Week 11 - Oncological Emergencies Flashcards
what are oncological emergencies
- life-threatning events that can occur as a result of cancer or cancer treatment
oncological emergencies can be.. (3)
- obstructive
- metabolic
- infiltrative
what are obstructive emergencies caused by
- primarily by tumour obstruction of an organ or blood vessel
what are examples of obstructive emergencies (4)
- SVC syndrome
- spinal cord compression
- intestinal obstruction
- third space syndrome
what is SVC syndrome
- results from obstruction of the SVC by a tumour
what are signs of SVC syndrome (6)
- facial edema
- periorbital edema
- distension of neck & chest
- HA
- seizures
- mediastinal mass on CXR
what is treatment for SVC (3)
- radiation therapy to site of obstruction
- treatment of primary tumour
- chemo
what is spinal cord compression (SCC)
- neuro emergency caused by the presence of a malignant tumour in the epidural space of the spinal cord
what are signs of SCC (5)
- intense, localized, persistent back pain
- vertebral tenderness
- motor weakness & dysfunction
- sensory parasthesia and loss
- autonomic dysfunction (ex. change in bowel & bladder function)
what is treatment of SCC (3)
- radiation if slowly progressive neuro deficits
- surgery is rapidly progressive neuro deficits, or radiologically resistant
- chemo
what is third space syndrome
- involves a shifting of fluid from the vascular space to the interstitial space d/t extensive surgical procedures, biological therapy, or septic shock
what are signs of third space syndrome (5)
- hypovolemia S&S
- hypotension
- low urine output
- tachycardia
- low central venous pressure
what is treatment for third space syndrome (3)
- fluids
- electrolytes
- plasma protein replacement
what occurs during recovery of 3rd space syndrome (4)
- hypervolemia
- HTN
- weight gain
- SOB
what is treatment for hypervolemia associated w recovery of 3rd space syndrome (2)
- reduction in fluid admin
- fluid balance monitoring
what is intestinal obstruction
- partial or complete obstruction of GI tract by a tumour
what is the treatment for intestinal obstruction (3)
- radiation
- chemo
- surgery
what are metabolic emergencies
- oncologic emergencies caused by the production of ectopic hormones directly from the tumour or are secondary to cancer treatment
what are examples of metabolic emergencies (5)
- SIADH
- hypercalcemia
- tumour lysis syndrome
- septic shock
- disseminated intravascular coagulation
what is SIADH
- abnormal or sustained production of ADH
- cancer cells manufacture, store, and release ADH
what are signs of ADH (7)
- weight gain
- weakness
- anorexia
- NV
- personality changes
- seziures
- coma
what is treatment for SIADH r/t cancer (2)
- fluid restriction
- hypertonic saline
when might hypercalcemia occur r/t cancer
- in the presence of cancer that involves the bone = release of CA into bloodstream
what are signs of hypercalcemia (7)
- apathy
- depression
- fatigue
- muscle weakness
- ECG changes
- polyuria and nocturia
- ANV
what is treatment of hypercalcemia (3)
- hydration
- diuretics
- biphosphate infusion (inhibits action of osteoclasts)
what is an example of a bisphosphate
- pamidronate
what is tumour lysis syndrome
-frequently triggered by chemo
- results from rapid destruction of tumour cells
= electrolyte imbalances and renal failure
what are the 4 hallmark signs of tumour lysis syndrome
- hyperuricemia
- hyperphosphatemia
- hyperkalemia
- hypocalcemia
what is the treatment of TLS (2)
- increase urine production thru hydration therapy
- decrease uric acid production thru allopurinol
what are infiltrative emergencies
- occur when malignant tumours infiltrate major organs secondary to cancer therapy
what are 2 examples of infiltrative emergencies
- carotid artery rupture
- cardiac tamponade
what does cardiac tamponade occur from (3)
- fluid accumulation in the pericardial sac
- constriction of the pericardium by tumour
- secondary to radiation therapy for the chest
what is cardiac tamponade
- accumulation of fluid in the pericardial sac = heart pumps ineffeciently
what are signs of cardiac tamponade (12)
- heavy feeling over chest
- SOB
- tachycardia
- cough
- dysphagia
- hiccups
- hoarseness
- NV
- excessive perspiration
- decreased LOC
- distant or muted heart sounds
- anxiety
emergency management of cardiac tamponade is aimed at? (3)
- reduction of fluid around the heart
- surgical establishment of a pericardial window
- indwelling pericardial cath
what does supportive therapy for cardiac tamponade include (3)
- O2
- IV hydration
- vasopressor therapy
what does carotid artery rupture result from
- occurs w head and neck cancers
- invasion of the artery wall from tumour or erosion from treatment
what can carotid artery rupture manifest as (2)
- ranges from minor oozing
- to spurting of blood
in the presence of bursting d/t carotid artery rupture . what should be done
- apply pressure to the site w a finger
what is included in treatment of carotid artery rupture (4)
- manual pressure
- IV fluids
- blood products
- surgery
what does surgery of carotid artery rupture involve (2)
- ligation of the carotid artery above and below the rupture site
- reduction of local tumour
