Oncological Emergencies Flashcards
What are the 3 types of Oncological Emergencies?
- Obstructive
- Metabolic
- Infiltrative
Oncological Emergency: Define Obstructive and give examples.
• Obstructive emergencies are mainly caused by tumor obstruction of an organ or blood vessel.
Obstructive Oncological Emergencies include:
- Superior vena cava syndrome
- Spinal cord compression syndrome
- Third space syndrome
- Intestinal obstruction.
Oncological Emergency: Define Metabolic
- 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.
Metabolic Oncological Emergencies include:
- Syndrome of inappropriate antidiuretic hormone (SIADH) secretion (Chapter 49)
- Hypercalcemia (Chapter 16)
- Tumor lysis syndrome, septic shock (Chapter 66)
- Disseminated Intravascular Coagulation (Chapter 30
Oncological Emergency: Define Infiltrative
• Infiltrative emergencies occur when cancer infiltrates major organs or from cancer treatment.
Infiltrative Oncological Emergencies include:
- Cardiac tamponade
- Carotid artery rupture
Oncological Emergency: What is Superior Vena Cava Syndrome?
- An obstructive oncological emergency
- Cause: Obstruction by tumor or thrombosis
What are the s/s of Superior Vena Cava Syndrome?
- Facial and periorbital edema
- Distention of veins of head, neck, and chest
- Seizures
- Headache
What is the tx for Superior Vena Cava Syndrome?
- Position upright
- Diuretics: furosemide (Lasix)
- Steroids: to reduce inflammation/pressure
- Adjust treatment plan
Oncological Emergency: What is Spinal Cord Compression?
- An obstructive oncological emergency
- Tumor in epidural space of spinal cord
What are the s/s of Spinal Cord Compression?
- 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
What is the tx for Spinal Cord Compression?
• Replacement of fluids, electrolytes, and plasma protein
Oncological Emergency: What is Third Space Syndrome?
• Shifting of fluid from vascular space to interstitial space
What are the s/s of Third Space Syndrome?
- Weight gain
- Decreased urinary OP
- Signs of hypovolemia (tachycardia, hypotension, bradycardia)
What is the tx for Third Space Syndrome?
• Administer fluids to draw fluids back into intravascular system for elimination
Oncological Emergency: What is SIADH?
- Syndrome of Inappropriate Diuretic Hormone
- Cancer cells can manufacture, store and release ADH
- Some chemotherapeutic agents stimulate release
What are the s/s of SIADH?
- Low urine OP
- N/V
- Cramps or tremors, seizures
- Depressed mood, memory impairment.
- Irritability, confusion, and hallucinations.
- Stupor or coma.
What is the tx for SIADH?
- Fluid restriction
- 3% NaCl
Why do we need to monitor sodium level when correcting SIADH?
• Correcting SIADH rapidly may result in seizures or death.
Oncological Emergency: What causes Hypercalcemia?
• Parathyroid hormone like substance secreted from cancer cells
What are the s/s of Hypercalcemia?
- Apathy, depression, fatigue, weak muscles
- Electrocardiogram changes
- Polyuria, nocturia
- Anorexia, nausea, vomiting
- Can be life-threatening w/ renal system
What is the tx for Hypercalcemia?
- Treatment is aimed at primary disease.
- Acute hypercalcemia is treated by:
- Hydration
- Diuretic administration
- Bisphosphonate (keep calcium in bones)
What is Tumor Lysis Syndrome (TLS)?
- An oncological emergency
- A condition that happens when cancer cells die quickly (as a result of radiation or chemotherapy
Why is TLS dangerous?
- 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
What are the unique s/s of TLS?
- 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
How is TLS dx’d?
• Blood tests for: K, Ca, Phos, and Uric Acid levels
What is the primary tx for TLS?
- Increase urine production with hydration therapy
- Decrease uric acid concentrations
- Primary goal is preventing renal failure and severe electrolyte imbalance
What are the four hallmark (lab) signs of TLS?
- Hyperuricemia
- Hyperphosphatemia
- Hyperkalemia
- Hypocalcemia
TLS usually occurs when?
• 24 to 48 hours after chemotherapy
