Oncological emergencies Flashcards
epidural spinal cord compression
definition
tumors found within the vertebral bodies compressing the dural sac
can be primary or secondary
95% of spine tumors are METS from 3 primary sources
breast
lung
prostate
ssx of cord compression
new onset back pain pain may be localized or radicular pain worsened by movement pain unimproved with rest urinary and bowel incontinence may develop
which portion of the spine if most often affected in spinal cord compression?
thoracic
examination findings for spinal cord compression?
- the quality of pain is often mimicked by percussion over the affected vertebra
- the intensity of the pain is often worsened upon valsalva
- DTR’s may be increased
- Lower extremity spasticity may develop
- Babinski’s sign may be positive
Cauda equina syndrome
definition
a subset of spinal cord compression when the nerve roots in the lumbar spine are compressed
examination findings for cauda equina syndrome?
- lower extremity weakness
- diminished DTR’s
- lower extremity flaccidity
- leg and perianal sensory loss
- urinary retention (instead of incontinence) and constipation
Imaging of choice for the spine?
MRI or CT
Lumbar puncture may be necessary
Tx of spinal cord compression?
if neurological sx are present –> IV steroids
radiation and/or surgery
ssx of brain tumor?
- altered mental status
- new onset of h/a or h/a with increasing intensity or frequency
- visual field changes
- focal neurologic deficits such as weakness, diminished function or sensation
- persistent nausea and vomiting
- stroke
- seizures
MC cancers to lead to brain METS are
lung breast renal cell colon melanoma
work-up for brain tumor?
MRI or CT scan IV Dexamethasone (steroid) surgery gamma-knife radiosurgery IV Mannitol (diuretic to dec spinal fluid)
Superior vena cava syndrome/obstruction (SVCS or SVCO)
definition
obstruction of the superior vena cava by malignancies
MC malignancy causing SVCS?
bronchogenic carcinoma
SSX of SVCS?
- SOB
- facial or arm swelling
- h/a
- edema of face, neck, upper extremity
- venous distention in the neck and distended veins in the upper chest and arms
- lightheadedness
- cough
DX and Tx of SVC syndrome?
MRI steroids diuretics bed rest with elevation of head chemotherapy to tumor mass tx with intravenous stents (increasingly common)
SSX of cardiac tamponade?
Beck’s triad: hypotension, JVD and muffled heart sounds
DX cardiac tamponade?
CXR- reveals cardiomegaly
US- reveals pericardial effusion
EKG- reveals electrical alternans + low voltage T waves
Febrile neutropenia
definition
one of the most common complications related to chemotherapy
bacterial infxn common
increasing incidence of fungal infxn
SSX of febrile neutropenia?
101 degree fever or greater
absolute neutrophil count (ANC)
TX of febrile neutropenia?
inpatient tx with empiric abx until ANC > 500
lab work up for febrile neutropenia?
cbc
CMP w/ renal and liver functions
U/A and targeted cultures
Tx of cardiac tamponade?
- pericardiocentesis
- sclerotic tx
- surgical placement of a pleuropericardial window or pericardiectomy
- low dose radiation tx
hypercalcemia may result from different pathologic processes due to malignancy
- bone lysis + resorption- metastatic breast or prostate CA
- cytokine production- multiple myeloma
- tumor production of Parathyroid hormone related protein (PTH-rP)
effects of hypercalcemia?
stones (renal or biliary) bones (bone pain) groans (abdominal pain, n/v) thrones (constipation & polyuria) psychiatric overtones (depression, anxiety, cognitive dysfunction, coma)
sx of hypercalcemia?
lethargy anorexia n/v confusion obtundation coma
tx of hypercalcemia?
- saline infusion (to correct dehydration)
- IV Lasix (promote renal excretion of calcium)
- bisphosphonates (to block bone resorption)
Syndrome of inappropriate anti-diuretic hormone (SIADH)
due to
small cell carcinoma of lung
Hallmark electrolyte finding of SIADH?
hyponatremia
Tx of SIADH?
- fluid intake restriction
- demeclocycline (ADH antagonist)
- treat CA
Tumor lysis syndrome
definition
- occurs in pts with large tumor burden that is very sensitive to chemotherapy
- circulating lysed tumor cells may result in hyperuricemia (high uric acid levels NOT urea), hyperkalemia, and hyperphosphatemia
Deep venous thrombosis
defintion
thrombosis within the deep veins of the calf, thigh, or pelvis
SSX of DVT?
swelling, tenderness, and redness in the calf or thigh or groin
a palpable cord
Homan’s sign- discomfort in the calf or behind the knee on dorsiflexion of the foot
Risk factors for DVT?
obesity smoking use of HRT long flight local trauma surgery hx of coagulopathy hx of prior DVT
SSX of pulmonary embolism?
- SOB
- pleuritic chest pain, worse with inhalation or cough
- tachypnea and tachycardia
