemo)
Dialysis

40
Q

What are the causes of superior vena caca syndrome?

A

SVC obstruction
Malignancy - lung cancers most common
Non-oncologic

41
Q

What are the s/sx of vena cava syndrome?

A 
Facial/neck swelling
Upper extremity swelling
Dyspnea
Cough
Dysphagia/stridor
Syncope
Sensation of fullness in head
Distended neck/chest veins
Facial, neck, arm edema
Facial plethora
Cyanosis
42
Q

What are the classifications of vena cava syndrome?

A

0-5
0=asymptomatic
5=death

43
Q

How is vena cava syndrome diagnosed?

A

Made with s/sx and imaging studies

44
Q

How is vena cava syndrome managed?

A

Treat underlying cause (chemo/radiation)
Endovascular revascularization
Supportive measures (elevate head of the bed/O2)
Corticosteroids/diuretics (controversial
Anticoagulation for thrombosis-related obstruction

45
Q

What cancers are the most common causes of pleural effusions?

A

Lung
Breast
Lymphoma

46
Q

What cancers are the most common causes of pericardial effusions?

A 
Lung
Breast
Leukemia/lymphoma
GI
Sarcomas
Melanoma
47
Q

What is the pathophysiology of pleural/pericardial effusions?

A

Impaired balance between normal fluid production and elimination

48
Q

What is the clinical presentation of pleural and pericardial effusions?

A

Dyspnea
Cough
Chest pain

49
Q

What is on the PE of pleural and pericardial effusions?

A

Decreased breath sounds
Dullness to percussion
Decreased fremitus
Pericardial rub

50
Q

What is the treatment for plerual/pericardial effusions?

A 
Treat the underlying cause
Diagnostic tap (may turn into therapeutic tap)
Thoracentesis/chest tube drainage
Pleurodesis/sclerotherapy
Doxycycline/bleomycin/talc
51
Q

What is pleurodesis?

A

Put talc into space where fluid was so that it won’t fill back up and closes it like a glue

52
Q

What are AEs of using doxycycline in pleural/pericardial effusion?

A

Pain

Fever

53
Q

What are AEs of using bleomycin in pleural/pericardial effusion?

A

Pain
Fever
Alopecia
Dyspnea

54
Q

What are the AEs of talc in pleural/pericardial effusion?

A

Pain
Hypotension
Infection

55
Q

What cancers commonly cause spinal cord compression (SCC)?

A

Prostate cancer
Breast cancer
Lung cancer
RCC, NHL, MM, CRC, sarcoma

56
Q

What is the clinical presentation of SCC?

A

Pain - mainly back

57
Q

What are the motor findings of SCC?

A

Weakness
Hyperreflexia below level of compression
+Babinski sign
Diminished LE deep tendon reflexes

58
Q

What are sensory findings of SCC?

A

Paresthesias (ascending numbness most common)

59
Q

What autonomic dysfunction does SCC cause?

A

Urinary retention

60
Q

What are the therapy options for SCC?

A

Tailored to patient severity
HD dexamethasone (LD + 4-24 mg q6h)
Surgery and radiation
Supportive care

61
Q

What is extravasation?

A

Accidental leakage of chemotherapy from the vein into the surrounding tissue

62
Q

What are irritants that cause extravasation?

A 
Cisplatin
Oxaliplatin
Irotecan
Topotecan
Paclitaxel
63
Q

What vesicants cause extravasation?

A

Anthracyclines
Vinca
Paclitaxel
Mitomycin

64
Q

What are patient related RFs for extravasation?

A

Age
Unable to communicate
Impaired circulation

65
Q

What are procedure related RFs for extravasation?

A

Administration technique
IV/port site
Drug itself (cellular toxicity)
Mobility of patient

66
Q

What are preventative measures for extravasation?

A

Patient and staff education
Check patency of lines, appropriate veins and equipment
Avoid easily “dislodged” lines
Flush line before and after administration
Use thin cannulas with high gauges
Monitor closely
Recognition of patient sx

67
Q

What is the management of extravasation?

A 
Stop infusion - leave needle/cannula/catheter in place
Slowly aspirate as much drug as possible
Apply antidote (if applicable)
Withdraw IV access
Elevate area to minimize swelling
Mark affected area and photograph
Plastic surgery may be necessary
68
Q

What is the localize and neutralize method?

A

Application of cold pack to affected area

69
Q

How does localize and neutralize method work?

A

Cold causes vasoconstriction to localize the extravasation
DMSO
Dexrazoxane
Sodium thiosulfate

70
Q

What is the disperse and dilute method?

A

Application of warm compress to affected area

71
Q

For which agents is disperse and dilute used?

A

Vincas

Oxaliplatin

72
Q

How does disperse and dilute work?

A

Warm causes decreased local drug concentrations

Hyaluronidase - pharmacological dispersing agent sometimes used, but limited evidence

Heme/Onc (20 decks)

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