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Oncology > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What are possible oncological emergencies?

A
  • Metastatic Spinal Cord Compression
  • Superior Vena Cava Obstruction
  • Hypercalcaemia
  • Major Haemorrhage
  • Neutropenic Sepsis
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2
Q

What is metastatic spinal cord compression caused by? What common cancers lead to this?

A
  • Caused by a tumour or metastases in the vertebral body or paraspinal region pressing on the spinal cord
  • Common cancers leading to this:
    • breast
    • bronchus
    • prostate
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3
Q

What are some of the catastrophic consequences of metastatic spinal cord compression?

A
  • Paraperesis
  • Paraplegia
  • Incontinence
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4
Q

What are the symptoms indiciative of metastatic spinal cord compression?

A
  • Back pain or nerve root pain
    • unilateral or bilateral
    • aggravated by movement, coughing or lying flat
    • Pain may preced other symptoms or absent
  • Motor weakness
    • rapid or slow onset
    • perceived changes in strength
  • Subjective sensory disturbance
  • Bladder/bowel dysfunctin
    • occurs late on
    • urinary retention often develops insidiously
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5
Q

What are the clinical signs of metastatic spinal cord compression?

A
  • Weakness/paraparesis/paraplegia
  • Changes in sensation occur below the level of compression -may be asymmetrical and not necessarily complete
  • Reflexes usually increased below level of lesion
  • Clonus and painless bladder distension
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6
Q

If metastatic spinal cord compression is suspected what investigation should be done?

A

Whole spine MRI

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7
Q

What is the management of metastatis spinal cord compression?

A
  • Corticosteroids (dexamthason 16mg) commenced
  • Surgery
  • Management is time critical, outcome correlate with level of function at time of treatment
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8
Q

What is superior vena cava obstruction caused by? Which cancers most likely cause it?

A
  • Extrinsic compression, thrombosis or invasion of the wall of the superior vena cava
  • Most commonly caused by extensive lymphadenopathy in the upper mediastinum
  • More likely in patients with lung cancer or lymphoma
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9
Q

What are the symptoms of superior vena cava obstruction?

A
  • Headache or feeling of fullness in the head
  • Facial swelling
  • Dyspnoea (often worse on lying flate)
  • Cough
  • Hoarse voice
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10
Q

What are the clinical signs of superior vena cava obstruction?

A
  • Facial / upper limb oedema
  • Prominent blood vessels on the neck, trunk and arms
  • Cyanosis
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11
Q

What is the management of superios vena cava obstruction?

A
  • Commenced on high dose corticosteroid (dexamethasone 16mg daily)
  • Urgent vascular stenting treatment of choice
  • Followed by radiotherapy or chemotherapy
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12
Q

When is Hypercalcaemia seen in cancer?

A
  • Associated with most tumours
  • Most commonly seen in breast cancer, lung cancer, squamous cell carcinomas and myeloma
  • Can develop without having bone metastases
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13
Q

What are the symptoms of Hypercalcaemia? Consider:

  • Early symptoms
  • Late features
A

Early symptoms

  • Lethargy
  • malaise
  • Anorexia
  • Polyuria
  • Thirst
  • Nausea
  • Vomiting
  • Constipation

Late Features

  • Confusion
  • Drowsiness
  • Fits
  • Coma
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14
Q

What investigation should be ordered if hypercalcaemia is suspected?

A

Serum calcium corrected for serum albumin

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15
Q

What is the management of hypercalcaemia? How many patients respond?

A
  • Rehydration using normal saline followed by IV bisphosphonate such as pamidronate or zoledronic acid
  • About 70% respond, max response seen after 6-11 days
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16
Q

How common is a major haemorrhage due to cancer?

A
  • Rare
  • Often preditable from the location of the tumour e.g. head and neck cancer eroding into a major vessel
17
Q

What is neutropenic sepsis?

A

Potentially life-threatening complication of neutropenia (low neutrophil count). It is defined as a temperature of greater than 38°C or any symptoms and/or signs of sepsis, in a person with an absolute neutrophil count of 0.5 x 109/L or lower.

18
Q

Patients receiving myelosuppressive chemotherapy should be warned of what? Advise given?

A
  • Potential neutropenic sepsis
  • Advised to seek immediate attention from unit if they develop a fever
19
Q

What is the management of neutropenic sepsis?

A
  • Broad spectrum antibiotics

Oncology (14 decks)

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