Oncological Emergencies

Question 1

What classifies mild, mod and severe renal F?

Answer 1

Mild <2.8
Mod <3.5
Severe >3.5

Question 2

Key Sx of hypercalcamia to ask about?

Answer 2

Bony pain
Renal stones
Depression
Abdo pain, constipation, vomiting, loss of appetite (GI)
Fatigue, weakness, weight loss (muscles)
Polyuria, polydipsia (water works)

Question 3

What might you see on urine sample in hypercalcaemia?

Answer 3

Raised urine phosphate

Question 4

What are the possible ECG features of hypercalcaemia?

Answer 4

Short QT (main feature)
J waves (Osborn waves) - notching of the QRS

Question 5

Management of hypercalcaemia?

Answer 5

1. Rehydration - 0.9% saline 1L over 4h
2. Add furosemide if risk of fluid overload
3. IV Pamidronate
4. if arrhythmias/seizures –> Calcitonin + Prednisolone

Question 6

What investigations are performed in suspected neutropenic sepsis?

Answer 6

Bloods: cultures, FBC, U+E, CRP, LFTs, clotting, ESR, glucose, lactate (ABG/VBG)
MC+S: urine, blood, stool, sputum, swabs from lines & skin folds

Question 7

What is the treatment for neutropenic sepsis?

Answer 7

Abx - IV Tazobactam/Piperacillin (if pen allergic - aztreonam + vancomycin). For 5 days

Question 8

Which cancers are often associated with MSCC?

Answer 8

Prostate, breast, lung, myeloma, lymphoma

Question 9

Where is the most common region for MSCC?

Answer 9

2/3rd in thoracic region.

Question 10

What are the early and late signs of MSCC?

Answer 10

Early –> radicular/band-like back pain, weakness, numbness

Late –> blader/bowel dysfunction

Question 11

What is the IMMEDIATE management of MSCC?

Answer 11

1. 16mg PO dexamethason + omeprazole

2. Urgent MRI within 24h

Question 12

What are the Sx of SVCO?

Answer 12

SOB, orthopnoea, headache worse on coughing, oedema, distended veins (neck + chest), cyanosis, hoarse voice, cough.

Also ask about weight loss, haemoptysis etc as might be first presentation of cancer!

Question 13

What is the Mx of SVCO?

Answer 13

16mg dex + PPI –> urgent imaging.

Balloon venoplasty + SVC stent

Question 14

What is tumour lysis syndrome and how might you suspect it?

Answer 14

Large amounts of tumour cells killed off by Tx –> released into blood.
Bloods: high K, Ph, uric acid. Low Ca
Sx: cardiac abnormalities, muscle weakness, renal F, tetany, confusion.

Question 15

What are the Mx options for MSCC?

Answer 15

RT, surgery.

Also - analgesia, laxatives, LMWH if immobile