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Y4 Cancer Care > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What are the common oncological emergencies?

A

Neutropenic sepsis
Metastatic spinal cord compression
Hypercalcaemia of malignancy
Tumour lysis syndrome

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2
Q

What is the clinical definition of neutropenic sepsis?

A

Patient undergoing systemic anticancer treatment (SACT)
Temp > 38
Neutrophil count <0.5x10^9 /l

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3
Q

What are the signs and symptoms of neutropenic sepsis?

A

Fever
Generally unwell (could be well!)
Tachycardia
Hypotension (<90 systolic = URGENT)
Tachypnoea
Systemic infection symptoms (cough, SOB, urinary symptoms, line)
Drowsy / confused
Commonly occurs 7-14 days following chemotherapy

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4
Q

What are the most frequent isolates in neutropenic sepsis?

A

Staph aureus
Staph epidermis
Enterococcus
Streptococcus
MRSA / VRE

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5
Q

What is the management of neutropenic sepsis?

A

Find source of infection (lines, MSUS, CXR)
Empirical IV Abx - tazocin / meropenem +/- vacomycin (for central venous access)
Nb. if low risk and improving, can switch to PO after 48 hours
G-CSF (to improve WCC)
Consider Abx prophylaxis upon discharge

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6
Q

What is the management of neutropenic sepsis?

A

Find source of infection (lines, MSUS, CXR)
Empirical IV Abx - tazocin / meropenem +/- vacomycin (for central venous access)
Nb. if low risk and improving, can switch to PO after 48 hours
G-CSF (to improve WCC)
Consider Abx prophylaxis upon discharge

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7
Q

What cancers are commonly associated with metastatic spinal cord compression?

A

Lung
Breast
Prostate

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8
Q

What are the presenting features of MSCC?

A

Back pain (worse on lying down / coughing)
LL weakness
Sensory loss and numbness
Neurological signs

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9
Q

What neurological signs present with MSCC?

A

Lesion below L1 > UMN signs (hyper-reflexia, spastic, Babinski positive, disuse atrophy)
Lesion above L1 > LMN signs (hypo-reflexia, hypotonic, absent plantar reflex, severe atrophy) + perianal numbness
Tendon reflexes absent at level of lesion and increased below level of lesion

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10
Q

What is the investigation indicated for suspected MSCC?

A

MRI spine

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11
Q

What is the indicated management for MSCC?

A

High dose dexamethasone (16mg PO STAT, 8mg PO BD)
Radiotherapy / surgery (if presenting before 48 hours)
Lie flat

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12
Q

Which region of the spine is most commonly affected in MSCC?

A

Thoracic (70%)
Lumbo-sacral (20%)

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13
Q

What cancers are commonly associated with hypercalcaemia of malignancy?

A

Breast
SSC
Renal
Myeloma
Lymphoma

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14
Q

What is the pathophysiology of hypercalcaemia of malignancy?

A

=> PTH-related peptide

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15
Q

What are the clinical features of hypercalcaemia of malignancy?

A

Bones (bone pain)
Moans (fatigue, memory loss, depression, psychosis)
Stones (renal stones, polyuria, polydipsia)
Groans (anorexia, weight loss, n/v, constipation, ileus)

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16
Q

What is the management indicated for hypercalcaemia of malignancy?

A

Rehydration with large IVI
IV bisphosphonate e.g. zoledronic acid
Systemic management of malignancy

17
Q

What cancer is commonly associated with superior vena cava obstruction?

A

Lung cancer (small cell)
= mediastinal mass > compression of SVC +/- intraluminal thrombus

18
Q

What are the clinical features of lung cancer?

A

Dyspnoea + cyanosis
Swelling of face, neck and arms
Headache
Papilloedema
CP
Pulseless jugular venous distension
Pemberton sign (cyanosis, dyspnoea or facial congestion worse when lifting arms)

19
Q

What investigations are indicated for suspected SVCO?

A

CXR (visualise mass)
CT + contrast (collaterisation / presence of thrombus)

20
Q

What is the management indicated for SVCO?

A

Dexamethasone (16mg STAT + PPI)
Chemotherapy (SCLC, lymphoma, teratoma) / Radiotherapy (other malignant causes)
Stent (if not radio / chemo sensitive)

21
Q

What is the pathophysiology of tumour lysis syndrome?

A

Typically in response to chemotherapy / steroid therapy
Breakdown of tumour cells => chemicals > ^ K, ^ H3PO4, v Ca (due to electrolyte release) and hyperuricaemia (due to nucleic acid breakdown)
> poor renal function (present as AKI)

22
Q

What is the grading system used for tumour lysis syndrome?

A

Cairo-Bishop scoring system

23
Q

How is tumour lysis syndrome routinely prevented?

A

Allopurinol - 2 days prior to treatment (prophylaxis)
IV fluids - 1 day prior to treatment
K monitoring every 2 hours for first 8-12 hours of treatment

24
Q

What is the management indicated for tumour lysis syndrome?

A

Rasburicase (recombinant urate oxidase)

Y4 Cancer Care (6 decks)

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