Oncological Emergencies + Symptom Management Flashcards
Outline neutropenic sepsis
Temp >38, neutrophil <0.5
Suspect in all Ca pts undergoing chemo who become unwell, as well as those who cant mount a fever (corticosteroids)
Typically 7-10 days post chemo (within 4w post chemo)
S+S = hypotension, tachycardia >90, fever, confused, signs of infection, RR >20, impaired MMSE
Mx = cannulate urgent FBC, IV Abx within 30min admission (tazocin + gent), fluids asap, catheter, escalation, granulocyte colony stimulating factor (GCSF)
Outline metastatic spinal cord compression
Breast, prostate, lung - 60% of cases, myeloma
Spine mets occur in 3-5% of Ca pts - common in thoracic spine
Below L2 - cauda equina
Pathophysiology = collapse/compression of vertebral body, contains metastatic disease = cord compression = oedema = venous congestion = demyelination
S+S = severe, prolonged, back pain, exacerbated by straight leg raise/sneeze/lying, limb weakness (flaccid to spastic paralysis), spinal/radicular pain, bladder/sphincter dysfunction
Ix = pain suggestive of spinal mets (MRI in 1 week), signs of MSSC (MRI in 24hrs), reconstructed CT (pacemaker)
Mx = ORAL 16mg BD DEX + PPI, analgesia, immobilise (?unstable spine), refer for neurosurgical opinion, surgery (decompression - remove tumour, stabilise spine), radiotherapy, physio/OT
Discuss SVCO
Compression/occlusion (90% extrinsic, 80% lung Ca, lymphoma) = mediastinal LN mets, thrombosis
S+S = breathlessness, neck/face/arm/trunk swelling, sensation of chocking, fullness in the head, headache, lethargy, distended neck and chest wall veins, papilloedema, stridor, pemberton sign
Ix = CXR (tracheal deviation, tumour), CT thorax with contrast, biopsy (in fit pts)
Mx =
- general: high dose dexamethasone, balloon venoplasty, stenting
- small cell: chemotherapy + radiotherapy
- non-small cell: radiotherapy
Discuss hypercalcaemia of malignancy
> 2.6
Most common in squamous cell carcinoma (lung, H+N, kidney, cervix)
Generally paraneoplastic (PTH-related peptide, increased bone resorption + renal reabsorption) + osteolytic mets
S+S = stone (not in malignant - too quick), groans, moans, new nausea, thirst, polyuria
Ix = bloods
Mx = 3L saline/24hrs, dehydration - 1L/3hrs (urea/creatinine), bisphosphonates (zolendronic acid - takes up to a week to work), systemic treatment of malignancy
Lytic malignancy = myeloma, breast, lung
Other causes = hyperPTH, iatrogenic high Ca intake
What is tumour lysis syndrome?
Large vol that responds quick to tx - haematological, seminoma
Prevention = pre-hydration, allopurinol (xanthine oxidase inhib), rasburicase (dec uric acid)
Release massive amounts of K, phosphate, uric acid = AKI, hypoCa
Normally 3-7 days post chemo
S+S = N+V, diarrhoea, anorexia, lethargy, haematuria, HF, arrhythmia
Mx = pre-hydration, vigorous hydration, allopurinol, rasburicase
Outline the symptoms and appropriate management of malignant ascites
Aetiology = massive liver mets causing portal hypertension, peritoneal disease (peritoneal mesothelioma, peritoneal carcinomatosis, and ovarian Ca), tumour (breast, colon, ovary, stomach, pancreas, bronchus)
Sx = abdominal distension, abdominal pain, nausea, vomiting, lower body oedema and breathlessness, flank dullness, shifting dullness, fluid thrill.
Ix = FBC, bilirubin, clotting, US/Doppler, CT, MRI
Mx = paracentesis + spironolactone
Outline the symptoms and appropriate management of malignant pleural effusion
Aetiology = lymphoma, breast, lung, and ovary
S+S = SOB, dry cough, pain, feeling of chest heaviness or tightness, inability to lie flat
Ix = resp exam, USS, CXR, thoracentesis
Mx = thoracentesis, tube thoracostomy + pleurodesis, shunt, chemo
Outline the symptoms and appropriate management of venous thromboembolism (oncological)
S+S = unilateral arm/leg swelling, localised pain, dyspnoea, chest pain, tachycardia, low O2
Mx = low-molecular weight heparin (LMWH) which is given every day for 6 months
Outline the symptoms and appropriate management of bowel obstruction (oncological)
S+S = N+V, colic pain, pain due to distension, absence of stools or emission of gases
X-ray signs = intestinal loop distention, fluid retention, gases with the presence of air-fluid levels in the zone proximal to the occlusion as well as a reduction in gas and stools in the segments distal to the obstruction
Mx = surgery, stents, nasogastric aspiration, total parenteral nutrition (TPN), analgesic, antiemetic (cyclizine)
Octreotide = inhibits release of GI hormones; reducing GI tract secretion, increasing GI absorption by slowing down intestinal mobility and decreasing the splanchnic blood flow
Outline the management of depression + anxiety (oncological)
Sertraline and citalopram
Outline the symptoms and appropriate management of fits (oncological)
Aetiology = brain mets, chemo, toxic–metabolic encephalopathy
S+S = tonic-clonic, myoclonic
Mx = lorazepam
Discuss RICP
Typically brain metastases (lung, breast and melanoma)
S+S = headache, nausea, vomiting, seizures, behavioural changes and sometimes focal neurological changes
Tumour + oedema may produce hydrocephalus and as the mass enlarges various herniation syndromes may occur depending on the location of the tumours within the cranium
Ix = CT (unstable), MRI
Mx = IV mannitol, IV dexamethasone
