Oncological Emergencies

MC malignancies: prostate, breast, lung, RCC, NHL, myeloma
Most affected part? Thoracic spine (65%)
Clinical presentation: back pain (esp when lying down), tenderness over spine, radicular pain (band-like), weakness (quadriplegia if cervical, paraplegia if thoracic), bladder and bowel dysfunction (cauda equina), sensory loss
Diagnosis: MRI
Most imp factor determining prognosis? Level of neurologic function at the beginning of therapy
Immediate tx: Dexamethasone (loading dose of 10 mg followed by 16 mg four times a day) + antacids
Definitive tx: radiotherapy\surgery, chemo in certain malignancies (leukemia, lymphoma, neuroblastoma, testicular, SCLC)

Gradual compression of SVC leading to edema and retrograde flow
MC malignancies: lung (SCLS, bc of its central location), lymphoma (NHL), breast. Can also be cause by thrombosis, esp if central line
Clinical presentation: facial\UL edema, dyspnea, cough, hoarseness, chest pain, dysphagia, headache
Diagnosis: CXR (widened mediastinum), CT\MRI. Obtain tissue
Immediate tx: steroids, head elevation, oxygen, limited IV fluids, and limited use of diuretics
Definitive tx: depends on cause. Radio\chemo. Endovascular stents (as palliative to ↓ edema)

MC malignancies: rapid proliferation index -> Burkitt’s lymphoma, acute leukemia. Other solid tumors: breast, SCLC, neuroblastoma
Usually follow induction chemo, or tx w\ radio, steroids, hormonal agents, or spontaneous!
↑ uric acid + potassium + phosphate, ↓ calcium -> precipitate in kidneys + impairs funx, met acidosis
Treatment:
- For hyperkalemia: cardiac monitor, Ca gluconate, kayexalate, insulin\glucose, dialysis
- For hyperuricemia: hydration, Allopurinol, Rasburicase, urine alkalization (sodium bicarbonate)
- For hyperphosphatemia + hypocalcemia: phosphate binders

MC malignancies: breast, lung, myeloma, kidney, head and neck ca
Pathogenesis: “humoral hypercalcemia of malignancy” -> mimics primary hyperPTH
Clinical presentation: non-specific vague symptoms
Treatment: AGGRESSIVE HYDRATION, then furosemide. Calcitonin or bisphosphonate

Oncologic emergencies 1

Definitions:
- Fever: single oral temp ≥ 38.3 OR temp ≥ 38.0 for at least an hour
- Neutropenia: < 500\mm³
Treatment:
- Low-risk: oral Ciprofloxacin + Augmentin
- But, most pts need to be admitted and given empiric IV Abx
- Monotherapy: Carbapenem, Cefepime
- Double therapy: Aminoglycoside + B-lactam
- Add Vancomycin if; skin\cath site infec, hypotension, MRSA
- If persistent\prolonged; add empiric antifungal drug

Download the PDF version: here

References: