Oncologic Emergencies Part 2

Question 1

Tumor Lysis Syndrome Risk Factors

Answer 1

	Tumor with high proliferative rate
	Tumor sensitive to cytotoxic therapy
	Large tumor masses
	Leukocytosis
	High LDH
	Pre-existing renal insufficiency
	Hematologic malignancies

Question 2

LDH + Tumor Lysis

Answer 2

Indirect measurement of patient’s tumor burden

Question 3

Tumors sensitive to cytotoxic therapy –>

Answer 3

Tumors that are more sensitive will have more dying and releasing of components

Question 4

Highest Risk of TLS

Answer 4

Burkitt’s lymphoma
Lymphoblastic lymphoma
ALL
AML

Question 5

Moderate Risk of TLS

Answer 5

Multiple myeloma
Breast cancer
Small cell lung
Germ cell

Question 6

What is Tumor Lysis Syndrome

Answer 6

 Rapid lysis of tumor cells leads to release of intracellular content which leads to exceeding ability for normal compensatory mechanisms

Question 7

Findings with TLS

Answer 7

Hyperuricemia
Hyperkalemia
Hyperphosphatemia
Hypocalcemia

Question 8

Consequence of TLS

Answer 8

Renal failure

Question 9

Hyperkalemia leads to

Answer 9

Cardiac and neuromuscular complications (cramps)

Question 10

Hyperphosphotemia leads to

Answer 10

GI symptoms, lethargy and seizures

Question 11

Hypocalcemia

Answer 11

Leads to cardiac arrhythmia, hypotension, tetany

Question 12

Hydration + TLS

Answer 12

• Initiate 24-48 hours prior to therapy
• Continue until 48-72 hours after therapy
• Diuretics should be considered to have equal fluid intake and output

Question 13

Alkalinize Urine + TLS

Answer 13

• Sodium bicarbonate or acetazolamide (inhibiters carbonic anhydrase → increases pH → increase solubility of uric acid)
GENERALLY NOT RECOMMENDED

Question 14

Allopurinol MOA and Dose

Answer 14

Inhibits xanthine oxidase so it inhibits the formation of uric acid
Dose: LD of 600 mg and then 300 mg/day

Question 15

Rasburicase MOA and Use

Answer 15

• Urate acid is converted to Allatoin via urate oxidase and is 5-10X more soluble than urate acid so it will get cleared quicker
• This prevents hyperuricemia and TLS

Question 16

Rasburicase Dose, CI, AE

Answer 16

Dose: 6 mg once daily
CI: G6PD deficiency
AE: urticaria, fever, N/V

Question 17

High Risk Treatment of TLS

Answer 17

Hydration and rasburicase

Question 18

Intermediate Risk Treatment of TLS

Answer 18

Hydration, allopurinol

Question 19

Low Risk Treatment of TLS

Answer 19

Clinical judgement and monitoring

Question 20

Close monitoring and imagining for TLS

Answer 20

• CBC
• Electrolytes
• Renal function
• Urine analysis to monitor pH (not necessary)
• Fluid intake and output (make sure good flow to kidneys, so all the electrolytes and enzymes are removed quickly

Question 21

Superior Vena Cave Syndrome Leads to

Answer 21

	Increased venous pressure
	Airway obstruction
	Cerebral edema
	Decreased cardiac filling
	Decreased cardiac output

Question 22

Signs and SYmptoms of SVC

Answer 22

	Dyspnea, tachypnea
	Cough
	Venous distension
	Facial or arm edema
	Chest pain (upper part- head should and upper chest)
	Dysphagia
	Sensation of fullness in head
	Cyanosis

Question 23

Causes of SVC

Answer 23

 Lung cancers – SCLC
 Lymphomas – NHL and HD
 Head and neck cancers

Question 24

Diagnosis of SVC

Answer 24

 Chest X-ray
 CT scan: neck and chest
 Venography: if thrombus expected
 Biopsy of mass (confirm that it is cancer)

Question 25

Treatment of SVC

Answer 25

Goal: relieve symptoms and prevent complications

Chemotherapy or radiation (most common first line and them chemo)

Question 26

Supportive Measures for SVC

Answer 26

	Bed rest 
	Oxygen
	Corticosteroid
	Diuretics
	Low salt diet

Question 27

Spinal Cord Compression Presentation

Answer 27

 Hematologic that have metastasized to the bone to lead to compression of the spinal cord

Question 28

Signs and Symptoms of PCC

Answer 28

	Pain >90% of patients
	Neurologic symptoms
•	Motor: weakness, spasticity
•	Sensory: numbness, ataxia
•	Autonomic dysfunction (loss of control of bowel movements)
•	Paraplegia

Question 29

Diagnosis of PCC

Answer 29

X-ray of spine

MRI/CT of spine

Question 30

Treatment of PCC

Answer 30

Dexamethasone to reduce edema

Radiation (treatment of choice)