Lecture 51 --- Oncologic Emergencies and Supportive Care

Question 1

what is the difference between Phase 1, 2, and 3 trials?

Answer 1

Phase I: Determine “tolerable dose” -

Phase II: Evaluate for possible efficacy –

Phase III: Compare to “standard” therapy

Question 2

Pain control —

• • types of pain
• • types of meds

Answer 2

chronic pain: long acting opiates + adjuvant NSAIDs

vs short term post operative pain

vs break through pain — short acting opiods

Question 3

• Anti-emetic therapy

• receptors of interest
• what is the area of the brain also known as the “chemoreceptor trigger zone”?

Answer 3

Serotonin (5HT3) Receptors and NK1 (substance P receptors)

Chemoreceptor Trigger Zone

Question 4

what are the Type 3 serotonin antagonists?

What is the NK1 Receptor Antagonist?

Answer 4

ondansetron (ZOFRAN), deolastron, granisetron

Aprepitant

Question 5

Neutropenia and neutropenic fever:

• what is it?
• how do you manage it? ]
• with what malignancies it it worse with?

Answer 5

Definition: ANC (absolute neutrophil count) < 1000; Temperature 100.4 F

○ Management — this is Life threatning; requires admission + Empiric broad spectrum abx

• worse with hematological cancers

Question 6

Hypercalcemia -

– associated cancers; cause?

• Mangement
• how does this typically present?
• how would this kill you?

Answer 6

NSCLC; Breast cancer, Myeloma, NHL — cancers releasing PTH RP

Mangement: Fluids, Lasix, Bisphosphonates (decresaed osteoclast activity)
Calcitonin (short term )

Presentation: confusion

Cause of death: arrythmias

Question 7

Hyponatremia

• associated cancers? causes?
• Management?
• how does it present/kill you?

Answer 7

Presentation: Mental status changes in setting of SCLC , GI cancers, Oral Cancers etc

Cause: SIADH

○ Management: Fluid restriction, Lasix; give sodium; treat the cancer

Significance of Low Sodium: CNS effects; seizures;

Question 8

Tumor Lysis Syndrome:
what is it?
cancers that typically cause it?
Consequences and potential causes of death?

Answer 8

most commonly hematologic malignancies

Characterized by release of intracellular components — Potassium, phosphorous, purines — relesaed from tumor burden after initial doses of chemo

Consequences: renal failure, Hyperkalemia, death

Question 9

Spinal cord compression

• what is it?
• most commonly with what types of cancer?
• presentation?
• management?

Answer 9

Mets outside the spinal cord

Presentation with compression: pain, weakness, paresthesia’s, bowel and bladder dysfunction, ataxia

Presenting –
New onset back pain in patient with known cancer – EMERGENT

Breast and lung cancer

Treatment:
§ If stable from orthopedic point of view: radiation;

§ If not stable: surgical decompression and stabilization, followed by radiation