Oncological Emergencies Flashcards
What investigation is required in suspected spinal cord compression?
Urgent MRI of the whole spine
What treatment can be given for spinal cord compression?
Dexamethasone
Palliative radiotherapy
Decompressive surgery in some cases
What is the most common cause of SVC obstruction with airway compromise?
Lung cancer
Give some symptoms of SVO obstruction with airway compromise
Dyspnoea Orthopnoea Cyanosis Cough Swollen face and arm Headache Engorged veins
What is Pemberton’s sign?
Lifting the arms over the head for >1 minute causes facial plethora, cyanosis, raised JVP (non-pulsatile) and inspiratory stridor. Seen in SVC obstruction.
What investigation is required in suspected SVC obstruction?
Urgent contrast enhanced CT scan
What is the management of SVC obstruction with airway compromise?
Dexamethasone
Consider balloon venoplasty and SVC stenting
Confirm and treat the underlying cause
What might be seen on biochemistry results in tumour lysis syndrome?
Raised uric acid, K+ and phosphate
Which medication can be started 24 hours before chemotherapy to prevent tumour lysis syndrome?
Allopurinol
Which antibiotic would you choose as empirical treatment for suspected neutropenic sepsis?
Piperacillin-tazobactam
What is the commonest cause of hypercalcaemia in cancer?
Bone metastasis
What is the treatment for malignant hypercalcaemia?
Rehydrate with normal saline +++
IV bisphosphonates
Which 2 cancers are commonly associated with intestinal obstruction?
Ovarian
Colon
What is the treatment for intestinal obstruction associated with malignancy?
‘Drip and suck’ i.e. IV fluids and NG tube
Surgery may be appropriate
Medical management if surgery considered inappropriate
What are the symptoms of spinal cord compression?
Back pain Weakness Sensory loss up to just below or at the level of the compression Urinary retention Constipation
What level of neutrophils defines ‘neutropenia’?
Less than 0.5 x 10^9/L
What is the drug treatment of neutropenic sepsis?
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
What is Tazocin?
Piperacillin + tazobactam
When might you consider adding vancomycin in the management of neutropenic sepsis?
If gram positive organisms are suspected or isolated (e.g. in Hickman line)
When might you consider giving granulocyte colony stimulating factor (G-CSF) in the management of neutropenic sepsis?
Reserved until day 2-3 if unresponsive to antibiotic therapy. It stimulates the immune system.
What investigations are appropriate for suspected intestinal obstruction?
Abdominal x-ray
CT scan to help to identify the level of obstruction (may be multiple)
What is the management of tumour lysis syndrome?
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
How might a patient with brain metastasis present?
Depends on site of the lesion: Headache Focal weakness Ataxia Seizures Nausea, vomiting Altered consciousness Altered personality Cranial nerve palsies
How might you investigate brain metastasis?
CT brain with contrast
MRI brain - might be useful to assess resectability
Staging CT for extra-cranial disease
What are the aims of neurosurgery in brain metastasis?
Resection of a solitary (or less than 3) accessible brain lesions
Shunt insertion for hydrocephalus
Biopsy for histological diagnosis e.g. in unknown primary
What is stereotactic radiotherapy?
High dose of radiotherapy to particular areas which preserves the surrounding tissues
