oncological complications Flashcards
what do you need to consider when you are treating an emergency
wishes of the patient and carers nature of the problem general health of the patient stage of the disease other comorbidities effect / toxicity of treatment
what is metastatic spinal cord compression
haematogenous spread of cancer causing bone metsa that caise collapse or compression of the spinal cord. it may also be caused through local tumour extension or a tumour deposited in the spinal cord.
most commonlu occurs in the thoracic region but may also occur in the cervical and lumbosacral regions
what are the symptoms of metastatic spinal cord compresssion
back pain
- radicular
- localised
- both
- abdominal pain
symptoms are made worse by coughing or straining
neurological symptoms - radicular pain - limb weakness - difficulty walking - sensory loss - bladder or bowel dysfucntion - pins and needles/ numbness it is important to know the dermatomes as this will signify which areas of the spine are affected
what other causes of spinal cord compression may there be
abcess
disk prolapse
haematoma
intrinsic cord tumour
but in a patinet with a known malignancy or symptoms of an undiagnosed malignancy MSCC should always be first on list of differentials and treated as this until proven otherwise
what investigations should you do for MSCC
MRI of the whole spine
DRE to assess tone and sensation
how is MSCC treated
immediate management
- stabilise patient like in spinal fracture
- steroids - decrease swelling. useually dexamethasone
- analgesic
definitive management
- radiotherapy - prevents neurological deteriation, improves neurological function, gives pain relief
- surgery - has a good prognosis in a radio-resistant tumour, spinal instability and local disease
- rehabilitation
- chemotherapy
prevention
- bisphosphonates / denosumab
- give patients info about signs to look out for
what is a superior vena cava obstruction
this is a common occurance in patients with lung cancer and mediastinal lymphoma. There is a mass that obstructs the superior vena cava and affects return to the heart causing backlog above the obstruction
what are the symptoms of a superior vena cava obstruction
dysponea cough facial swelling (head fullness) arm swelling more prominent veins plethoric face and chest wall cyanoisis
what investigations are done for superior vena cava obstruction
CT with contrast to confirm obstruction
biopsy is ideal but may not be possible. this is only needed if it is a new cancer diagnosis
how is superior vena cava obstruction managed
steroids - decrese swelling
anticoagulation
endovascular stent
radiotherapy - effect could be delayed and may have side effects
define neutropenic sepsis
sepsis that fits the following diagnostic criteria
- neutrophils less than 0.5x10^9
- anti cancer treatment
- temperature higher than 38
- other symptoms and signs of sepsis
- the source of infection should be looked for thoroughly in examination and with investigations. In neutropenic sepsis there will be no cause
what are the symptoms of neutropenic sepsis
fever - those who are having chemo are advised to take their temperature regually at home and if above 38 they must contact the local oncology department
feeling generally unwell
focal infection symptoms
how is neutropenic sepsis treated
A-E management
treat as normal sepsis with sepsis 6
- give IV antibiotics
- give oxygen
- give IV fluids
- measure urine output
- measure lactate
- take blood cultures
how can neutropenic sepsis be prevented
patient eductation of risks and symptoms
HCP education for early identification
in some adults you can give prophylaxis with flurorquinolone during the neutoprnic period (day 7-12 after chemo when neutrophil count is less than 1)
how can cancer cause raised intercranial pressure
causes through a brain tumour (primary or seccondary) which is a space occupying lesion
can also be caused by meningeal disease
what are the clinical features of raised intercranial pressure
headache - early morning, worse on coughing, worse when lying down nausea and vomiting confusion focal weakness seizures focal neurology paplioedema in cranial nerve 6 palsy
what investigations should be done in suspected oncological raised ICP
CT head
how is raised intercranial pressure treated
A-E approach
may need antiepileptic treatment if presenting with seizures
medical treatment
- dexamethasone with PPI for cerebellar oedema
- analgesia
- anti-emetics
- chemotherapy
- radiotherapy
surgery
what paraneoplastic oncological problems may occur
hypercalcaemia
cushings syndrome - glucocorticoid excess
SIADH
lambert-eaton syndrome
what are the symptoms and signs of hypercalcaemia
symptoms
- bones - Ca released from bones
- stones - renal colic
- groans - abdominal pain, nausea, vomitting, constipation, anorexia, weight loss
- moans - depression, tiredness, confusion
signs
- polyuria
- polydypsia
- ECG - shortened QTc
what are the common causes of oncological hypercalcaemia
osteolytic bone tumour
myeloma
parathyroid hormone recominant protein secreted by squamous cell lung cancer or breast cancer
how do you investigate and manage oncological hypercalcaemia
inestigations - you need to differentoate between malignancy and primary hypercalcaemia by looking at phosphate and ALP
management
- treatmnet depends on symptoms, ca levels and how quickly teh ca has risen
- IV fluids
- bisphosphonates
- desosumab, calcatonin and dieuretics as seccond line
- treat underying tumour
what are the different oncological causes of cushing syndrome?
ACTH independent
- adrenal adenoma or carcinoma
- adrenal nodular polyps
- steroids used in cancer treatmnet
ACTH dependant
- ectopic ACTH production
- cushings disease
what are the symptoms and signs of cushings syndrome
symptoms
- weight gain
- mood change
- proximal weakness
- acne
- hirtuism
- irregular periods
- erectile dysfunstion
signs
- obesity
- moon face
- supraclavicular fat pads
- bruises
- striae
- hypertension
- hyperglycaemia
what investigations are done for cushings syndrome?
imaging to localise the lesion
cause dependadnt
eg. bone protection and PPI
what cancers may cause SIADH
prostate small cell lung cancer pancreatic thymus lymphoma
may also be caused by drugs, CNS disease, fluid restriction or ADH receptor
how do you diagnose SIADH
euvolaemic hyponatraemia with no other cause
how do you treat SIADH
hypertonic saline to replace sodium
fluid restriction
ADH receptor antagonist
needs to be corrected slowly to prevent myanosis which causes pathology of the brainstem
what is lambert eaton syndrome
an autoimmune disease which may be caused by small cell lung cancer
diagnosus of this may often precede the cancer diagnosis so careful screening must be done
what are the symptoms and signs of lambert eaton syndrome
symptoms
- difficulty walking
- double vision
- autonomic involvemet
signs
- hyporeflexia
- proximal muscle weakness
how is lambert eaton syndrome treated
diaminopyridine
IV immunoglobulin
treatment of underlying cancer
