Oncological Emergencies Flashcards

1
Q

What cancers cause MSCC + how?

A

Commonly breast, bronchus + prostate

Due to tumour in vertebral body or paraspinal region pressing on spinal cord

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2
Q

Where does MSCC usually occur?

A

2/3 in thoracic region, remainder in cervical or lumbar spine

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3
Q

Consequences of MSCC

A

Paraparesis, paraplegia, incontinence

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4
Q

Symptoms of MSCC

A

Back pain, nerve root pain
Worse on movement, coughing or lying flat
Motor weakness
Sensory disturbance (walking on cotton wool)
Bladder/ bowel dysfunction (late) - urinary retention

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5
Q

Signs of MSCC

A
Weakness/ paraparesis/ paraplegia 
Changes in sensation 
Increased reflexes 
Clonus 
Painless bladder distension
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6
Q

Investigations for MSCC

A

Whole spine MRI

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7
Q

Management of MSCC

A

Dexamethasone stat
Surgery favoured when there is mechanical collapse of vertebral body
Can use RT or chemo

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8
Q

SVC obstruction causes

A

Extrinsic compression, thrombosis, invasion of wall of SVC

Commonly due to extensive lymphadenopathy in upper mediastinum - usually with lung cancer or lymphoma

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9
Q

Symptoms of SVC obstruction

A
Headache, fullness in head 
Facial swelling - periorbital oedema 
SOB - worse on lying flat
Cough
Hoarse voice
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10
Q

Signs of SVC obstruction

A

Facial/ upper limb oedema
Prominent blood vessels on neck, trunk, arms
Cyanosis

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11
Q

Management of SVC obstruction

A

Dexamethasone relieves symptoms

Urgent vascular stenting followed by RT or chemo

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12
Q

Causes of hypercalcaemia

A

Commonly seen in breast, lung, squamous cell carcinomas + myeloma
Due to PTpH

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13
Q

Symptoms of hypercalcaemia

A
Develop insidiously 
Early:
Lethargy
Anorexia
Polyuria 
Thirst 
N+V
Constipation 

Late:
Confusion, drowsiness
Fits
Coma

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14
Q

Investigations for hypercalcaemia

A

Calcium corrected for serum albumin

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15
Q

Management of hypercalcaemia + max response time

A

Rehydration with saline + IV bisphosphonate (pamidronate or zolendronic acid)
Max response seen after 6-11 days

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16
Q

Management of major haemorrhage

A

Keep green towels close

IM of SC midazolam as sedative

17
Q

What is Pemberton’s sign?

A

Bilateral arm elevation causes facial plethora

Used to evaluate SVC obstruction

18
Q

What cancers commonly cause SVC?

A

Lung, germ cell (testicular) + lymphoma