Oncological Emergencies Flashcards
What are oncological emergencies?
Any clinical oncological situation that requires diagnostic attention and therapeutic intervention
Varices over the chest is likely due to what cause?
Increase pressure/blockage in the IVJ
What are the tumors that can cause Periorbital edema, and respiratory symptoms?
Mediastinal tumors
What is superior vena cava syndrome?
Ay condition, benign or malignant, that causes obstruction of blood flow through the SVC
What areas does the SVC drain?
Head
Arms
Upper torso
What are the ssx of SVC syndrome?
JVD
Edema of the head/neck/ upper chest
Larynx
What are the emergency parts of SVC syndrome?
Impairment of breathing/pharynx
Confusion/coma
What is the most common malignancy causing SVC syndrome?
Lung CA and NHL
What are the benign causes of SVC syndrome?
Thrombosis d/t intravascular devices
Fibrosing mediastinitis
What is the diagnostic study of choice for SVC syndrome?
CT w/ contrast
Why do you want contrast with imaging for SVC syndrome?
Outline venous
What is the treatment for SVC syndrome?
SVC stent
Treat underlying disease (xrt or chemo)
Are diuretics indicated for SVC syndrome?
No
Are steroids indicated for SVC syndrome?
No
The role of stenting in SVC syndrome?
Dependent on the tumor type, and the anticipated response to therapy and the severity of the symptoms
Why is it not a big deal about the thrombogenic nature of stents in SVC syndrome?
CA has poor prognosis, and they probably will die of CA sooner than the stent
Breast CA with fever, tachycardia, and hypotension is probably what?
Infections secondary to myelosuppression
What is neutropenic fever?
Neutropenia induced infection and fever
What is the absolute neutrophil count in neutropenic fever?
What are the three different syndromes that present in neutropenic fever?
- Microbiologically documented infection
- Clinically documented infection
- Unexplained fever
What is the sign of neutropenic fever?
Mucositis
What is the treatment for neutropenic fever?
Empiric abx/antifungals
Remove infected devices
What are the important bits of evaluating neutropenic fevers? (General, labs (4), imaging)
Meticulous H&P CBC w/ diff LFTs CMP Cultures
CXR
What is the cause of neutropenic fever?
Effects of chemo on mucosal barriers and the immune system
Obstruction of lymphatics, biliary tract, or UG system
What is the cause of most infections in neutropenic fever?
Gut flora
What are the usual gram + agents that cause neutropenic fevers?
staph strep
What are the usual gram -agents that cause neutropenic fevers?
e.coli
Pseudomonas
What are the usual fungal agents that cause neutropenic fevers?
Candida
Aspergillus
What are the usual viral agents that cause neutropenic fevers? (4)
Herpes simplex
Herpes zoster
CMV
EBV
How fast must broad spectrum abx be administered for neutropenic fever?
60 minutes
Is GSF usually indicated for neutropenic fever?
Not usually
What is pulsus paradoxus?
Variable pulse strength with respiration
What is the sensitivity of CXR with pericardial effusion?
Very low
What is the cause of alternating electrical magnitude on an EKG?
Pericardial effusion
What is the test of choice for diagnosing a pericardial effusion?
Echocardiogram
What is pericardial tamponade?
Accumulation of fluid in the pericardial sac surrounding the heart
Pericardial tamponade is usually caused by what?
Malignant disease most commonly Lung CA, beast CA, leukemia, lymphomas or previous chemo
What are the ssx of pericardial tamponade?
Cough, CP, SOB, weakness
Tachycardia, JVD, peripheral edema
Pulsus paradoxus
What is the treatment for pericardial effusion?
Pericardiocentesis
What is malignant spinal cord compression?
Tumor that compresses the spinal cord, that may lead to paraplegia d/t spinal cord infarction
What are the common etiologies of malignant spinal cord compression?
Lung
Breast
Prostate
Multiple Myeloma
What is the most frequent site of spinal cord compression in malignant spinal cord compression?
Thoracic
What are the SSx of malignant spinal cord compression?
Localized back pain worse with movement
Lhermitte’s sign
Bowel and bladder dysfunction
What are the ssx of cauda equina?
Decreased patella and achilles reflex
LE weakness
Bowel/bladder dysfunction
What is the diagnostic study of choice for malignant spinal cord compression?
MRIs
What is the treatment for malignant spinal cord compression?
Steroids
XRT
Surgical intervention
What is tumor lysis syndrome?
Syndrome caused by the rapid death or cell turnover of a large colume of rapidly proliferating cells
What are the characteristics of tumor lysis syndrome (metabolic effects)?
Hyperkalemia Hyperuricemia Hyperphosphatemia Hypocalcemia Metabolic acidosis
What is the major organ damage with tumor lysis syndrome? How?
Acute kidney injury
Deposition of uric acid crystals in the renal tubule
Why is uric acid increased in tumor lysis syndromes?
Metabolism of nucleic acids
What causes the hypocalcemia in tumor lysis syndrome?
Hyperphosphatemia
What is the major issue problem with hyperkalemia in tumor lysis syndrome?
Arrhythmias
What is the major issues of CaPO3 release in tumor lysis syndrome?
Precipitate throughout the body, can cause serious dysrhythmias
What causes the inflammatory response seen in tumor lysis syndrome?
Release of cytokines
What is the primary means of excreting xanthine and phosphate?
Renal
What are the CAs that are at high risk for tumor lysis syndrome?
High grade lymphomas
Acute leukemias
ANy rapidly proliferating tumors
What is the prophylactic treatment for tumor lysis syndrome?
Hydration
Allopurinol
Rasburicase
What is rasburicase?
Drug that catalyzes the oxidation of uric acid to the more water soluble allantoin
What are the high risk group of tumor lysis syndrome?
Preexisting renal insufficiency
Hypotension
Acidic urine
What is the acute treatment of tumor lysis syndrome?
Dialysis
What is the MOA of allopurinol?
Blocks the conversion of xanthine and hypoxanthine to uric acid
What is the therapy for PE?
tPA or heparin
When are V/Q scan performed for PEs?
Absolute contraindications to contrast
