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Oncology and Palliative Care > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What investigation is required in suspected spinal cord compression?

A

Urgent MRI of the whole spine

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2
Q

What treatment can be given for spinal cord compression?

A

Dexamethasone
Palliative radiotherapy
Decompressive surgery in some cases

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3
Q

What is the most common cause of SVC obstruction with airway compromise?

A

Lung cancer

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4
Q

Give some symptoms of SVO obstruction with airway compromise

A 
Dyspnoea
Orthopnoea
Cyanosis
Cough
Swollen face and arm
Headache
Engorged veins
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5
Q

What is Pemberton’s sign?

A

Lifting the arms over the head for >1 minute causes facial plethora, cyanosis, raised JVP (non-pulsatile) and inspiratory stridor. Seen in SVC obstruction.

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6
Q

What investigation is required in suspected SVC obstruction?

A

Urgent contrast enhanced CT scan

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7
Q

What is the management of SVC obstruction with airway compromise?

A

Dexamethasone
Consider balloon venoplasty and SVC stenting
Confirm and treat the underlying cause

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8
Q

What might be seen on biochemistry results in tumour lysis syndrome?

A

Raised uric acid, K+ and phosphate

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9
Q

Which medication can be started 24 hours before chemotherapy to prevent tumour lysis syndrome?

A

Allopurinol

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10
Q

Which antibiotic would you choose as empirical treatment for suspected neutropenic sepsis?

A

Piperacillin-tazobactam

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11
Q

What is the commonest cause of hypercalcaemia in cancer?

A

Bone metastasis

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12
Q

What is the treatment for malignant hypercalcaemia?

A

Rehydrate with normal saline +++

IV bisphosphonates

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13
Q

Which 2 cancers are commonly associated with intestinal obstruction?

A

Ovarian

Colon

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14
Q

What is the treatment for intestinal obstruction associated with malignancy?

A

‘Drip and suck’ i.e. IV fluids and NG tube
Surgery may be appropriate
Medical management if surgery considered inappropriate

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15
Q

What are the symptoms of spinal cord compression?

A 
Back pain
Weakness
Sensory loss up to just below or at the level of the compression
Urinary retention
Constipation
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16
Q

What level of neutrophils defines ‘neutropenia’?

A

Less than 0.5 x 10^9/L

17
Q

What is the drug treatment of neutropenic sepsis?

A

Door to needle time = 1 hour MAX
Combination therapy with piperacillin / tazobactam (Tazocin)
Consider vancomycin if grade +ve organisms isolated or suspected e.g. in Hickman line
Consider fungal (candida aspergillus) or viral (CMV) causes if no improvement on antibiotics

18
Q

What is Tazocin?

A

Piperacillin + tazobactam

19
Q

When might you consider adding vancomycin in the management of neutropenic sepsis?

A

If gram positive organisms are suspected or isolated (e.g. in Hickman line)

20
Q

When might you consider giving granulocyte colony stimulating factor (G-CSF) in the management of neutropenic sepsis?

A

Reserved until day 2-3 if unresponsive to antibiotic therapy. It stimulates the immune system.

21
Q

What investigations are appropriate for suspected intestinal obstruction?

A

Abdominal x-ray

CT scan to help to identify the level of obstruction (may be multiple)

22
Q

What is the management of tumour lysis syndrome?

A

Prevention strategies are key:
Good hydration
Allopurinol given 24 hours before chemotherapy
Rasburicase - helps to reduce urate levels in those whose levels are high
Haemodialysis in acute renal failure

23
Q

How might a patient with brain metastasis present?

A 
Depends on site of the lesion:
Headache
Focal weakness
Ataxia
Seizures
Nausea, vomiting
Altered consciousness
Altered personality
Cranial nerve palsies
24
Q

How might you investigate brain metastasis?

A

CT brain with contrast
MRI brain - might be useful to assess resectability
Staging CT for extra-cranial disease

25
Q

What are the aims of neurosurgery in brain metastasis?

A

Resection of a solitary (or less than 3) accessible brain lesions
Shunt insertion for hydrocephalus
Biopsy for histological diagnosis e.g. in unknown primary

26
Q

What is stereotactic radiotherapy?

A

High dose of radiotherapy to particular areas which preserves the surrounding tissues

Oncology and Palliative Care (4 decks)

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