Oncology

Question 1

Immediate issues of leukaemia

Answer 1

• Tumor lysis syndrome
• hyperleukocytosis
• DIC
• mediastinal masses (CXR)
• fever/neutropenia

Question 2

blood work for leukaemia

Answer 2

• lytes, BUN, Cr
• Cal, phos
• uric acid, LDH
• PT, PTT, INR, dimer, fibrinogen
• cultures (if febrile)

Question 3

key airway management point in mediastinal masses

Answer 3

sit them up

Question 4

management of tumour lysis

Answer 4

• IV rehydration (1.5 to 2x maintenance)
• ABX (if febrile)
• allopurinol or urate oxidase (drops uric acid)
• bicarb if allopurinol unavailable

Question 5

Superior vena cava syndrome

Answer 5

• obstruction of VC +/- trachea by mediastinal mass
• s/s cough orthopnea, dyspnea, wheeze, syncope

*** consider this in a new onset asthma at an odd age. steroids will lessen the responsiveness of tumours to chemo

Question 6

Spinal cord compression

Answer 6

compression > 24hrs causing irreversible neuro damage (every hour increases long term damage)

• causes CNS tumours and extradural cord compression
• s/s urinary retention, back pain
• management: dexmethasone, spinal cord decompression, chemo

Question 7

ICP and brain herniation

Answer 7

• space occupying tumour +/- hemorrhage, +/- CSF outflow obstruction
• most tumours are infratentorial
• S/S headaches, irritability, hemiparesis, vomiting after waking, increased head circumference, DLOC
• ***LP contraindicated
  tx: dex, mannitol if coning

Question 8

hyperleucocytosis

Answer 8

> 100 000 WBC definition

• 200 000 aml, 300 000 all more likely
• increase blood viscosity causing obstructed circulation, damage to vessel walls = bleed (common in lung and brain)
• S/S seizure, Ha, dyspnea, hypoxia, RVF, AKI, priapism
• management: ++ hydration to reduce sludgeing, keep plt > 20, Hb should not be raised >10g/dl unless in failure, avoid diuretics

Question 9

fever and neutropenia

Answer 9

Definition: fever (>38.5) and ANC < 1
- chemo induces leukopenia
-neutropenia increases risk of bact/fung infection
TX: ABX, cultures!, hickman sites are common site of infection, fluid
**Sepsis develops very quickly even in a absence of fever

Question 10

tumour lysis syndrome

Answer 10

metabolic consequence of spontaneous or treatment related tumour necrosis (common in first 24-48hrs of chemo in Burkitts, T-cell lymphoma and ALL with high WBC)
- high K
- high phosphate
- high nucleic acid
- low Ca and high Ua causing crystals in kidneys and infrarenal AKI
** can cause MODS
S/S: abdo pn, flank pn, low U/O, (low ca anorxia), high K (common cause of complication)
**monitor Phosphate trend to predict hyperkalemia
** management ++ fluid, alkalize, allopurinol, rate oxidase, monitor K

Question 11

DIC

Answer 11

uncontrolled activation of coagulation and fibrinolysis

• consumption of clotting factors and platelets
• common in AML
• tx: FFP/cyro/plt, PRBCstreat underlying cause

Question 12

Typhlitis

Answer 12

chronic low neutrophils causing bactertia to occupy bowel wall. high risk of perforation
S/S abdo pn, free air in abdo
management: ABX, fluids, NPO, TPN, Pn
***high dose steroids will suppress peritoneal signs of peritonitis

Question 13

SIADH

Answer 13

• secondary to malignancy or chemo
• S/S seizure refractory to standard tx, HTS for hyponatremia
• **easy fix for seizure for hyponatrmia is HTS