Oncological Emergencies

Spinal Cord Compression:

  • 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)

 


Superior Vena Cava Syndrome: 

  • 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)

 


Tumor Lysis Syndrome: 

  • 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

 


Hypercalcemia: 

  • 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

 


Febrile Neutropenia:

  • 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

 

 


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References:

 

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