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:Â
- 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:Â
- 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:Â
- 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
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
Download the PDF version: here
References:
- Dr. Sabatin’s lecture
- http://www.cancernetwork.com/articles/oncologic-emergencies
- https://www.slideshare.net/CurrentOncology/oncologic-emergencies-8294057
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