Oncological Emergencies Flashcards
What are possible oncological emergencies?
- Metastatic Spinal Cord Compression
- Superior Vena Cava Obstruction
- Hypercalcaemia
- Major Haemorrhage
- Neutropenic Sepsis
What is metastatic spinal cord compression caused by? What common cancers lead to this?
- 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
What are some of the catastrophic consequences of metastatic spinal cord compression?
- Paraperesis
- Paraplegia
- Incontinence
What are the symptoms indiciative of metastatic spinal cord compression?
- 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
What are the clinical signs of metastatic spinal cord compression?
- 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
If metastatic spinal cord compression is suspected what investigation should be done?
Whole spine MRI
What is the management of metastatis spinal cord compression?
- Corticosteroids (dexamthason 16mg) commenced
- Surgery
- Management is time critical, outcome correlate with level of function at time of treatment
What is superior vena cava obstruction caused by? Which cancers most likely cause it?
- 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
What are the symptoms of superior vena cava obstruction?
- Headache or feeling of fullness in the head
- Facial swelling
- Dyspnoea (often worse on lying flate)
- Cough
- Hoarse voice
What are the clinical signs of superior vena cava obstruction?
- Facial / upper limb oedema
- Prominent blood vessels on the neck, trunk and arms
- Cyanosis
What is the management of superios vena cava obstruction?
- Commenced on high dose corticosteroid (dexamethasone 16mg daily)
- Urgent vascular stenting treatment of choice
- Followed by radiotherapy or chemotherapy
When is Hypercalcaemia seen in cancer?
- Associated with most tumours
- Most commonly seen in breast cancer, lung cancer, squamous cell carcinomas and myeloma
- Can develop without having bone metastases
What are the symptoms of Hypercalcaemia? Consider:
- Early symptoms
- Late features
Early symptoms
- Lethargy
- malaise
- Anorexia
- Polyuria
- Thirst
- Nausea
- Vomiting
- Constipation
Late Features
- Confusion
- Drowsiness
- Fits
- Coma
What investigation should be ordered if hypercalcaemia is suspected?
Serum calcium corrected for serum albumin
What is the management of hypercalcaemia? How many patients respond?
- Rehydration using normal saline followed by IV bisphosphonate such as pamidronate or zoledronic acid
- About 70% respond, max response seen after 6-11 days
How common is a major haemorrhage due to cancer?
- Rare
- Often preditable from the location of the tumour e.g. head and neck cancer eroding into a major vessel
What is neutropenic sepsis?
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.
Patients receiving myelosuppressive chemotherapy should be warned of what? Advise given?
- Potential neutropenic sepsis
- Advised to seek immediate attention from unit if they develop a fever
What is the management of neutropenic sepsis?
- Broad spectrum antibiotics
