Oncological Emergencies Flashcards
Malignancies most commonly associated with hypercalcaemia
Lung Breast Renal Multiple myeloma Adult T cell lymphoma
Sx of hypercalcaemia
Bones: pain
Stones: polydipsia, polyuria
Abdo groans: pain, N+V, constipation
Psychic moans: confusion, lethargy
Ix for hypercalcaemia
Ionised calcium
Total calcium
Check PTH (N/L)
4 Complications of hypercalcaemia
Coma
Seizures
Renal failure
Cardiac arrhythmias
Tx for hypercalcaemia
Intensive rehydration- IV saline
IV bisphosphonates- pamidronate disodium/ Zoledronic acid
Tx for calcitriol mediated hypercalcaemia
IV saline
Prednisolone PO
ECG change in hypercalcaemia
Shortened QT interval
Which cancers most commonly metastasise to bone and cause spinal cord compression?
Breast Thyroid Renal Prostate Lung Multiple myeloma
5 Sx of spinal cord compression
Back pain Paresis/ Paralysis Paraesthesias Sphincter dysfunction (urinary or anal) Hyper-reflexia
Ix for spinal cord compression
MRI Spine
Tx for spinal cord compression
Dexamethasone IV Enoxaparin SC Maintenance of volume + BP Omeprazole PO (prevent gastric stress ulcer) Catheter Bowel regimen prophylaxis
What motor symptoms may be caused by spinal cord compression?
Weakness or paralysis
UMN signs BELOW the level of the lesion
LMN signs AT the level of the lesion
What is Brown-Sequard Syndrome?
HEMISECTION of the spinal cord (due to tumour)
Ipsilateral spastic paralysis
Ipsilateral loss of vibration + proprioception
Contralateral pain + temperature sensation loss from 1-2 segments below lesion.
What is Cauda equine syndrome?
Compression of nerves caudal to the level of spinal cord termination
List 7 signs and symptoms of caudal equine syndrome
Low back pain + pain in legs
LL motor weakness + sensory deficits: usually asymmetrical with loss of reflexes
Saddle anaesthesia.
Loss of anal tone + sensation.
Urinary dysfunction (retention, difficulty starting or stopping, overflow incontinence, decreased bladder + urethral sensation)
Bowel disturbances: incontinence + constipation.
Sexual dysfunction.
What may suggest spinal cord compression rather than cauda equine syndrome?
Increased lower limb reflexes + other UMN signs e.g. extensor plantars indicate spinal cord involvement + excludes CES
What is febrile neutropenia?
Raised temperature
Neutrophils (ANC) <500 cells/microlitre
In chemotherapy patients
RFs for febrile neutropenia
Recent +/- high dose chemotherapy
Age >65
Pre-existing organ dysfunction
Haematological Ca
3 Sx of febrile neutropenia
Fever
Tachycardia
Hypotension
Ix for febrile neutropenia
Give empirical Abx before Ix
Bloods
Blood cultures
Septic screen
Tx for febrile neutropenia
Piperacillin/ Tazobactam IV
+/- Amikacin
+ Vancomycin if MRSA or viridan’s group streptococci
Tx for febrile neutropenia with penicillin allergy
Meropenem
Aetiology of superior vena cava obstruction
Lung cancer: NSCLC 50%, SCLC 25%
Lymphoma
Thrombosis e.g. from central venous catheters, Multiple pacemaker leads
RF for superior vena cava obstruction
Smoking hx
Central venous catheter
Multiple pacemaker leads
4 Sx of superior vena cava obstruction
SOB
Cough
Dysphagia
Dizziness/ headaches
5 Signs of superior vena cava obstruction
Oedema of face + extremities Facial plethora Distended neck/ chest veins Hoarse voice Stridor
Ix for superior vena cava obstruction
CT CAB + IV contrast
Transthoracic needle aspiration biopsy
Immediate tx for superior vena cava obstruction with acute airway obstruction
Intubate
Dexamethasone +/- anticoagulant (if clot)
+/- Radiotherapy (precludes subsequent biopsy in 1st presentations)
+/- Stenting (if haemodynamically unstable)
Tx for superior vena cava obstruction
Chemotherapy (Lymphoma, germ cell + SCLC)
Radiotherapy
What is tumour lysis syndrome?
Metabolic abnormalities that can occur as a complication during tx where large amounts of tumour cells lyse at the same time releasing contents
Characteristics of tumour lysis syndrome
High phosphate High potassium High urate Low calcium Acidosis
Sx of tumour lysis syndrome
N+V
Diarrhoea
Tx for tumour lysis syndrome
IV Fluids Furosemide (PO4) Rabicurase (urate) Calcium gluconate, insulin + glucose (K+) Aluminium hydroxide (PO4)
Complications of tumour lysis syndrome
AKI Cardiac arrhythmia Seizure Neuromuscular dysfunction Death
`Most common cancers with occurrence of tumour lysis syndrome
Highly proliferative, bulky, chemosensitive haematological malignancies:
High-grade non-Hodgkin’s lymphoma (e.g., Burkitt’s lymphoma)
Acute lymphoblastic leukaemia
Ix for tumour lysis syndrome
Bloods: metabolic + biochemical profile
Tx for tumour lysis syndrome if resistant to medical management
Dialysis
RF for tumour lysis syndrome
High tumour burden with rapid response to tx
Prevention of tumour lysis syndrome
Prophylactic allopurinol/ rabicurase (CI in G6PD deficiency)
Hydration
Monitor electrolytes, urate, lactate, LDH
