Oncology Emergencies Flashcards
What is the definition of neutropenic sepsis?
Temp >38 (or sepsis signs)
Neutrophil count <0.5x10^9
How is neutropenic sepsis managed?
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
What is the presentation of hypercalcemia?
Bones, groans, stones and psychiatric overtones:
- bone pain
- kidney stones
- dehydration
- neuro: weakness, confusion, seizures, coma
What is the pathophysiology of hypercalcemia?
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
What cancers is hypercalcemia commonly associated with?
Note: don’t have to have bone mets
Myeloma Lymphoma Breast Lung Prostate
How is hypercalcemia investigated?
ABCDE
Bloods - U&ES, corrected Ca, phosphate, Mg, LFTs, plasma PT, ECG
Why do you have to do a corrected calcium when investigating hypercalcemia?
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
How is hypercalcemia managed?
ABCDE
IV fluids and monitor U&Es
IV bisphosphonates
Admit and refer to acute oncology team
What is the pathophysiology of tumour lysis syndrome?
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
Which cancers are more susceptible to tumour lysis syndrome?
Cancers targeted by chemotherpay
Eg, lymphoma, leukaemia, myeloma
Also bulky tumours e.g, hepatoblastoma and neuroblastoma
What are the symptoms of tumour lysis syndrome?
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+)
What are the blood results in tumour lysis syndrome?
Hyperuricaemia (high uric acid)
Hyperkalaemia (high potassium)
Hyperphospatemia (high phosphate)
Hypocalcaemia (low calcium)
How is tumour lysis syndrome managed?
A-E
Investigations - U&Es, bone profile, ECG
Fluids - needs to correct hyperkalaemia
Admit and inform acute oncology
How does MSCC present?
Back pain
What are the red flags for back pain in regards to MSCC?
Radicular pain Exacerbated by coughing/straining Progressively worsening Nocturnal back pain affecting sleep Lower limb neuroglocial issues Bowel/bladder incontinance History of cancer
How is MSCC managed?
MRI whole spine Dexamethasone 8mg BD (PPI and monitor glucose) Opioid analgesia for pain Admit and refer to acute oncology Potential surgery or radiotherapy
What are the red flags for Headache regarding brain mets?
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
How are brain mets managed?
A-E assessment
Dexamethasone 8mg BM (PPI cover and monitor BM)
Surgery
Or radiotherapy for large tumours
How does superior vena cava obstruction present?
Dyspnoea Swelling of face/neck/arms Dilated veins Headache (worse in morning) Visual disturbances
How would you investigate superior vena cava obstruction?
CXR - right paratracheal mass
CT thorax - for diagnosis and staging
How is superior vena cava obstruction managed?
A-E assessment Sit patient up 100% o2 if appropriate Dexamethasone 8mg BD Stent
