Oncological Emergencies

Question 1

What are the 3 types of Oncological Emergencies?

Answer 1

• Obstructive
• Metabolic
• Infiltrative

Question 2

Oncological Emergency: Define Obstructive and give examples.

Answer 2

• Obstructive emergencies are mainly caused by tumor obstruction of an organ or blood vessel.

Question 3

Obstructive Oncological Emergencies include:

Answer 3

• Superior vena cava syndrome
• Spinal cord compression syndrome
• Third space syndrome
• Intestinal obstruction.

Question 4

Oncological Emergency: Define Metabolic

Answer 4

• Metabolic emergencies are caused by the production of ectopic hormones directly from the tumor or from metabolic problems caused by the cancer or cancer treatment.
• Ectopic hormones arise from tissues that do not normally make these hormones.
• Cancer cells return to a more embryonic form, thus allowing the cells’ stored potential to become evident.

Question 5

Metabolic Oncological Emergencies include:

Answer 5

• Syndrome of inappropriate antidiuretic hormone (SIADH) secretion (Chapter 49)
• Hypercalcemia (Chapter 16)
• Tumor lysis syndrome, septic shock (Chapter 66)
• Disseminated Intravascular Coagulation (Chapter 30

Question 6

Oncological Emergency: Define Infiltrative

Answer 6

• Infiltrative emergencies occur when cancer infiltrates major organs or from cancer treatment.

Question 7

Infiltrative Oncological Emergencies include:

Answer 7

• Cardiac tamponade
• Carotid artery rupture

Question 8

Oncological Emergency: What is Superior Vena Cava Syndrome?

Answer 8

• An obstructive oncological emergency
• Cause: Obstruction by tumor or thrombosis

Question 9

What are the s/s of Superior Vena Cava Syndrome?

Answer 9

• Facial and periorbital edema
• Distention of veins of head, neck, and chest
• Seizures
• Headache

Question 10

What is the tx for Superior Vena Cava Syndrome?

Answer 10

• Position upright
• Diuretics: furosemide (Lasix)
• Steroids: to reduce inflammation/pressure
• Adjust treatment plan

Question 11

Oncological Emergency: What is Spinal Cord Compression?

Answer 11

• An obstructive oncological emergency
• Tumor in epidural space of spinal cord

Question 12

What are the s/s of Spinal Cord Compression?

Answer 12

• Intense, localized, persistent back pain
• Motor weakness
• Sensory paresthesia and loss
• Change in bladder or bowel function
• Signs of hypovolemia including hypotension, tachycardia, low central venous pressure, and ↓ urine output

Question 13

What is the tx for Spinal Cord Compression?

Answer 13

• Replacement of fluids, electrolytes, and plasma protein

Question 14

Oncological Emergency: What is Third Space Syndrome?

Answer 14

• Shifting of fluid from vascular space to interstitial space

Question 15

What are the s/s of Third Space Syndrome?

Answer 15

• Weight gain
• Decreased urinary OP
• Signs of hypovolemia (tachycardia, hypotension, bradycardia)

Question 16

What is the tx for Third Space Syndrome?

Answer 16

• Administer fluids to draw fluids back into intravascular system for elimination

Question 17

Oncological Emergency: What is SIADH?

Answer 17

• Syndrome of Inappropriate Diuretic Hormone
• Cancer cells can manufacture, store and release ADH
• Some chemotherapeutic agents stimulate release

Question 18

What are the s/s of SIADH?

Answer 18

• Low urine OP
• N/V
• Cramps or tremors, seizures
• Depressed mood, memory impairment.
• Irritability, confusion, and hallucinations.
• Stupor or coma.

Question 19

What is the tx for SIADH?

Answer 19

• Fluid restriction
• 3% NaCl

Question 20

Why do we need to monitor sodium level when correcting SIADH?

Answer 20

• Correcting SIADH rapidly may result in seizures or death.

Question 21

Oncological Emergency: What causes Hypercalcemia?

Answer 21

• Parathyroid hormone like substance secreted from cancer cells

Question 22

What are the s/s of Hypercalcemia?

Answer 22

• Apathy, depression, fatigue, weak muscles
• Electrocardiogram changes
• Polyuria, nocturia
• Anorexia, nausea, vomiting
• Can be life-threatening w/ renal system

Question 23

What is the tx for Hypercalcemia?

Answer 23

• Treatment is aimed at primary disease.
• Acute hypercalcemia is treated by:
  
  • Hydration
  • Diuretic administration
  • Bisphosphonate (keep calcium in bones)

Question 24

What is Tumor Lysis Syndrome (TLS)?

Answer 24

• An oncological emergency
• A condition that happens when cancer cells die quickly (as a result of radiation or chemotherapy

Question 25

Why is TLS dangerous?

Answer 25

• Dying cells release large amounts of potassium, phosphate, and uric acid into the blood.
• This can cause heart or kidney problems and lead to heart/kidney failure.
• TLS can become life-threatening if is not managed or treated
• Increased phosphate also cause calcium to go down resulting in hypocalcemia

Question 26

What are the unique s/s of TLS?

Answer 26

• Muscle weakness, cramps, or spasms
• Tingling around the mouth or in the hands or feet
• Palpitations the heart feels like it beating faster or slower
• Seizures

Question 27

How is TLS dx’d?

Answer 27

• Blood tests for: K, Ca, Phos, and Uric Acid levels

Question 28

What is the primary tx for TLS?

Answer 28

• Increase urine production with hydration therapy
• Decrease uric acid concentrations
• Primary goal is preventing renal failure and severe electrolyte imbalance

Question 29

What are the four hallmark (lab) signs of TLS?

Answer 29

• Hyperuricemia
• Hyperphosphatemia
• Hyperkalemia
• Hypocalcemia

Question 30

TLS usually occurs when?

Answer 30

• 24 to 48 hours after chemotherapy