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SpM Oncology > Oncologocial emergencies > Flashcards

Oncologocial emergencies Flashcards

1
Q

What does MSCC stand for?

A

Malignant spinal cord compression?

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2
Q

How common is malignant spinal cord compression?

A

15% of patients with advanced cancers develop spinal cord compression

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3
Q

Which part of the spine is MSCC most common?

A

In the thoracic spine

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4
Q

In what cancers is MSCC most common?

A

Breast, prostate and lung

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5
Q

What is the cause of symptoms in MSCC?

A

Most commonly the mets cause collapse or compression of a vertebral body. Less common the tumour directly presses into spinal canal

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6
Q

What are the main symptoms in MSCC?

A

Back pain in around 95%, thoracic/cervical is concerning

Loss of sensation, power, difficult walking, bowel/bladder dysfunction

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7
Q

What will be the difference between the symptoms in spinal cord compression and cauda equina compression?

A

In spinal cord it will cause UMN signs (hypertonia, hyperreflexia, upgoing plantars and clonus)
In the cauda equina then is LMN signs (hypotonia, hyporeflexia, weakness, fasciculations)

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8
Q

What is the management of MSCC?

A

Need to admit for bedrest
Urgent MRI of whole spine to find site of lesion and any missed lesions elsewhere in spine
16mg/24 hours PO dexamethasone with gastric protection (PPI)
Refer to oncology where radiotherapy is commonest treatment
Also may recieve decompressive surgery

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9
Q

How common is malignant hypercalcaemia in cancer patients? What cancers is it commonly associated with?

A

It occurs in 10-20% of patients with cancer. Commonly associated with breast, myeloma and lung cancers

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10
Q

How does hypercalcaemia commonly present?

A

Neuro symptoms: malaise, fatigue
GI symtpoms : nausea, vomiting, abdo pain
Renal symtpoms: polydipsia, polyuria

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11
Q

What are some of the mechanisms by which cancer causes hypercalcaemia?

A

Osteolysis from bone mets

Tumours producing PTHrP (parathyroid hormone related peptide

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12
Q

What investigations should be done for malignant hypercalcamia?

A

Corrected calcium - calcium related to albumin so needs to be corrected for changes in albumin
FBC, U and Es, LFTs
Plasma PTH to exclude non-malignant causes
ECG to detect and changes

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13
Q

What is corrected calcium?

A

If albumin is low then bound calcium may be measured as low even though the free calcium may be normal. This means that the corrected calcium is more representative of the real calcium levels e.g. if albumin low then it corrects and increases the calcium reading

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14
Q

What is the management of hypercalcaemia of malignancy?

A

Aggressive rehydration with 0.9% IV saline

If calcium is >0.3 after rehydration the IV bisphosphonates should be given e.g. zolendronic acid 4mg

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15
Q

How Do bisphosphonates work?

A

They inhibit the osteoclast activity so there is less bone breakdown so calcium levels decrease as the equilibrium shifts towards osteoblasts

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16
Q

What are the two main ways that cancer comprimises the immune system?

A

Malnutrition

Damage to immune system from cancer or treatment

17
Q

What is the criteria for a diagnosis of neutropeanic sepsis?

A

Neutrophil count <0.5x10^9/L

Temp >38 degrees OR signs consistent with sepsis

18
Q

What are the investigations for neutropaenic sepsis?

A

Treat as with sepsis
Should immediately be given empirical antibiotics (tazobactam) if suspected
Routine bloods (FBC, LFT, U and E, CRP and albumin
ABG for lactate
Blood culture

19
Q

What management should be done for neutropaenic sepsis?

A

Remeber infection control procedures!
A patient with leukaemia feeling ‘a bit ill’ should be taken seriously
Direct treatment towards aim e.g. cure or palliation
Avoid IM injections as risk of infection
Use antibiotics e.g. tazobactam and include vancomycin if gram +ve organisms suspected
Continue until afebrile

20
Q

How should risk of complications in neutropenia be predicted?

A

Should use the MASCC score “multinational association for supportive care in cancer” to work out the risk of septic complications

21
Q

What are the dangers in leukaemic patients?

A

Tumour lysis syndrome
Hyperviscosity
Disseminated intravascular coagulation

22
Q

What are the signs of superior vena cava obstruction?

A

THere is reduced venous return from the head, neck and upper limbs so it causes a red face, engorgement of facial veins, tachypnoea, headaches, visual disturbance

23
Q

What are the causes of superior vena cava obstruction?

A

Most commonly non small cell lung cancer and lymphoma

24
Q

What is the management of SVC obstruction?

A

Prop up
Assess for hypoxia and give oxygen if nessesary
Dexamethasone 16mg should be given
Use CT to find cause of obstruction
Baloon venoplasty or stenting provides most rapid relief of symptoms
Treat with chemo or radiotherapy

25
Q

What is the management of the symptoms of brain mets?

A

Urgent CT/MRI
Dexamethasone 16mg to reduce cerebral oedema
Radiotherapy

26
Q

What is tumour lysis syndrome?

A

This is when chemo or even steroids in some cases trigger the release of chemicals from the breaking up tumour cells and causes electrlyte imbalances

27
Q

What imbalances of electrolytes does tumour lysis syndrome cause?

A

It causes hyperkalaemia, hyperphosphotaemia and low calcium

28
Q

What presenting bloods should be suspected for tumour lysis syndrome?

A

AKI in the presence of high phosphate and uric acid

29
Q

How should patients at high risk of tumour lysis syndrome be prophylactically treated?

A

Should treat with IV allopurinol and IV rasburicase immediately prior and during first days of chemo
These both reduce build up of uric acid so it is excreted more easily

30
Q

How should a patient presenting with tumour lysis be treated?

A 
A - E approach
IV fluids to rehydrate
Treat each abnormality
Allopurinol and rasburicase IV for urea
Aluminium hydroxide to bind to phosphate
Calcium gluconate slow infusion with ECG to protect the heart from hyperkalaemia and to counteract the hypocalcaemia
Insulin dextrose to reduce hyperkalaemia
31
Q

What scoring system can be used for tumour lysis syndrome and what does it involve?

A

Cairo bishop score
High urea, high phophate, high potassium
Low calcium

32
Q

What are the side effects of the treatments that treat tumour lysis syndrome?

A

Allopurinol is nephrotoxic
Calcium gluconate can cause hypercalcaemia
Insulin dextrose can cause hypoglycaemia and hypokalaemia

SpM Oncology (8 decks)

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