Red flags Flashcards
Common red flags- cancer
Previous history of cancer, unintentional weight loss (5% weight over 6/12)m pt feels generally unwell, smoking, obesity, ethnicity, gender, age
cancer- malignant
metastasize through blood, lymph or direct extension
cells display uncontrollable rapid and often aggresive growth, cells invade and destroy structures adjacent to the tumour, cannot be removed with surgery alone, will need to be combined with radiotherapy or chemo
cancer- benign
do not metastasize, do not grow in unlimited, out of control, aggressive manner, do not invade surrounding tissues, can be removed with surgery alone
spinal tumors
60% extradural (outside CNS) usually in the vertebral body, presenting features of spinal tumours: PMH of cancer, smoking history, localised pain, night pain, weight loss, mass>?
Metastatic spinal cord compression- RED FLAGS
Reffered back pain, Escalating pain that responds poorly to Rx, Different location of sx to previous, Funny feeling, heavy legs, Lying flat increases back pain, Agonising back pain causing despair, Gait disturbances, Sleep disturbed
Local pathway for MSCC with a hx of cancer
Oncology emergency- should be discussed with MSCC coordinators available through UHL switchboard
Local pathway for MSCC without a hx of cancer
Should have full bloood screen by GP and referred through 2 week pathway to acute spine clinic.
New onset of hard neurology red flags that are suspected of being an emergency and no known Hx of Ca
can be discussed with on-call spine consultant
Signs of spinal malignancy- history of cancer and constant pain
History of cancer- 50% metastasise in first 5 years- ask where was the cancer and how aggressive was it?
Severe, constant or progressive pain- can increase with lying flat- check for band-like pain (MSCC)
Signs of spinal malignancy- night pain and systemtically unwell
Night pain- pain unremitting
Systemically well- stages of fatigue, nausea, constipation, stomach pain and fever
Signs of spinal malignancy- thoracic pain, neurological S+S, Unexplained weight loss
Thoracic- most common site for metastatic bone cancer, might have a mechanical pattern to start with, might be tender to touch
Neurological S+S- loss of nerve function (Espicially BL or QL) or UMN or CES
Unexplained weight loss- 5-10% over 3-6 months
Signs of spinal malignancy- unfamiliar back pain, altered sensation from trunk down, spinal tenderness
unfamiliar back pain- not like normal back pain and progressively worse
Altered sensation from trunk down- non-dermatomal and strange sensation in legs- difficult to describe, decreased mobility
Spinal tenderness- tenderness on palpation, percussion or vibration
what is it Cauda equina syndrome?
A person presenting with acute back pain and/or leg pain with suggestions of bladder or bowel function and/or saddle sensory disturbance should be suspected of having CES
When does CES occur
As a result of compression of 2 or more of the 20 nerve roots that originate from the conus meduallris
Risk factor CES
Large central disc herniation at the L4-5 or L5-S1- higher risk in <50 year olds and obese people
Lumber spinal stenosis- can result in slow onset of CES, typically leg aching or cramping or tingling and heaviness provoked by walking and eased by sitting
Lumber surgery- can cause extradural spinal haematoma
