Oncology Emergencies Flashcards
Red flags for cancer
Age > 50 (single most important risk factor) or < 17
Previous history of cancer
Night pain or pain at rest
Unexplained weight loss
Family history (1st generation)
Environment and lifestyle
Failure to improve as expected
Red flags for cancer recurrence
- Positive lymph nodes
- Tumor size > 2cm
- High grade histopathologic
designation - Can reoccur at same location, in local lymph nodes, in distant
lymph nodes, or in metastatic sites
Most Common tumors that metastasize to bone
Breast
Lung
Thyroid
Kidney
Prostate
Multiple Myeloma
Melanoma
What is myelosuppresion
- Common side effect associated with nearly all chemotherapy and immunosuppressive agents
- Inhibition of bone marrow cells resulting in fewer red cells, white cells, and/or platelets
What does myelosuppresion often result in?
anemia, infection, and bleeding as a result of a reduced number of cells
Anemia
- A pathologic state resulting in a reduction of the oxygen carrying capacity of the blood
- Not a disease, rather a symptom of many other diseases
- Frequent complication of cancer treatment especially chemotherapy and radiation
Hemoglobin reference values
Norms
Male: 14-17.4 g/dL
Female: 12-16 g/dL
Anemia: <11 g/dL
Severe anemia: <8 g/dL
Anemia Rehab Implications
- Aerobic capacity is increased with higher levels of hemoglobin
- Worsening anemia reduces exercise tolerance and endurance
- Precautions should be used in prescribing progressive resistance and moderate to
high intensity aerobic exercise in individuals with severe anemia
Rehab implications for hemoglobin less than 11 g/dL
establish baseline vital signs; may be tachycardic or present
with orthostatic hypertension; symptom-based approach to intervention, monitoring
self-perceived exertion
Rehab implication for severe anemia
close monitoring of symptoms and vital signs with interventions; transfusion may or may not be indicated based on individual presentation; short periods of intervention, symptom-limited; education for energy conservation
What is thrombocytopenia
decrease in platelet count below 150,000 of blood
causes of thrombocytopenia
Inadequate platelet production from bone marrow
Increased platelet destruction outside the bone marrow
Splenic sequestration
< 150,000 thrombocytopenia
Symptoms based approach; monitor tolerance to activity
150,000 - 50,000 platelet count
Progressive exercise tolerated; aerobic and resistive with monitoring for symptoms associated with bleeding; swimming; low bench stepping; bicycling (flat only, no grade); manual muscle testing could be performed without restriction
20,000 to 50,000 platelet count
Active range of motion exercises; moderate activity; light weights;
stationary bicycle; walking as tolerated; no prolonged stretching; aquatic therapy based on immune status
10,000 to 20,000 platelet count
Light exercise; no resistive training or activity; avoid Valsalva; AROM exercise only; walking as tolerated, guard carefully; assess fall risk, implement safety plan for falls prevention; understand transfusion status
< 10,000 platelet count
Restricted to ADLs; walking with MD approval; dependent upon individual risk factors and characteristics
Neutrophils
Target bacterial and fungus
General Phagocytosis
45-75%
Lymphocytes
- Produce antibodies
- B cells, T cells, natural killer cells
- 20-40%
Eosinophins
- target large parasites and modulate allergic inflammatory responses
1-4%
Monocytes
Largest WBC
Phagocytosis of large parasites
2-8%
Basophils
Release heparin and histamine during an allergic reaction
0.5-1%
Neutropenia
- A condition associated with a reduction in circulating neutrophils or absolute neutrophil count (ANC)
- Typically, the result of toxicity to neutrophil precursors in the bone marrow
What is neutropenia associated with?
Carcinoma
Malignant hematopoietic disorders that can lead to pancytopenia (reduction in ALL
blood cells)
mild neutropenia
1,000 - 1,500
moderate neutropenia
500 - 1,000
severe neutropenia
< 500
Profound neutropenia
< 100
ANC Nadir
- Chemotherapy induced neutropenia
Point when the ANC is at its lowest after chemotherapy treatment
Typically, 3-10 days after the administration of the chemotherapeutic agent
What does ANC Nadir cause?
- Increased susceptibility to infection
Typical signs and symptoms of infection are often absent in neutropenia
Fever remains the earliest sign of occult infection
Primary sites of infection: GI tract, sinuses, lungs, and skin
What is one of the most common complications related to cancer treatment?
- Neutropenic Fever
80% of people for hematologic malignancy
10-50% with solid tumor
What is neutropenic fever defined as?
- A single oral or axillary temperature of > 101 degrees F
OR - A temperature > 100.4 degrees F sustained over 60 minutes in a patient with ANC <500
Is PT contraindicated with neutropenic fever?
NOPE
Rehab implications for neutropenic fever
- Proceed with treatment based on facility guidelines
Special consideration should be given if the patient is experiencing Fatigue, Malaise, Dizziness, Lethargy - PT should monitor at-risk individuals for early signs and symptoms of infection –> expedite medical management * Practice good hand hygiene with antimicrobial products during every patient encounter
What is tumor lysis syndrome
- Collection of metabolic disorders that result from the death of neoplastic cells which
then release their intracellular contents into the circulation = metabolic crisis that can lead to death - Most commonly seen in patients with very aggressive hematologic cancers
** can be fatal if not addressed
When does tumor lysis syndrome occur?
- Occurs after effective therapy is initiated or spontaneously (cytotoxic chemotherapy, glucocorticoid therapy, endocrine therapy,
radiotherapy)
Most commonly as a result of chemotherapy - Typically presents within 7 days of cancer treatment
Tumor Lysis syndrome clinical presentation
Fatigue, signs of dehydration, seizures, cardiac arrythmias, nausea and
vomiting
Key lab findings in tumor lysis syndrome
- hyperkalemia (most immediate threat)
- hyperuricemia
- hyperphosphatemia (leads to hypocalcemia)
What can kyperuricemia lead to
acute kidney injury
hyperphosphatemia
Phosphate binds with calcium to form calcium phosphate crystals leading to
hypocalcemia
Leads to anorexia, vomiting, seizures, or cardiac arrest
tumor lysis syndrome rehab implications
- Patient’s may complain of muscle weakness, spasm, and/or cramping
- ↑ uric acid –> arthralgias and renal colic
Paresthesia and paralysis (hyperkalemia)
Seizures, tetany, lethargy (hyperphosphatemia)
Lethargy, malaise, sleepiness, seizures (hyperuricemia)
Paresthesia, tetany, confusion, delirium, hallucinations (hypocalcemia)
*** type of pain you get with kidney stones
