Oncological Management and it's complications

Question 1

What are the oncological emergencies?

Answer 1

Spinal cord compression

Febrile neutropenia

Hypercalcaemia

Tumour lysis syndrome

Chemotherapy related emesis

Question 2

What is the definition of febrile neutropenia?

Answer 2

Neutrophils <0.5

Temp >38

Question 3

Which types of cancers more commonly get tumour lysis syndrome? How do you prevent it?

Answer 3

Lymphoma

Leukaemia

Large testes cancer

Allopurinol

Question 4

What do you think of in a patient with a fever and recent chemotherapy?

Answer 4

Febrile neutropenia

Question 5

How is chemotherapy related emesis managed?

Answer 5

Come to ED for:

Fluids

Dexamethasone 8mg

5HT3 antagonists (ondansetron 8mg)

Metaclopromide aka maxalon

Exclude other causes of N/V

Question 6

What must you be wary of in an older patient with ?FN?

Answer 6

Older patients don’t necessarily mount a fever

Question 7

How is FN treated?

Answer 7

Well patient - Tazocin 4.5mg IV

Unwell - Tazocin 4.5mg IV

plus antifungal

Question 8

How do you rule out spinal cord compression on Ix?

Answer 8

MRI

Question 9

Who do you refer to when there is spinal cord compression?

Answer 9

Neurosurgery

Question 10

How does hypercalcaemia present?

Answer 10

N/V

Constipation

Dehydration

Obtunded

Unwell

Question 11

How is spinal cord compression treated medically?

Answer 11

Dexamethasone 4mg QID

Question 12

Which cancer picture is high risk for febrile neutropenia?

Answer 12

Those on curative regimens

Those with malignancies involving the bone marrow

Question 13

How is hypercalcaemia treated?

Answer 13

Hydration

IV zoledronic acid (bisphosphonates)

Treat underlying cancer

Dexamethasone / Lasix

Question 14

What causes hypercalcaemia in malignancy?

Answer 14

Osteolytic metastases

Paraneoplastic hyperPTH