ONCOLOGICAL EMERGENCIES Flashcards
Oncological emergencies are defined as any acute possible morbid or
life-threatening events in patients with cancer either because of the
__________ or because of their _____________.
These can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease.
malignancy
treatment
Classification of oncological emergencies
• It can be broadly divided into two:
•__________-related
•___________ - related
Cancer-related
Cancer treatment
oncological emergencies
Metabolic -2
Neurologic - 2
Cardiovascular -2
Hematologic- 2
Infectious- 1
Hypercalcemia; tumor lysis syndrome
Malignant spinal cord compression; raised ICP
Superior vena cava syndrome ; malignant pericardial effusion
Hyperviscosity; stasis
Febrile neutropenia
Superior vena cava syndrome
• Superior vena cava syndrome (SVCS) refers to the symptoms that occur from ____________ or _________ of the _____________— and it is usually caused by either _________ or an _______________.
compression
obstruction
superior vena cava
thrombosis
anterior mediastinal mass.
The most common symptoms of SVCS are ________ , shortness of breath,
______________, __________ , ___________ , ________ pain, ________ swelling, _______, headache, orthopnea, hoarse voice, __________ distention, blood pressure changes, and _________________.
cough ; wheezing
pleural effusions ; pericardial effusion
chest pain ; facial
syncope ; jugular venous
respiratory arrest.
Diagnosis of SCVS is usually confirmed by a ___________.
• Treatment, regardless of cause, starts with _________.
chest radiograph
supportive care
Spinal cord compression
• Spinal cord compression is a result of a ________ or ________ invading the
________ and ________ the spinal cord or causing ____________ in the spinal canal.
• It is seen in 2.7 to 5 percent of children with cancer at diagnosis,
progression, or recurrence of disease.
mass ; tumour
vertebrae ; collapsing
increased pressure
Spinal cord compression has been seen in almost every tumor type
including leukemia and Wilms’ tumor.
T/F
T
Spinal cord Compression
Symptoms include ________ pain (80%), weakness, _____ abnormalities,
______ and __________ dysfunction, numbness, _________, and decreased
ability to differentiate between dull and sharp pain; __________ and
_____________
back pain (80%)
gait
bowel and bladder
tingling
paraplegia ; quadriplegia
Diagnosis of spinal cord compression is normally made based on a complete ____________ and ____________________.
• Treatment can include the use of high-dose _________ , emergent _______, _________ therapy, and surgical decompression via ___________.
neurologic exam ; magnetic resonance imaging.
steroids ; radiation
chemotherapy, ; laminectomy.
Tumor lysis syndrome
• It is a triad of __________ , __________, and __________ (usually with __________) due to the (slow or rapid?) release of _______________ at rates exceeding the ____________________________.
hyperuricemia
hyperkalemia
hyperphosphatemia
hypocalcemia ; rapid
intracellular metabolites
kidney’s excretory capacity.
TLS is usually seen with _________________ leukemia and ______-grade lymphomas.
•
acute lymphoblastic leukemia
high-
TLS can present prior to the start of chemotherapy, but is normally seen
within ___________ of starting therapy.
6 to 72 hours
Symptoms of TLS include _____eased urine output, fatigue, muscle
_______ /_______, nausea, _______, _______, respiratory distress, edema, _______, _______, seizures, cardiac _______,
_______ changes, and death secondary to ________________
decreased ; cramps/twitching
vomiting ; diarrhea
hematuria ; acute kidney injury
arrhythmias ; neurologic
multi-organ failure
TLS TREATMENT
__________ is the best treatment. Measures are directed towards
decreasing uric acid production, increasing uric acid solubility, and
reducing the concentration of uric acid in urine.
Prevention
FEBRILE NEUTROPENIA
Neutropenia is defined as a decrease in circulating neutrophils. Only
about ______% of total body neutrophil stores are contained in the
central pool
4-5
Neutropenia is defined in terms of the _____________
absolute neutrophil count
(ANC).
Neutropenia is classified as mild, moderate, or severe, based on the
ANC, as follows:
• Mild neutropenia: ANC ____-_____ cells/µL
• Moderate neutropenia: ANC ____-______/µL
• Severe neutropenia: ANC < _______ cells/µL
1000-1500 cells/µL
500-1000/µL
500 cells/µL
• Febrile neutropenia, or neutropenic fever, can be defined as an
absolute neutrophil count of <______cells/µL with either of the
following:
• single oral temperature ≥ _____ degrees C (101 degrees F)
• 3 oral temperatures ≥ _____ degrees C (100.4 degrees F) over ≥ _____
• oral temperature ≥ _____ degrees C sustained for ≥ _____
1500cells/µL
38.3
38 ;1 hour
38 ; 1 hour
In cancer patients Febrile neutropenia , is a serious, potentially fatal condition
complicating cancer treatment, associated with significant morbidity
and mortality and common reasons for hospital admission in children
with cancer.
Okay
Epidemiology of febrile neutropenia
• During ≥ 1 chemotherapy cycle associated with neutropenia, fever
may develop in
• 10%-50% of patients with _______ tumors
• ≥ 80% of patients with ________ malignancies
• Infection prevalence in children with episode of fever and chemotherapy-induced neutropenia
• documented infection reported in 10%-40%
• bacteremia reported in 15%-25%
solid tumors
hematologic
Risk Factors for febrile neutropenia
• Duration and severity of neutropenia - neutrophils <0.5x109/L and
predicted to continue for > 7 days or rapidly falling neutrophil count
•_________ and ________ due to chemotherapy or radiotherapy
• Radiotherapy
• Previously documented ____________
• Evidence of serious sepsis - hypotension, shock
Mucositis and gut toxicity
Pseudomonas aeruginosa
Risk Factors for febrile neutropenia
• _________ anaemia with neutrophils < 0.5 x 109/L
• Autologous, allogeneic or unrelated donor bone marrow or stem cell
transplant recipients
• Chronic _____________ disease
• Long term ___________ treatment
• In-dwelling Central Venous Access Device or CSF access device or
other ‘foreign body.’
Aplastic
graft versus host disease
immunosuppressive
Associated Organisms in FEBRILE NEUTROPENIA
• _________ bloodstream infection is the most commonly diagnosed cause of febrile neutropenia, with Gram-___________ organisms most
frequently isolated. However, Gram-negative organisms are becoming
more prevalent, with a worrying trend towards resistant organisms.
• Viruses are also common
• When FN is prolonged, lasting for more than _________ , there is an
increased risk of invasive fungal infections.
Bacterial
positive
5 days
Management of febrile neutropenia
Patients can be stratified into high and low risk FN based upon several
factors including:
• the general condition of patient
• cancer type (________ ALL, ______ with ALL, any child with ___________ and any child within 30 days of ________ are high risk)
• intensity of chemotherapy
• expected duration of neutropenia (a neutrophil count of less than
______ x 109/L for more than ________ days is considered high risk)
• associated comorbidities, e.g. renal and hepatic impairment increase the risk of complications and morbidity/mortality
• any localising symptoms such as central nervous system,
pulmonary, gastrointestinal (especially __________), CVC site symptoms such as erythema or swelling increase the risk.
induction ; infants
acute myeloblastic leukaemia (AML)
HSCT
0.5 x 109/L ; seven
mucositis
_________________________________________ therapy is the main management
initiated for the treatment of FN in patients with cancer. This is to
reduce the mortality rate that is associated with a delayed treatment.
In addition to the above , the management of FN in
cancer patients includes a thorough physical examination, blood
cultures, including sampling from all lumens of a central venous line if
present, and other investigations depending on presenting signs and
symptoms.
Empiric broad-spectrum antibiotic therapy
