oncological emergencies Flashcards
what are common oncological emergencies?
febrile neutropenia
spinal cord compression
SVCO w airway compromise
hypercalcaemia
raised ICP
tumour lysis syndrome
what is febrile neutropenia?
neutrophils <1
broad spectrum abx, anti-fungals, anti-virals
what is the presentation of spinal cord compression?
back pain, radicular pain- worse on lying down + coughing
bladder and bowel dysfunction
lower limb weakness
sensory loss + numbness
lesions above L1- UMN signs in legs and a sensory level
lesions below L1- LMN signs in legs + perianal numbness.
tendon reflexes increases below level of lesion + absent at level of lesion
what are causes of spinal cord compression?
extradural compression- usually due to vertebral body metastases
more common with lung, breast + prostate cancer
crush fracture
what investigations needed for spinal cord compression?
urgent MRI spine within 24hrs of presentation
what is the management of spinal cord compression?
high dose PO dexamethasone
d/w neurosurgery + oncology
consider radiotherapy/surgery
what are the causes of SVCO w airway compromise?
usually lung ca
thymus malignancy
LNs
SVC thrombosis- central lines, nephrotic syndrome
fibrotic bands- lung fibrosis after chemo
how do SVCO w airway compromise present?
headache
dyspnoea + orthopnoea
plethora + thread veins in SVC distribution
swollen face + arms
engorged neck veins
what is pemberton’s sign
lifting arms above head for >1 min leads to facial plethora, raised JVP + inspiratory stridor
due to narrowing of thoracic inlet
what investigations are needed for SVCO?
sputum cytologoy
CXR
CT
venography
what is the management of SVCO w airway compromise?
dexamethasone
consider balloon venoplasty + SVC stenting
radial or palliative chemo/radio
what are the causes of hypercalcaemia?
lytic bone metastases
production of PTHrP (stimulates calcium resorption from bone and reabsorption in the kidneys)
what are the symptoms of hypercalcaemia?
confusion
renal stones
polyuria + polydipsia-> dehydration
abdominal pain
constipation
depression
oethargy
anorexia
what investigations are needed in hypercalcaemia?
calcium-
PTH- to exclude primary hyperparathryoidism
CXR
isotope bone scan
what is the treatment of hypercalcaemia?
aggressive hydration - 1L/4hourly
monitor volume status
furosemide to allow more fluid
if primary hyperparathyroidism excluded, give maintenance therapy with bisphosphonate eg zoledronate
