Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cancer Care Block > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What are the main emergencies we need to know about?

A 
Neutropenic sepsis
Metastatic spinal cord compression
Hypercalcaemia
Tumour lysis syndrome
SVC obstruction
RICP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is neutropenic sepsis?

A

Sepsis with a neutrophil count below 0.5 x 10^9/L (and a temperature above 38 degrees)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why does neutropenic sepsis occur?

A

As a side effect of chemotherapy, typically 7-10 days afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the onset of neutropenic sepsis?

A

Very rapid, often within 7-10 days post-chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How should neutropenic sepsis be treated immediately?

A

IV antibiotics within 1 hour of admission (no need to wait for blood results) and IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Who should neutropenic sepsis be watched for in?

A

Any pt who has had chemo in the last 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the symptoms of neutropenic sepsis?

A 
Fever
Drowsiness
Confusion
Tachycardia (technically a sign)
Any specific system signs e.g. abdo pain, haematruia etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What increases the risk of developing neutropenic sepsis apart from chemo in the past 6 weeks?

A
  • Prolonged neutropenia (over 7 days)
  • Co-morbidities
  • Poor cancer response to chemo
  • Central lines
  • Mucositis
  • Being an inpatient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What organisms cause neutropenic sepsis?

A

Mostly endogenous flora.

Increasing incidence of MRSA and VRE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the differentials for neutropenic sepsis and when should you consider them?

A

Chemo or cancer related fever
PE

If the neutrophils aren’t low. This should be after treatment is commenced anyway. If symptoms of PE are also present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What else can we do to treat/prevent neutropenic sepsis?

A

GCSF to stimulate neutrophil production
Abx prophylaxis
Patient education on how to avoid it (infection control)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is metastatic spinal cord compression?

A

The name pretty much explains it - spinal cord compression due to spinal mets, or direct paraspinal tumour extension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which cancers are most commonly associated with spinal mets and cord compression?

A 
Lung
Prostate
Breast
Myeloma
Melanoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How many cancer pts get spinal mets?

A

3-5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where are spinal mets most common?

A

Thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Do all MSCC pts who present already have a cancer diagnosis?

A

No - 1/4 don’t have a diagnosis of cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the pathogenesis of MSCC?

A

Metastasis causing oedema, venous obstruction, and demyelination.

Chronicly leads to vascular injury and cord necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does MSCC present?

A

Over 90% of pts have back pain.

May also have limb weakness, sensory changes, &/or bladder/anal sphincter dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If MSCC is suspected, what are the initial management steps?

A

Try to get rapid diagnosis.

In between, admit, bed rest, analgesia, and dexamethasone+PPI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is MSCC diagnosed?

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is MSCC managed?

A

Radiotherapy (within 24 hours of MRI diagnosis).

Decompression with surgery can be considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which MSCC pts can we consider for surgery?

A

If pt is fit enough with good prognosis

Single level of spinal disease with good motor function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How can we medically support pts with MSCC?

A 
Analgesia
Laxatives
Bladder care
VTE
PT/OT
24
Q

What is the prognosis for MSCC?

A

1-3 months if mobility isn’t regained
5-8 months if mobility is regained.
Longer if MSCC is due to myeloma/lymphoma

25
Q

How common is hypercalcaemia in cancer?

A

Most common metabolic abnormality in cancer.

10-20% of cancer pts, and 40% of myeloma pts.

26
Q

What is the most common pathogenesis of hypercalcaemia in cancer pts?

A

Osteolytic metastasis causing calcium release from bones into blood

27
Q

What are the symptoms of hypercalcaemia?

A

In cancer patients, they are very non specific.

Look out for new onset nausea, thirst, constipation, or confusion.

28
Q

What is important about the symptoms of hypercalcaemia in cancer pts?

A

As they are non specific, you need to have a low threshold for testing.

29
Q

How do we treat hypercalcaemia in cancer pts?

A

Hydrate with IV fluids - 3L over 24 hours

IV Bisphosphonates

30
Q

What is the prognosis like with hypercalcaemia in cancer pts?

A

Poor, many may die within 3/12

31
Q

What is tumour lysis syndrome?

A

Syndrome that occurs as a side effect of tumour cell breakdown

32
Q

What is the pathogenesis of tumour lysis syndrome?

A

Tumour cell breakdown -> efflux of K+, phosphate, and uric acid into systemic circulation

33
Q

When does tumour lysis syndrome often occur?

A

After the commencement of chemo, within the first 3-7 days

34
Q

Which malignancies is tumour lysis syndrome most commonly associated with?

A

Haematological malignancies

35
Q

What are the symptoms of tumour lysis syndrome?

A 
N&V
Diarrhoea 
Anorexia
Lethargy
Gout
Haematuria
HF
Cardiac complications
36
Q

How do we manage tumour lysis syndrome?

A

IV hydration
Monitor electrolytes
Allopurinol

37
Q

If serum electrolytes do not go back to normal after initial management of tumour lysis syndrome, what might the pt need?

A

Haemodialysis

38
Q

Why might SVC obstruction occur?

A

Due to external compression or an internal clot.

39
Q

Which condition is SVC obstruction most common in?

A

Lung cancer

40
Q

What are the symptoms of SVCO?

A 
Swollen face/neck
Breathlessness
Headache
Choking sensation
dysphagia
41
Q

What are the signs of SVCO?

A

Red face
Oedema of face and neck
Distended veins of neck and arms
Elevated but non-distended JVP

42
Q

If SVCO is left untreated, what further symptoms might a pt have?

A

Hallucinations or seizures

43
Q

How can we investigate SVCO?

A

CXR
CT

Both will show the presence of a tumour/mass

44
Q

Where will the mass be usually in SVCO?

A

Upper zone of the lungs or thereabouts i.e. the mediastinum

45
Q

How can we manage SVCO?

A

Everyone gets steroids for swelling (no evidence)

Stent the SVC

If radio/chemo-therapy sensitive, use that.

46
Q

What is the onset of SVCO usually like?

A

Insidious, over weeks/months

Can be acute.

47
Q

Which pt group is particularly at risk for thrombus formation -> SVCO?

A

Pts with central IV catheters

48
Q

What simple things can we do for pts with SVCO?

A

Sit them up
Oxygen for breathlessness
Opioids for pain and potentially breathlessness

49
Q

How quickly can radiotherapy + stenting work for SVCO?

A

Symptom relief within 2 weeks (in 90% of pts)

50
Q

Other than the big ones, what are some additional/rarer oncological emergencies?

A 
Catastrophic haemorrhage
Pericarditis
Coagulopathies
Haemoptysis
Hypoglycaemia
Obstructive emergencies
51
Q

What obstructive emergencies can occur in oncology?

A 
Gastric outlet
Small Bowel
Large bowel
Biliary tract
Ureteric
52
Q

Why is RICP a problem for cancer patients?

A

Cranial mets, usually from lung, breast, or melanoma tumours, can cause RICP, small bleeds, and acute symptoms.

53
Q

What are the symptoms of RICP?

A

Headache
Nausea and Vomiting
Behavioural changes
Seizures

54
Q

What are the sigs of RICP?

A 
Focal neurological deficit
Falling level of consciousness
Papilloedema
Unilateral ptosis/CNIII or VI palsies
Bradycardia(late)
55
Q

How should suspected RICP be investigated in a cancer patient?

A

Urgent CT/MRI to delineate lesion if that is likely to affect managament.

56
Q

How should RICP be managed?

A

ABCDE Mx esp. if loss of consiousness to protect airway and aim for higher than average resp rate

Mannitol with dexamethasone to reduce risk of cerebral herniation
High dose dexamethasone appropriate for palliative solution

Further Mx - cranial irradiation, or surgery depending on type and number of mets

Cancer Care Block (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions