Oncological Emergencies

Question 1

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?

Answer 1

low sodium:syndrome of inappropriate anti-dieuretic hormone. (SIADH)

Question 2

mechanism of SIAGH and clinical manifestations

Answer 2

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

Question 3

treating SIADH

Answer 3

• treat underlying cause
• restrict fluid intake to increase the concetrations of Na+
• if mores severe, may have to correct the hyponatremia with hypertonic saline.

Question 4

what might happen if you correct hyponatremia from SIADH too quickly?

Answer 4

central pontine myelinokysis

-characterized by lethargy and affective changs, mutism or dysarthria, spastic quadraparesis

Question 5

presentation of hypercalcemia of malignancy

Answer 5

bones stones, moans and groans

bone pain, kidney stones, abdominal pain, altered mentation/confusion

Question 6

management of malignancy associated hypercalcemia

Answer 6

IV fluids, bisphosphonates

Question 7

oncological emergency?

Answer 7

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

Question 8

malignant bleeding is most often seen with ___ cancers

Answer 8

solid cancers

Question 9

DIC is due to ___ activation, causing fibrin clots, consumption of clotting factors, and clot degradation.

Answer 9

due to thrombin activation. treat the underlying cause ASAP because DIC will not improve otherwise.

Question 10

Answer 10

airway is compromised and there is vascular congestions (swelling and headache). this is supererior vena cava obstruction.

Question 11

diagnosing SVCO?

Answer 11

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

Question 12

symptoms are indicative og?

Answer 12

superior vena cava obstruction

Question 13

management of SVCO

Answer 13

• 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

Question 14

pericardial tamponade

Answer 14

 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)

Question 15

presentation of pericardial tamponade

Answer 15

 Presentation
 dyspnea, tachycardia, and tachypnea  elevated JVP and Pulsus paradoxus  Chest pressure  Decreased urine output  Confusion; and, Dysphoria

Question 16

management of percardial tamponade

Answer 16

can result in pulmonary edema, shock and death

management:

• urgent removal of fluid

- pericardiocentesis

• pericardial window
• symptom management
• analgesia
• volume support as needed.

Question 17

Answer 17

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

Question 18

diagnosing spinal cord compression

Answer 18

cold standard is MRI spine with gadolinium

Question 19

spinal cord compression management

Answer 19

1. rapid steroids to reduce any inflammation (like dexamethasone)
2. surgical decompression.
3. 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.

Question 20

T/F most brain tumors are due to metastasis

Answer 20

true. true brain-originating cancers are less common

Question 21

most accurate diagnosis of brain tumors

Answer 21

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

Question 22

management of brain tumors

Answer 22

1. steroids to reduce edema and ICP– will improve cognitive symptoms
2. anticonvulsants if having seizures
3. surgical management (decompression)
4. radiation treatment in patients with limited brain mets.

Question 23

what type of radiation therapy is used to treat small brain tumors? large brain tumors?

Answer 23

small brain tumors: stereotactic radiotherapy

whole brain radiation for extensive tumors.

Question 24

dx? treatment?

Answer 24

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