Oncological emergency Flashcards

1
Q

what are the 4 oncological emergency?

A

metastatic spinal cord compression

Malignant hypercalaemic

neutropenic sepsis

SVC obstruction

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2
Q

what cancer is metastatic spinal cord compression common in?

A
breast 
lung 
prostate 
myeloma 
lymphoma
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3
Q

symptoms of metastatic spinal cord compression

A

back pain/nerve pain

  • uni or bi lateral
  • at night and at rest
  • aggravated by movement, cough, lying flat

motor weakness

  • rapid/slow in onset
  • subtle at first
  • monitor changes

sensory disturbance
- below L1 = saddle anaestehesia

Bladder/bowel dysfunction

  • late
  • urinary retention/dribbing/incontience insidious
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4
Q

signs of metastatic spinal cord compression

A

weakness/paraparesis/paraplegia

sensation change below the level of compression
- visible/palpable gibbus at sign of wedged/collapsed vertebra
- o Pain/tenderness on palpation of vertebra at the level of compression
o Hyperaestesia at level of lesion
o Loss of power e.g. anal tone
inc reflexes below level
clonus
painless bladder distention

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5
Q

investigation for metastatic spinal cord compression

A
  • Neurological, PNS and anal tone exam (PR)
  • Whole spine MRI with 24h
  • X-ray useless
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6
Q

management of metastatic spinal cord compression

A

dexamethasoen 16mg + PPI if suspected
- inform local oncological SPR on call
- anticoagulate
- catheteristaion if necessary
- • Surgery + radio mainly, sometimes + chemo
o Surgery favoured when mechanical collapse of vertebral body
 Must have good performance status and not paraplegic for more than 48 hours

o Single fraction radiotherapy
• Rehabilitation

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7
Q

what is the most common cancer which SVCO occurs in

A

lung or any solidary cancer

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8
Q

pathophysiology of SVCO

A

extrinsic compression

  • via primary or met
  • lymphadenopathy in the upper mediatinsum

thrombus
- due to hackman or PICC line

invasion of wall of SVC
- vai primary or met

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9
Q

symptoms of SVCO

A
  • dyspnoea - esp lying flat
  • headache/head fullness - worse on coughing
  • facial, neck arm swelling - worse in the morning, wrosened by bending forwards/lying down
  • visual disturbances
  • cough
  • hoarse voice
  • stridor = emergency
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10
Q

signs of SVCO

A

facial oedema
caynosis
engrogement of external and internal jugular veins/colalteral veins
pappilloedema - late feature

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11
Q

investigation of SVCO

A

CT thorax - ideally with contrast

CXR - mass, lymphadenopathy or other indications of lung cancer seen

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12
Q

management of SVCO

A

acute - sit pt up, get IV access and give O2 if needed

dexamethasone 16mg + PPI

depending on cause - vascular stenting/radio/chemo/thrombolysis

if SOB 5mg morphine can be given

speak to interventional radiology

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13
Q

what are the common cancers which can lead to hypcalcaemia?

A
breast 
non small cell lung 
squamous cell lung 
prostate 
myeloma
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14
Q

symptoms of hypercalacemia

A

early

  • lethargy/malaise
  • weight los
  • polyuria/thirst
  • N+V/constipation
  • arrythmias/altered BP

late

  • confusion
  • drowsiness
  • fits
  • coma

general

  • dehydration
  • weakness
  • fatigue
  • bone pain

cardiac
- bradycardia, shirt QT interval, wide T wave, prolonged PR interval, BBB, arrythmia

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15
Q

investigation for hypercalcaemia

A
U&E
Phosphate 
magnesium 
LFT 
amylase 
FBC
plasma PTH
serume calcium 

if free Ca2+ > 3 –> urgent intervention

ecg - bradycardia, short QT, wide T wave, prolonged PR, arrythmia, arrest

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16
Q

management of hypercalcemia?

A

rehydration with 1L 4 hourly for 24 hours then 6 hoursly for 48-72 hours

IV bisphophonates - pamidronate 90m/zoledronic acid 4mg

if ineffective, consider calcitonin and coritcosteriods