Oncological Emergencies Flashcards
What cancers commonly cause MSCC?
Breast, bronchus and prostate
-Myeloma and lymphoma
But can occur with any tumours
Caused by a tumour / mets in the vertebral body or paraspinal region pressing on the spinal cord
Where do most MSCCs occur in the spine?
2/3 occur in the thoracic region
Remainder in the cervical or lumbar spine
What symptoms does MSCC present with?
-BACK PAIN / NERVE ROOT PAIN, can be uni- or bilateral, may be aggravated by movement, coughing or lying flat (NB pain may be absent in some patients)
-MOTOR WEAKNESS, may be rapid or slow in onset and can be subtle, patients often describe a perceived change in strength
-SENSORY DISTURBANCE (subjective), often precede objected physical signs eg ‘feels like I’m walking on cotton wool’
-BLADDER / BOWEL DYSFUNCTION generally occurs late, urinary retention often develops insidiously
NB must screen for cauda equine syndrome (saddle anaesthesia, urinary retention, faecal / urinary incontinence, weakness, pain)
What signs might MSCC have?
-Weakness / paraparesis / paraplegia
-Changes in sensation occur below the level of compression - may be asymmetrical and may be incomplete
-Increased reflexes below the level of the lesion
-Clonus and painless bladder distension may be present
What investigations would you order for someone with suspected MSCC?
Whole spine MRI
What is the management of MSCC?
-Dexamethasone (16mg) pending investigations
-Surgery (favoured in cases of collapse of vertebral body, less likely to be used if extensive disease)
-Radiotherapy and / or chemotherapy
-Lie flat
What causes SVCO?
Extrinsic compression, thrombosis or invasion of the wall of the SVC
-Most commonly caused by extensive LYMPHADENOPATHY in the upper mediastinum (lung cancer or lymphoma patients)
-Can occur with any solid tumour (eg germ cell tumours)
What are the symptoms of SVCO?
-Headache, or a ‘feeling of fullness’ in the head
-Facial swelling
-Dyspnoea (worse lying flat)
-Cough
-Hoarse voice
What are the signs of SVCO?
-Facial / upper limb OEDEMA
-Prominent blood vessels on the neck, trunk and arms
-Cyanosis
-Positive Pemberton’s test
–Lift arms over head for 1 min - facial redness, increased JVP + stridor observed
How would you investigate SVCO?
-Urgent contrast enhanced CT
-Consider biopsy if unknown aetiology
What is the management of SVCO?
-Dexamethasone 16mg
-Urgent vascular stenting
-Followed by radio- or chemotherapy depending on primary tumour
-If this is the first presentation of cancer then biopsy is important - likely to be progressing rapidly
-If germ cell tumour is possible then tumour markers (AFP, beta-hCG, LDH) may be done
What causes hypercalcaemia in cancer patients?
-Commonly seen in BREAST cancer, NSC LUNG cancer, SCC and MYELOMA
-Also Head and neck and renal cell cancers
-Can occur in most tumours
What are the symptoms of hypercalcaemia?
Can develop insidiously and can be missed
Early symptoms:
-Lethargy
-Malaise
-Anorexia
-Polyuria
-Thirst
-N+V
-Constipation
Late:
-Confusion
-Drowsiness
-Fits
-Coma
What investigations would you order for someone with suspected hypercalcaemia?
Serum calcium corrected for serum albumin
What is the management of hypercalcaemia?
-Rehydration using normal saline
-Then IV bisphosphonates eg pamidronate / zoledronic acid
-Can try SC calcitonin or oral corticosteroids also
-Max response seen after 6-11 days (70% of patients respond)
