Oncological Emergencies Flashcards
a 75 yo woman with confusion has been shown to have a large right hilar mass, and innumerable liver mets. she was dianogsed with small cell lung cancer. her sodium is 119. what oncological emergency might she have?
low sodium:syndrome of inappropriate anti-dieuretic hormone. (SIADH)
mechanism of SIAGH and clinical manifestations
SIADH is caused by cancer cells secreting ADH/or causing ADH secretion (ex/ brain mets causing pituitary stimulation)
presens with confusion, lethargy, seizures, anorexia, diarrhea, muscle cramping, death
treating SIADH
- treat underlying cause
- restrict fluid intake to increase the concetrations of Na+
- if mores severe, may have to correct the hyponatremia with hypertonic saline.
what might happen if you correct hyponatremia from SIADH too quickly?
central pontine myelinokysis
-characterized by lethargy and affective changs, mutism or dysarthria, spastic quadraparesis
presentation of hypercalcemia of malignancy
bones stones, moans and groans
bone pain, kidney stones, abdominal pain, altered mentation/confusion
management of malignancy associated hypercalcemia
IV fluids, bisphosphonates
oncological emergency?
malignant Bleeding.
Regardless of where the bleeding is originating
Ensure ABC If necessary, large bore iv with fluids on hands, and cardiac
monitoring if large volume bleed
malignant bleeding is most often seen with ___ cancers
solid cancers
DIC is due to ___ activation, causing fibrin clots, consumption of clotting factors, and clot degradation.
due to thrombin activation. treat the underlying cause ASAP because DIC will not improve otherwise.
airway is compromised and there is vascular congestions (swelling and headache). this is supererior vena cava obstruction.
diagnosing SVCO?
chest X ray: look for anterior mediastinal mass
CT= best to assess
histological confirmation of type of cnacer is important.
Presentation
Dyspnea, sensation of pressure, stridor Swelling of face/hands/arms; Headache Jugular distention; Collateral vessels on chest wall
symptoms are indicative og?
superior vena cava obstruction
management of SVCO
- steroids and chemo for chemosensitive cancers
- radiation
- SVC stent if unable to intitiate a treatment, not responding to treatment or severe symptoms needing relief ASAP
pericardial tamponade
Accumulation of fluid in the pericardial
space, resulting in reduced ventricular
filling and subsequent hemodynamic
compromise.
May be blood or other fluids (such as a
malignant pericardial effusion)
presentation of pericardial tamponade
Presentation
dyspnea, tachycardia, and tachypnea elevated JVP and Pulsus paradoxus Chest pressure Decreased urine output Confusion; and, Dysphoria
management of percardial tamponade
can result in pulmonary edema, shock and death
management:
- urgent removal of fluid
- pericardiocentesis
- pericardial window
- symptom management
- analgesia
- volume support as needed.
spinal cord compression is occuring. Presentation
Presentation:
Worsening Back Pain with/without radicular pain
Weakness (mostly lower extremity)
Numbness/tingling (sensory deficit)
Loss of bowel/bladder Control
diagnosing spinal cord compression
cold standard is MRI spine with gadolinium
spinal cord compression management
- rapid steroids to reduce any inflammation (like dexamethasone)
- surgical decompression.
- raditaion treatment
- if the person is walking prior to radiation, there is usually a 80-90% recovery of neurological function.
If they aren’t able to walk prior to RT, then only about 30% will have recovery of neurological function.
T/F most brain tumors are due to metastasis
true. true brain-originating cancers are less common
most accurate diagnosis of brain tumors
CT will show most lesion, but MRI is more sensitive for smaller lesions
Presentation
Headache, Seizure, Nausea/Vomiting
Falls due to imbalance, weakness, dizziness
Visual disturbances
management of brain tumors
- steroids to reduce edema and ICP– will improve cognitive symptoms
- anticonvulsants if having seizures
- surgical management (decompression)
- radiation treatment in patients with limited brain mets.
what type of radiation therapy is used to treat small brain tumors? large brain tumors?
small brain tumors: stereotactic radiotherapy
whole brain radiation for extensive tumors.
dx? treatment?
febrile neutropenia– medical emergency
bone marrow issue? could be due to bone marrow secondary infiltration/metastasis.
immediate antibiotics– then do cultures
needs GCSF since she was post chemo
