spinal cord compression and superior vena cava obs Flashcards
what malignancies are associated with spinal cord compression
Balls, Breasts and Blood
prostate cancer
breast cancer
multiple myeloma
when is spinal cord compression the initial presentation in cancer ?
in lung cancer
cancer of unknown primary origin
myeloma
non Hodgkins lymphoma
where does spinal cord compression arise from
arises from the thoracic spine mostly
lumbo-sacral
cervical spine
gold standard for the diagnosis of SCC
MRI
what is the most important prognostic factor associated with SCC ?
patients pre treatment neurological status
rapidity of symptom onset is also associated with treatment outcome
what is the management for SCC ?
glucocorticoids - first line treatment
EBRT and SBRT
surgery is also used for decompression
what is first line treatment for a patient presenting with paraparesis or paraplegia
high dose glucocorticoids -
96mg IV dexamethasone
then 24 mg four times a day for 3 days
tapered over 10 days
what is thee first line treatment of patient with SCC but presented with no paraplegia or paraesthesia , only minimal neurological dysfunction
IV bolus of 10 mg dexamethasone
followed by 16mg daily
what are the toxicities associated with long term use of glucocorticoids ?
gastritis
peptic ulcer
hypokalemia
fluid retention
subcapsular cataract
after completion of first line - what is the recommended treatment for SCC
radiotherapy with or without surgery
long courses
when is decompressive surgery followed by RT recommended
patients with radio resistant primary tumors
displacement of the spinal cord on MRI
a single area of cord compression
loss of motor function in less than 48 hours
estimated survival longer than 3 months
role of chemo in SCC ?
limited unless associated with chemo sensitive tumors
when is superior vena cava obstruction an oncological emergency ?
when it is accompanied with tracheal compression and airway compromise
severity of symptoms of SVCO depends on
degree of obstruction and speed of onset of symptoms
what are the causes of SVCO
lung cancer
lymphoma
metastatic disease to mediastinum
primary mediastinal tumors
non-malignant causes : goitre, congestive heart failure
