Oncological Emergencies Flashcards
What are oncological emergencies?
Neutropenic sepsis Spinal cord compression Superior vena cava obstruction Hypercalcaemia of malignancy Brain metastases Tumour lysis syndrome
What is neutropenic sepsis?
Complication of chemotherapy
USually occurs 7-14 days after chemotherapy
Neutrophil count of < 0.5x10^9 in a pt who is having anticancer treatment and one of:
Temp > 38C
Other signs or symptoms consistent with clinically significant sepsis
Suspect in all patient unwell and within 6 weeks of receiving chemotherapy
What is management of neutropenic sepsis?
Immediate empirical ABX - Piperacilin + Tazobactam IV Tazocin
Sepsis 6
Specialist assessment
If patients are still febrile and unwell after 48h, alternative antibiotic such as meropenem is often presribed ± vancomycin
If patients are nor responding after 4-6 days, order investigations for fungal infection e.g. HRCT
There may be a role later fro GCSF
What prophylaxis for neutropenic sepsis?
Fluoroquinolone
What causes spinal cord compression? What is it associated with?
Spinal mets
Lung, prostate, breast, myeloma, melanoma
Collapse or compression of a vertebral body due to mets
What are signs and symptoms of spinal cord compression? Most common?
Back pain - may be worse lying down (nocturnal) or coughing/straining - most common earliest symptom Lower limb weakness Difficulty walking Sensory loss Bowel/bladder dysfunction
Lesions above L1 usually result in UMN signs in legs
Lesions below L1 result in LMN signs in legs and perianal numbness
Tendon reflexes increased below level of lesion and absent at level of lesion
What is management for spinal cord compression
Admit for bed rest
Urgent MRI spine
Oral Dexamethasone 16mg/24h PO
Prophylactic gastroprotection - PPI and blood glucose monitoring
Consider thromboprophylaxis if reduced mobility
Refer to clinical oncology/cancer MDT
Radiotherapy given within 24h of MRI
Decompressive surgery ± radiotehrapy
What is SVCO? Causes? Most common cause?
Reduced venous return from head, neck and upper limbs due to extrinsic compression or venous thrombosis of SVC
Most commonly: Lung - non-small cell
Lymphoma
Mets from breast
Thymoma
Germ cell
Aortic aneurysm
What are signs/symptoms of SVCO? Special sign?
Dyspnoea Orthopnea Stridor Oedema of face neck arms Headache - worse in mornings Visual disturbance Engorged neck veins, forehead veins Pulsatile raised JVP
Pemberton’s test - elevation of the arms to the side of the head causes facial plethora/cyanosis/SOB worsens
What is Mx of SVCO??
Prop up
Pulse oximetry, blood gas
O2 if needed
Dexamethasone 16mg/24h
Balloon venoplasty
Stenting
Treat with radiotherapy or chemotherapy depending on underlying cancer
What are causes of hypercalcaemia in malignancy?
PTH-related protein produced by tumour - squamous cell lung cancer
Local oestolysis e.g. myeloma, bone mets
tumour production of calcitriol
What are signs and symptoms of hypercalcaemia?
Weight loss Anorexia Nausea Polydipsia Polyuria Constipation Adominal pain Dehydration Weakness Confusion Seizure Come
What is management of hypercalcaemia?
Aggressive rehydration with normal saline
Bisphosphonates .eg. zolendronic acid IV - takes 2-3 days to normalises calcium
Calcitonin produces a more rapid but short term effect
Treat underlying malignancy
What cancer metastasise to brain
Lung
Breast
Colorectal
Melanaoma
What are signs/symptoms of brain mets?
Headache - worse in morning, coughing or bending Focal neurological sign Ataxia Fits N/V Papilloedema
