Oncological emergencies II Flashcards
definition: malignant spinal cord compression
compression of the spinal cord or cauda equina by an extra dural tumor leading to ischemia
malignant spinal cord compression occurs in what % of cancer patients?
5-10%
what are the common cancer etiologies associated with malignant spinal cord compression?
lung, breast, prostate, multiple myeloma
85-90% of malignant spinal cord compression cases are due to what cause?
metastatic tumor in vertebral column with tumor growing into epidural space
which part of the vertebral column is the most frequent site for malignant spinal cord compression?
thoracic
what are the signs and symptoms of malignant spinal cord compression?
localized back pain - first symptom
lhermette’s sign - feeling of an electric shock down spine with neck flexion
motor - weakness, spasticity, reflexes
sensory - numbness, paresthesia
what are the signs and symptoms of cauda equina syndrome?
low back pain decreased sensation over buttocks, posterior thigh, perineum (saddle) bladder and bowel dysfunction decreased patella and achilles reflex lower extremity weakness
what is the test of choice for malignant spinal cord compression?
MRI
what is the test of choice for patients with malignant spinal cord compression who cannot get an MRI (pacemaker)?
CT myelogram
MRI can differentiate between which types of tumors?
extradural vs intramedullary / leptomeningeal
what are the treatment options for malignant spinal cord compression?
glucocorticoids chemo radiation surgery radiofrequency ablation (for pain resulting from collapsed vertebral body, but NOT cord compression)
tumor lysis syndrome is characterized by what findings?
hyperkalemia hyperuricemia hyperphosphatemia hypocalcemia metabolic acidosis acute kidney injury
what is the most common disease related emergency in patients with hematologic malignancies?
tumor lysis syndrome
what are the two types of tumor lysis syndrome?
laboratory
clinical
what is the pathophysiology of tumor lysis syndrome?
when cancer cells lyse they release potassium, phosphorus, and nucleic acids which are metaboliszed to eventually uric acid
what is the cause for hypocalcemia in tumor lysis syndrome? what is the result?
hyperphosphatemia
leads to neuromuscular irritability, dysrhythmia, seizure
how can hyperuricemia cause acute kidney injury?
precipitation into tubules renal vaoconstriction impaired autoregulation decreased renal flow oxidation and inflammation
how does calcium phosphate cause cardiac dysrhythmias?
precipitation into cardiac conduction system
how does tumor lysis syndrome cause multiorgan failure?
cytokines - systemic inflammatory response syndrome
what is the main cause of renal insufficiency in tumor lysis syndrome?
crystal induced tissue injury
what renders patients with tumor lysis syndrome at high risk for crystal associated acute kidney injury?
high levels of both uric acid and phosphate
which cancers have high potential for cell lysis?
high grade lymphomas
acute leukemias
any rapidly proliferating tumor
what are the high risk groups for tumor lysis syndrome?
preexisting chronic renal insufficiency oliguria volume depletion hypotension acidic urine
what is the management for high risk groups in tumor lysis syndrome?
hydration - mainstay
allopurinol - blocks uric acid formation
rasburicase - makes uric acid more soluble
what are the most common signs for PE?
tachypnea
tachycardia
rales
JVD
what test can be used to rule out PE?
D dimer
what is the test of choice for PE?
CT pulmonary angiogram
what are the treatments for pulmonary embolus?
resuscitation
diagnostic studies
initiation of anticoagulation with LMWH
