Oncological Emergencies Flashcards

1
Q

What cancers commonly cause MSCC?

A

Breast, bronchus and prostate
-Myeloma and lymphoma
But can occur with any tumours
Caused by a tumour / mets in the vertebral body or paraspinal region pressing on the spinal cord

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2
Q

Where do most MSCCs occur in the spine?

A

2/3 occur in the thoracic region
Remainder in the cervical or lumbar spine

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3
Q

What symptoms does MSCC present with?

A

-BACK PAIN / NERVE ROOT PAIN, can be uni- or bilateral, may be aggravated by movement, coughing or lying flat (NB pain may be absent in some patients)
-MOTOR WEAKNESS, may be rapid or slow in onset and can be subtle, patients often describe a perceived change in strength
-SENSORY DISTURBANCE (subjective), often precede objected physical signs eg ‘feels like I’m walking on cotton wool’
-BLADDER / BOWEL DYSFUNCTION generally occurs late, urinary retention often develops insidiously
NB must screen for cauda equine syndrome (saddle anaesthesia, urinary retention, faecal / urinary incontinence, weakness, pain)

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4
Q

What signs might MSCC have?

A

-Weakness / paraparesis / paraplegia
-Changes in sensation occur below the level of compression - may be asymmetrical and may be incomplete
-Increased reflexes below the level of the lesion
-Clonus and painless bladder distension may be present

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5
Q

What investigations would you order for someone with suspected MSCC?

A

Whole spine MRI

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6
Q

What is the management of MSCC?

A

-Dexamethasone (16mg) pending investigations
-Surgery (favoured in cases of collapse of vertebral body, less likely to be used if extensive disease)
-Radiotherapy and / or chemotherapy
-Lie flat

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7
Q

What causes SVCO?

A

Extrinsic compression, thrombosis or invasion of the wall of the SVC
-Most commonly caused by extensive LYMPHADENOPATHY in the upper mediastinum (lung cancer or lymphoma patients)
-Can occur with any solid tumour (eg germ cell tumours)

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8
Q

What are the symptoms of SVCO?

A

-Headache, or a ‘feeling of fullness’ in the head
-Facial swelling
-Dyspnoea (worse lying flat)
-Cough
-Hoarse voice

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9
Q

What are the signs of SVCO?

A

-Facial / upper limb OEDEMA
-Prominent blood vessels on the neck, trunk and arms
-Cyanosis
-Positive Pemberton’s test
–Lift arms over head for 1 min - facial redness, increased JVP + stridor observed

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10
Q

How would you investigate SVCO?

A

-Urgent contrast enhanced CT
-Consider biopsy if unknown aetiology

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11
Q

What is the management of SVCO?

A

-Dexamethasone 16mg
-Urgent vascular stenting
-Followed by radio- or chemotherapy depending on primary tumour
-If this is the first presentation of cancer then biopsy is important - likely to be progressing rapidly
-If germ cell tumour is possible then tumour markers (AFP, beta-hCG, LDH) may be done

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12
Q

What causes hypercalcaemia in cancer patients?

A

-Commonly seen in BREAST cancer, NSC LUNG cancer, SCC and MYELOMA
-Also Head and neck and renal cell cancers
-Can occur in most tumours

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13
Q

What are the symptoms of hypercalcaemia?

A

Can develop insidiously and can be missed
Early symptoms:
-Lethargy
-Malaise
-Anorexia
-Polyuria
-Thirst
-N+V
-Constipation
Late:
-Confusion
-Drowsiness
-Fits
-Coma

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14
Q

What investigations would you order for someone with suspected hypercalcaemia?

A

Serum calcium corrected for serum albumin

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15
Q

What is the management of hypercalcaemia?

A

-Rehydration using normal saline
-Then IV bisphosphonates eg pamidronate / zoledronic acid
-Can try SC calcitonin or oral corticosteroids also
-Max response seen after 6-11 days (70% of patients respond)

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16
Q

What cancers commonly cause major haemorrhage?

A

Rare and predictable
eg head and neck cancer eroding into a major vessel

17
Q

What are the most appropriate management steps of a major haemorrhage?

A

-Keep green towels nearby to absorb blood loss and reduce visual distress
-IM / SC midazolam as a sedative and amnesic
-Must stay with patient

18
Q

What are the guidelines for treating suspected neutropenic sepsis?

A

-Broad spectrum IV abx (tazocin 4.5 QDS) must be given within 1 hour (Teicoplanin if penicillin-allergic but check guidelines)
-Admission to hospital in all suspected cases
-Then continue with BUFALO
-If no improvement in 48h consider switching abx or switch to antivirals / antifungals but requires specialist management

19
Q

How is neutropenic sepsis defined?

A

-Neutrophil count <1 x10^9/L
-Temp >38.5 OR >38 for an hour

20
Q

What must you ascertain in history and examination of a neutropenic sepsis patient?

A

HISTORY
-Chemo drugs history - timing, line
-Previous episodes?
-Any localising symptoms?
-Allergies?
EXAMINATION
-Temp
-A-E, NEWS
-Potential sites of infection

21
Q

How would you investigate neutropenic sepsis?

A

-BUFALO (incl FBC)
-Culture all lines
-Swabs
-If relevant then sputum, urine, stool, CXR etc