Oncological Emergencies Flashcards
Name some common cancer-related oncological emergencies
Hypercalcaemia Spinal cord compression Superior vena cava obstruction Large airway obstruction Pleural effusion Haemoptysis Ureteric obstruction GI obstruction Gut perforation Hyperviscosity syndrome
Name some common treatment-related oncological emergencies
Neutropenic sepsis
Extravasation
Tumour lysis syndrome
Thrombocytopenia
What is the normal range of serum calcium?
2.2-2.7 mmol/L
2.7-3.7 = requires treatment to avoid renal damage >3.7 = emergency, may cause cardiac arrhythmias/arrest
Particularly occurs in lung, breast, prostate cancer and myeloma
How do cancer cells cause hypercalcaemia? (Pathology)
They interfere with normal balance between osteoclasts (bone breakdown) and osteoblasts (bone building)
They secrete cytokines that activate osteoclasts which causes bone lesions, leading to hypercalcaemia
What is the clinical presentation of hypercalcaemia?
- ↑ serum Ca impairs reabsorption function of kidney tubules (reduces sensitivity to ADH) → salt-losing diuresis → polyuria & polydipsia
- Abdo pain
- Nausea & vomiting
- Drowsiness, confusion
- Impaired consciousness
- Cardiac arrhythmias
- Severity of symptoms depends on serum Ca level
- If untreated → dehydration, renal failure & coma
How is hypercalcaemia managed?
Attempt to rid body of calcium
Protect/improve renal function
Reduce bone breakdown
Main treatments:
- Rehydration
- Bisphosphonates
Rehydration (for hypercalcaemia)
Many symptoms linked to dehydration
Rehydration temporarily reduces Ca levels
If renal and cardiac function are OK then give 3L iv fluids over 24 hours (slower if impaired function)
Bisphosphanates (for hypercalcaemia)
Interfere with osteoclast activity -> inhibit calcium release from bone & inhibit bone resorption
- Take 3-5 days to have maximal effect on Ca level
- Effect maintained for ~3 wks
- Some patients need regular bisphosphonates (IV or oral) to maintain normocalcaemia
- e.g. Disodium pamidronate IV infusion
- Some symptoms e.g. confusion are slow to improve after treatment, even if Ca has normalised
What is Neutropenia?
• Neutropenia = neuts less than 1.5 x 10^9 per L
What can cause Neutropenia?
- Chemotherapy
- Radiotherapy
- Disease with bone marrow involvement
What infections can occur due to neutropenia?
Bacterial, Fungal and Viral
Most pathogens are part of the host’s own gut or skin flora (e.g. staphylococcus aureus)
Fungal infections often candida or aspergillus
Viral infections often herpes simplex or varicella zoster
Prolonged neutropenia -> increased risk of fungal infections
What are the main risk factors for neutropenic sepsis?
Neuts less than 0.5 x 10^9 per L Neutropenia lasting longer than 7 days Patients with mucositis Concurrent illness Poor performance status
What is the clinical presentation of neutropenia?
- Often only pyrexia
- If left untreated patient may rapidly become unwell & go into septic shock
- Common sites of infection:
o GI tract
o Respiratory tract
o Skin - Treat as neutropenic sepsis if:
o 2 x temps of above 38oC
o 1 x temp of above 39oC - Do not wait for culture results, start empirical antibiotics straight away
What is the treatment for neutropenic sepsis?
Cover most common & virulent organisms
Usually combination therapy e.g. Tazocin & Gentamicin
Metronidazole if patient has diarrhoea or dental symptoms
- > If still high temp after 48hrs change antibiotics
- > If still high temp after 96hrs, add in antifungal (amphotericin B)
What prophylaxis should be given for neutropenic patients?
Prophylactic antibiotic (e.g. ciprofloxacin)
Prophylactic antifungal (e.g. nystatin, fluconazole, itraconazole)
Mouthcare (chlorhexidine mouthwash)
Patient education
Medical staff education
