Oncological emergencies

Question 1

What are the most common cancers to cause MSCC? (metastatic cord compression)

Answer 1

• breast
• bronchus
• prostate

Question 2

In what region do most occur?

Answer 2

• two thirds in thoracic region

- remainder in cervical/ lumbar spine

Question 3

what are the symptoms?

Answer 3

• back/ nerve root pain
• aggravated by movement, coughing or lying flat
• motor deficit
• subjective sensory deficit ( for example it feels like i am walking on cotton wool)
• bladder/ bowel dysfunction is late symptom
• urinary retention

Question 4

What are the signs?

Answer 4

• weakness/ paraparesis/ paraplegia
• changes in sensation occur below level of compression (assymetrical/ incomplete)
• increased reflexes
• clonus and painless bladder distension

Question 5

Investigation/ management?

Answer 5

• Whole spine MRI
• dexamethasone 16mg
• possible surgery/ radiotherapy/ chemotherapy

Question 6

What is the main cancers that cause SVCO?

Answer 6

• lung cancer

- lymphoma

Question 7

What are the symptoms and signs of SVCO?

Answer 7

• headache/ feeling of “fullness in the head”
• facial swelling
• dyspnoea
• cough
• hoarse voice
• facial oedema
• prominent blood vessels in neck, trunk and arms
• cyanosis

Question 8

Management of SVCO?

Answer 8

• Dexamethasone 16mg

- vascular stenting followed by radio/ chemotherapy

Question 9

What cancers is hypercalcaemia most common in?

Answer 9

• breast
• lung
• squamous cell carcinoma
• myeloma
  ( A patient may develop hypercalcaemia without having bone mets)

Question 10

What are the symptoms?

Answer 10

• lethargy
• malaise
• anorexia
• polyuria
• thirst
• nausea
• vomiting
• constipation

late features include:

• confusion
• drowsiness
• fits
• coma

Question 11

Investigations?

Answer 11

Serum calcium (corrected for serum albumin)

Question 12

How would you manage these patients?

Answer 12

• rehydration using normal saline

- IV bisphosphonates (zolendronic acid)

Question 13

What is another (rare) oncological emergency?

Answer 13

• major haemorrhage

- (due to for example head and neck cancers eroding into a major vessel)

Question 14

how is it managed? (major haemorrhage)

Answer 14

• keep green towels close by to absorb blood
• IM/ sub cut midazolam as a sedative and amnesic
• stay with patient