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Oncology > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

When is neutropenic sepsis most likely to occur?

A

7-14 days post-chemo

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2
Q

What is neutropenic sepsis defined as?

A

Patients undergoing treatment whose neutrophil count is <1x10^9, with either:

  1. Temperature >38
  2. Other signs consistent with sepsis
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3
Q

What is febrile neutropenia?

A

60-70% of fevers during neutropenia have no identifiable ateology

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4
Q

How is neutropenic sepsis managed?

A

Broad spectrum antibiotics within 1 hour

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5
Q

What is a MASCC score?

A

Assessment of the risk of complications during a febrile neutropenic episode

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6
Q

What tumours is hypercalcaemia most common in?

A

Breast, lung, prostate, SCC, myeloma

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7
Q

What is normal calcium homeostasis when there is an increase in blood calcium?

A

Thyroid releases calcitonin

Promotes osteoblasts to deposit calcium in bones & reduces absorption in the kidneys

Calcium blood level falls

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8
Q

What is normal calcium homeostasis when there is a decrease in blood calcium?

A

Parathyroid releases PTH

Promotes osteoclasts to release calcium from bones (resorption)

Stimulates absorption by the kidney

Activates vitamin D (stimulates bowel to absorb calcium)

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9
Q

What is transforming growth factor alpha?

What does it do?

A

Stimulator of cell growth, produced by many tumour cells

Stimulates bone resorption

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10
Q

What is PTH related peptide

A

Mimics PTH

Stimulates bone resporption & increases plasma calcium

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11
Q

Hypercalcaemia presentation:

CNS

A 
Confusion
Seizures
Proximal neuropathy
Hyporeflexia
Coma
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12
Q

Hypercalcaemia presentation: GI

A

Nausea & vomiting
Constipation
Dyspepsia
Abdo pain

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13
Q

Hypercalcaemia presentation: Cardiac

A

Bradycardia
ECG changes
Arrhythmia
Hypertension

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14
Q

Hypercalcaemia presentation: other

A 
Dehydration
Weakness
Fatigue
polyuria
Bone pain
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15
Q

What ECG changes may you see in hypercalcaemia?

A

Short QT interval

Wide T wave

Prolonged PR

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16
Q

How is hypercalcaemia managed?

A
  1. Normal saline quarter hourly for 24 hours (then 6 hourly for 48-72 hours with adequate K+)
  2. IV Bisphosphonates
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17
Q

Give 2 examples of bisphosphonates

A

Pamindronate

Zolendronic acid

18
Q

Side effects of bisphosphonates

A

Oesophagitis

Osteonecrosis of the jaw

19
Q

How do bisphosphonates work?

A

Inhibit osteoclastic bone resorption, reducing amount of calcium from bones released into blood

20
Q

How are seizures/ arrhythmias from hypercalcaemia managed?

How are they given?

A

Calcitonin & corticosteroids

S/C calcitonin with oral prednisolone

21
Q

What is the pathophysiology of MSCC?

A

Direct compression by vertebral collapse

Or direct extension of malignancy

22
Q

Which part of the spine is MSCC most common in?

A

Thoracic

23
Q

Which cancers is MSCC most common in?

A

Prostate, breast, lung, myeloma, lymphoma

24
Q

What % of people with MSCC have no pain?

A

40% painless

25
Q

How is the pain from MSCC usually described?

A

‘Band-like’ pain

26
Q

What is the initial management for suspected MSCC?

A

16 mg dexamethasone (+ PPI)

Urgent MRI (within 24 hours)

27
Q

How does dex help in MSCC?

A

Reduces swelling & oedema around the tumour & reduces pressure on the spinal cord

28
Q

What are the 3 definitive treatment options for MSCC?

A

Spinal surgery
Radiotherapy
Chemotherapy

29
Q

when is surgery indicated for MSCC?

A

Single site & good prognosis, few co-morbidities

30
Q

How is radiotherapy given for MSCC?

A

Single fraction of radiotherapy

Mainstay of treatment for MSCC

31
Q

When would you give chemo for MSCC?

A

In a very chemosensitive cancer

e.g. SCLC, germ cell tumour, lymphoma

32
Q

If patients are treated in <24 hours, how many are able to walk again?

A

60%

33
Q

What is the pathophysiology of SVC obstruction?

3

A

Extrinsic compression, thrombosis or invasion of the wall of the SVC

34
Q

What is the most common cause of SVC obstruction?

A

Extensive lymphadenopathy in the upper mediastinum

35
Q

What cancers most commonly cause SVC obstruction?

2

A

Lung cancer & lymphoma

36
Q

How does SVC obstruction present?

A

Breathlessness, headache, swelling in the face, neck or arm
Distented neck & chest veins
Cyanosis
Visual disturbance

37
Q

What are the features of headache in SVC obstruction

A

Worse on coughing & worse in the morning

38
Q

What is the immediate management of SVC obstruction?

A

16mg dexamethasone daily

39
Q

What procedure is needed urgently in SVC obstruction?

A

Urgent vascular stenting

40
Q

What treatment is needed following stenting?

A

Radiotherapy or chemotherapy

41
Q

What should be done if SVC obstruction is the initial presentation of a cancer?

A

Biopsy (N.B. tumour likely to progress rapidly)

42
Q

Give two alternative causes of SVC obstruction

A

Goitre

Aortic aneurysm

Oncology (8 decks)

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