Oncological emergencies

Question 1

Febrile neutropenia

Answer 1

chemotherapy kill neutrophil progenitor cells so febrile neutropenia occurs 10-14 days after treatment; ANC 38C; start broad spectrum antibiotics

Question 2

Spinal cord compression

Answer 2

majority result from spine metastases with extension into the epidural space; symptoms are pain and tenderness; perform MRI immediately; start steroids, external beam irradiation, surgical decompression

Question 3

Hypercalcemia

Answer 3

most common paraneoplastic syndrome, 10-30% of advanced cancer; secrete PTHrP that resorbs bone and affects tubular calcium reabsorption; upregulation of osteoclast activation factors; higher than 13 mg/dL, treat with hydration and bisphosphonates

Question 4

Superior vena cava syndrome

Answer 4

SVC is compressed by catheter devices and malignancies; signs: venous distention of the neck and chest wall, facial edema, plethora and cyanosis, cough; if tumor chemoresponsive givee radiation therapy, endovascular stenting, angioplasty, thrombolytic therapy, surgery

Question 5

Hyperviscosity syndrome

Answer 5

caused by IgM (Macroglobulinemia of Waldenstrom), IgA and IgG (Multiple Myeloma) excess and self aggregating properties compromising the circulation; paraproteinemia, mental status change, pulmonary distress, rapidly decreasing renal function; treat with plasmapheresis

Question 6

Clinical tumor markers

Answer 6

Most useful in following disease response and recurrence