Oncological emergency Flashcards
what are the 4 oncological emergency?
metastatic spinal cord compression
Malignant hypercalaemic
neutropenic sepsis
SVC obstruction
what cancer is metastatic spinal cord compression common in?
breast lung prostate myeloma lymphoma
symptoms of metastatic spinal cord compression
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
signs of metastatic spinal cord compression
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
investigation for metastatic spinal cord compression
- Neurological, PNS and anal tone exam (PR)
- Whole spine MRI with 24h
- X-ray useless
management of metastatic spinal cord compression
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
what is the most common cancer which SVCO occurs in
lung or any solidary cancer
pathophysiology of SVCO
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
symptoms of SVCO
- 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
signs of SVCO
facial oedema
caynosis
engrogement of external and internal jugular veins/colalteral veins
pappilloedema - late feature
investigation of SVCO
CT thorax - ideally with contrast
CXR - mass, lymphadenopathy or other indications of lung cancer seen
management of SVCO
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
what are the common cancers which can lead to hypcalcaemia?
breast non small cell lung squamous cell lung prostate myeloma
symptoms of hypercalacemia
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
investigation for hypercalcaemia
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