Oncology Emergencies Flashcards
What emergencies fall into each of the following categories?
- right now this minute
- today
- if not today, tomorrow
right now: neutropenic fever, tamponade, cord compression, CNS mets w/ sx
Today: coagulopathies, tumor lysis, leukostasis, hyperviscosity, severe thrombocytopenia, INR over 9
if not today, tomorrow: SVC syndrome, most hypercalcemia, most CNS mets w/o edema, INR 5-9
Spinal Cord Compression
- MC presentation
- other sx
- MC cancers causing this
- usually arise in which vertebrae?
- describe CA metastases to the spine
MC presentation is BACK PAIN!!! make sure to always get XRAY when seeing for 1st time.
Other sx:
- inflammation, paraesthesias, autonomic dysfunction follows motor/sensory
- radicular pain
MC cancers causing this: breast, prostate, lung, and MM. They like to go to the bone.
Mets usually arise in the thoracic vertebrae.
mets: travel here through venous plexus and invades the epidural space and thecal sac.
Spinal Cord Compression:
- best initial evaluation?
- Tx
Best initial evaluation is MRI of WHOLE SPINE! next best step is CT myelogram.
Tx:
- Decadron (dexamethasone)
- Neurosurgery
- Radiation therapy IF multiple levels
CNS metastases w/ Sx:
- signs and sx
- MC from what types of CA?
- dx
- tx
signs and sx:
-HA, seizures, altered mental status, focal deficits
MC from lung, breast, kidney, colorectal, and melanoma.
Dx:
-MRI of whole brain
Tx:
- decadron if edema
- dilantin if seizures
- surgery plus radiation therapy for isolated mets.
What is the MC type of brain tumor?
What is the MC intracranial tumor in adults?
Brain METASTATIC CA!!!!
PANCE
Vascular events- Hyperviscosity:
- sx
- MC cause
- serum viscosity level
- tx
sx: sombolence, HA, blurry vision, dizziness
MC cause: Waldenstroms
others: polycythemia vera, essential thrombocytosis, MM
Serum viscosity is usually greater than 5cP
Tx:
- hydrate patient
- apheresis for IgM plus chemotherapy
- phlebotomy for polycythemia vera
- Hydroxyurea (chemotherapy) and aspirin for essential thrombocytosis
Vascular Events- Leukostasis:
- MC associated with what type of CA?
- Sx
- What is this?
- tx
MC associated with AML w/ WBC greater than 100,000
sx: altered mental status, coma, hypoxia, renal insufficiency
WHat: blood is thick with tones of white cells that are behaving inappropriately.
Tx:
- hydration
- quinton access(central catheter) (renal) and chemotherapy (onc)
- LP for cytology to rule in/out CNS leukemia
- steroids
(Hydrate to dilute the blood since its very viscous. ; need rapid cytoreduction via chemotherapy. Will need prophylaxis for tumor lysis syndrome.)
Cardiac Tamponade:
- most commonly associated with which CA?
- sx
- EKG findings
- dx
- tx
MC associated with Lung and breast CA
Sx:
- pulses paradoxus
- big heart on CXR
- left/right sided failure
- Becks triad*
- -hypotension
- -distended neck veins
- -muffled heart sounds (rub-velchro)
EKG findings:
-electrical alternans, low voltage, ST elevation
Dx: echo and cytology from pericardiocentesis
Tx:
- catheter drainage of fluid
- chemotherapy
- subxiphoid pericardial window or balloon pericardiotomy
Superior venacava syndrome:
-MC associated with what CA?
-sx
-
MC associated with lung (bronchogenic*)(Pancoast) CA, lymphoma, breast CA, mediastinal tumors
Sx: facial edema, symmetric or asymmetric upper extremity edema
- SOB
- edema is worse in the AM and gets better as the day progresses.
SVC Syndrome:
- Dx
- Tx
Dx:
- CXR
- pulse ox (not hypoxic)
- CT
Tx:
- chemo for CA
- radiation
- heparin or corticosteroids
Tumor Lysis syndrome:
- when does this occur?
- MC with which CA??
- sx
- Lab findings
- Tx
When: occurs in tumors with high body burden and high chemosensitivity, occurs d/t therapy
Associated with : high grade lymphomas(Burketts) or leukemias, small cell, germ cell less common
Sx: few clinical sx other than being ill with obvious lab abnormalities due to RENAL FAILURE.
- n/v/diarrhea
- anorexia
- blood in urine
- tetany
- cramps
Lab:
- hyperkalemia
- hyperphosphatemia
- hyperuricemia
- hypocalcemia
Tx:
- correct conditions that make effects worse: dehydration, renal obstruction, IV contrast
- D5 with 1/2 NS and insulin(drives K+ into cells)
- lasix, mannitol
- allopurinol (keeps uric acid production down)
- Kayexalate (lowers K)
- may use dialysis
Hypercalcemia:
- MC associated with what CA?
- Sx
- Tx
MC associated with breast, lung, MM, squamous CA (make PTH-rP)
Sx: fatigue, n/v, constipation, anorexia, apathy, decreased consciousness
Tx:
- replete volume
- furosemide
- IV pamidronate ( slows down the breakdown of bone)
- IV zoledronic
SIADH:
- MC CA associated
- sx at serum Na levels
- -less than 120
- -less than 110
- tx
MC associated with small cell
Serum Na:
- less than 120: anorexia, irritability, n/v, constipation, muscle weakness, myalgia
- less than 110: seizure, death, coma, abnormal relfexes, papilledema
tx:
- treat the underlying tumor
- limit fluid intake to 500-1000ml/day
- lasix
- parenteral Na replacement with severe neurological sx
Neutropenic Fever:
- sx
- duration of neutropenia determines organism,
- -short term
- -long term
- cause
- tx
Sx: initially subtle, then rapid development of hypotension, dyspnea, sepsis
Short term: gram -
Long term: fungal, viral, opportunistic
Cause: chemotherapy, usually 10-15 days after chemo is given
Tx:
- treat the source of the problem or you treat emperically.
- Cefipime, moxifloxacin, Pip/gent, aztreonam
Severe Thrombocytopenia
- cause
- sx
- tx
Cause: idiopathic. immune
Sx:
- asymptomatic
- mucosal bleeding, epistaxis, gingival bleeding, bullous hemorrhage
- cutaneous bleeding, petechiae, ecchymoses
- menorrhagia
- CNS bleeding
Tx:
- be sure its not TTP, DIC, HIT, Hellp
- check smear, LDH, PT/PTT, fibrinogen, CBC, any heparin use?
- if actively bleeding you transfuse (hgb less than 7)
- Prednisone if pt well
- IVIG if ill
