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Year 4 > Oncology Emergencies > Flashcards

Oncology Emergencies Flashcards

1
Q

What is the definition of neutropenic sepsis?

A

Temp >38 (or sepsis signs)

Neutrophil count <0.5x10^9

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2
Q

How is neutropenic sepsis managed?

A

A-E assessment
Sepsis 6
Notify acute oncology team
Admit to single room
Bloods - FBC, U&E, LFTs, ABG, lactate, blood cultures
Bedside tests - urine dip, swabs
Investigations ? On source - CXR, ECG, CT head, LP

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3
Q

What is the presentation of hypercalcemia?

A

Bones, groans, stones and psychiatric overtones:

  • bone pain
  • kidney stones
  • dehydration
  • neuro: weakness, confusion, seizures, coma
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4
Q

What is the pathophysiology of hypercalcemia?

A

Osteolytic effects of tumour - tumour breaking down bone
OR
Paraneoplastic syndrome - tumour producing PTH which releases calcium from bone e.g, SCC can do this

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5
Q

What cancers is hypercalcemia commonly associated with?

A

Note: don’t have to have bone mets

Myeloma 
Lymphoma 
Breast 
Lung 
Prostate
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6
Q

How is hypercalcemia investigated?

A

ABCDE

Bloods - U&ES, corrected Ca, phosphate, Mg, LFTs, plasma PT, ECG

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7
Q

Why do you have to do a corrected calcium when investigating hypercalcemia?

A

Calcium binds to albumin
So if albumin is low then calcium can look normal but there will be a free level high
Corrected calcium corrects to albumin levels vs free level

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8
Q

How is hypercalcemia managed?

A

ABCDE
IV fluids and monitor U&Es
IV bisphosphonates
Admit and refer to acute oncology team

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9
Q

What is the pathophysiology of tumour lysis syndrome?

A

Extracellular release of intracellular components following treatment of cancer

(E.g breakdown of cancer cells and release of components)

Usually occurs 2-3 days after chemotherapy treatment

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10
Q

Which cancers are more susceptible to tumour lysis syndrome?

A

Cancers targeted by chemotherpay
Eg, lymphoma, leukaemia, myeloma

Also bulky tumours e.g, hepatoblastoma and neuroblastoma

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11
Q

What are the symptoms of tumour lysis syndrome?

A

GI - Nausea and vomitting
Neuro - Seizures and confusion
MSK - Cramps (due to high uric acid)
Renal - flank pain, haematuria, oedema (build up of uric acid in kidneys can cause renal stones to form)
Cardiac - heart failure, arrhythmias, syncope (due to high K+)

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12
Q

What are the blood results in tumour lysis syndrome?

A

Hyperuricaemia (high uric acid)
Hyperkalaemia (high potassium)
Hyperphospatemia (high phosphate)
Hypocalcaemia (low calcium)

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13
Q

How is tumour lysis syndrome managed?

A

A-E
Investigations - U&Es, bone profile, ECG
Fluids - needs to correct hyperkalaemia
Admit and inform acute oncology

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14
Q

How does MSCC present?

A

Back pain

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15
Q

What are the red flags for back pain in regards to MSCC?

A 
Radicular pain 
Exacerbated by coughing/straining 
Progressively worsening 
Nocturnal back pain affecting sleep
Lower limb neuroglocial issues 
Bowel/bladder incontinance 
History of cancer
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16
Q

How is MSCC managed?

A 
MRI whole spine 
Dexamethasone 8mg BD (PPI and monitor glucose)
Opioid analgesia for pain 
Admit and refer to acute oncology 
Potential surgery or radiotherapy
17
Q

What are the red flags for Headache regarding brain mets?

A 
Worsening headache 
Worse in morning and when lying flag 
Not settling with analgesia 
Worse on coughing/straining 
Assocaited nausea and vomiting 
Focal neurological symptoms 
History of cancer
18
Q

How are brain mets managed?

A

A-E assessment
Dexamethasone 8mg BM (PPI cover and monitor BM)
Surgery
Or radiotherapy for large tumours

19
Q

How does superior vena cava obstruction present?

A 
Dyspnoea 
Swelling of face/neck/arms 
Dilated veins 
Headache (worse in morning)
Visual disturbances
20
Q

How would you investigate superior vena cava obstruction?

A

CXR - right paratracheal mass

CT thorax - for diagnosis and staging

21
Q

How is superior vena cava obstruction managed?

A 
A-E assessment 
Sit patient up 
100% o2 if appropriate 
Dexamethasone 8mg BD 
Stent

Year 4 (16 decks)

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