Oncology Flashcards
What is the definition of febrile Neutropenia?
Febrile neutropenia (FN) is defined as an oral temperature >38.5°C or two consecutive readings of >38.0°C for 2 h and an absolute neutrophil count <0.5 × 109/l, or expected to fall below 0.5 × 109/l
In what time frame does febrile neutropenia usually occur post chemo therapy?
5-7 days post chemo
What is the metabolic disturbances associated with tumor lysis syndrome?
Hyperkalemia
Hyperuricemia
Hyperphosphatemia
Hypocalcemia
Which cancers are more likely to get tumor lysis syndrome?
AML/ALL
High grade non-hodgkins (Burkitts)
also seen in small cell and germ cell tumors
What time frame do you see TLS (tumor lysis syndrome)
1-5 days post from initiation of chemo or radiation in rapidly growing and treatment responsive tumors
What are the main treatment(s) for TLS?
- IVF hydration
- Correct HyperK
- Allopurinol (used to prevent) (Reduces the conversion of nucleic acids to uric acid)
Others
- May consider alkalinizing urine but potential to harm with CaPhos precipitation in renal tubules.
- Lasix in select circumstances
- ** Hemodialysis.
What is hyperviscosity syndrome (HVS)?
Its a Clinical syndrome from increased blood viscosity Caused by elevations in protein, all types of blood cells. This results in sludging –> decreased microcirulation perfusion –> vascular stasis.
What conditions are associated with hyperviscosity syndrome (HVS)?
Plasma cell dyscarias (paraproteinemias) o Waldenstrom’s macroglobinemia (90%) o Multiple myeloma o Cryoglobinemia o Benign hyperglobinemia
Leukemias (When WBC >100)
o CML
o CLL
o ALL blast crisis
Leukemoid reaction
Polycythemia vera
Sickle cell during crisis
What is the triad for HVS (hypeviscosity syndrome)
- Bleeding → mucosal, GI
- Visual disturbances → abnormalities on fundoscopy
- Neurologic manifestations → H/A, Sz, hearing disturbances,
- Others:
a. Cardiac → AMI, CHF
b. Pulmonary → Acute respiratory failure
c. Renal → ARF
What is a ‘classic finding on blood smear’ in someone with HVS?
Rouleaux clumps/cells
What is the Management of HVS?
- Plasmapheresis
- Leukapheresis
- Exchange transfusion
- Immediate temporizing measure → phlebotomy of 2 units → replace with NS
Acute oliguria after radiation or chemotherapy suggests what diagnosis?
Hyperuricemia
• Cell destruction → hyperuricemia → crystal precipitation in renal tubules
• ARF → exacerbates uricemia
List 5 benign diseases associated with hyperuricemia that can co-exist with neoplasia:
- Gout
- Hyperparathyroidism
- Psoriasis
- Sarcoid
- Renal failure – any cause
- Drugs: thiazide and loop diuretics
What is the treatment of Hyperuricemia?
• Stop cytolytic therapy
• Fluids → goal is >2L urine / day
• Allopurinol 300-600mg/day
o Rasuricase (recombinant urate oxidase) is newer therapy that can be used if standard approaches not working
- Alkalinization of the urine (pH > 7)
- Diuretics (Acetazolamide/Mannitol)
- Urate oxidase – breaks down urate to allantoin (more soluble)
- If patients have gout → colchicine 0.6mg PO BID, to avoid gout flare with allopurinol initiation
What are complications of chronically elevated uric acid? (3)
- Renal colic → if cancer patient presents to ED with stone, MUST look at urate levels!!
- Obstructive uropathy
- CRF
(Most commonly seen in polycythemia vera, CLL)
