Oncological emergencies

Question 1

what is spinal cord compression?

Answer 1

an oncological emergency

Question 2

what are the symptoms of spinal cord compression?

Answer 2

back pain
bilateral leg weakness
difficulty walking
sensory loss
bowel/bladder dysfunction

Question 3

what is the investigation for spinal cord compression?

Answer 3

an urgent MRI spine

Question 4

management of spinal cord compression in a cancer patient?

Answer 4

urgent dexamethasone

then consider radiotherapy or de-compressive surgery

Question 5

a patient undergoing chemotherapy presents with a temperature >38 and neutrophil count <0.5x10^9, what are you suspecting?

Answer 5

neutropenic sepsis

Question 6

when may neutropenic sepsis occur?

Answer 6

within 6 weeks of starting chemotherapy

Question 7

treatment of neutropenic sepsis?

Answer 7

urgent blood cultures and antibiotics (piperacillin / tazobactam)

Question 8

what are the symptoms of superior vena cava syndrome?

Answer 8

SOB
orthopnoea
stridor
cyanosis
oedema of face and arm
cough
headache
enlarged neck veins

Question 9

which cancer is a common cause of superior vena cava syndrome?

Answer 9

lung cancer (75%)

Question 10

management of superior vena cava syndrome?

Answer 10

prop up and give oxygen if needed
dexamethasone
then consider radiotherapy or chemotherapy

Question 11

what is the most common metabolic abnormality in cancer patients?

Answer 11

malignancy associated hypercalcaemia

Question 12

which cancers release may PTH?

Answer 12

lung, oesophagus, skin, cervix, breast, kidney

Question 13

management of malignancy associated hypercalcaemia

Answer 13

IV saline (rehydrate) and bisphosphonates

Question 14

management of hypercalcaemia not related to malignancy?

Answer 14

IV saline

Question 15

what might lethargy, consitpation, anorexia, confusion, weakness, polyuria suggest?

Answer 15

hypercalcaemia

Question 16

how common are brain metastases in cancer patients?

Answer 16

about 40% of cancer patients get them

Question 17

which cancers are most commonly associated with brain metastases?

Answer 17

lung, breast, colorectal, melanoma

Question 18

what are some symptoms of brain metastases?

Answer 18

headache
focal neurological signs
ataxia
fits
nausea, vomiting
papilloedema

Question 19

imaging for suspected brain metastases?

Answer 19

urgent CT/MRI

Question 20

immediate management for brain metastases?

Answer 20

dexamethasone

Question 21

what causes tumour lysis syndrome?

Answer 21

rapid death of neoplastic cells e.g. during chemotherapy of leukaemia, lymphoma or myeloma

Question 22

signs of tumour lysis syndrome?

Answer 22

increased serum urate, potassium and phospate

decreased serum calcium

Question 23

risks associated with tumour lysis syndrome?

Answer 23

arrhythmias and renal failure

Question 24

what should be given to prevent tumour lysis syndrome?

Answer 24

hydration and uricolytics e.g. allopurinol

Question 25

a patient presents with a red, swollen, painful arm during chemotherapy treatment, what may have happened?

Answer 25

extravasation of chemotherapy

accidental administration of chemo drugs into surrounding tissues rather than a vein, due to displaced cannula

Question 26

management of extravasation of chemotherapy?

Answer 26

stop chemotherapy infusion, elevate arm and mark affected area