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OCN Review > Oncologic Emergencies > Flashcards

Oncologic Emergencies Flashcards

1
Q

S&S of SVC syndrome

A

Head fullness, chest pain, facial/neck/arm swelling, distension of superficial veins of chest, neck and upper arms

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2
Q

S&S of cardiac tamponade

A

Anxiety, jugular vein distension, tachycardia, pulsus paradoxes (decline in blood pressure on inspiration), substernal chest pain

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3
Q

What is Beck’s Triad?

A

Distended neck veins, hypotension, distant heart sounds

(Sign of cardiac tamponade)

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4
Q

What can untreated pneumonitis lead to?

A

Fibrosis

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5
Q

What are confusion and restlessness early signs of?

A

Hypercalcemia

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6
Q

What is the most common underlying disorder that leads to acute (rapid onset) DIC?

A

Infection —> sepsis

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7
Q

Which oncologic emergency is most often associated with APL?

A

DIC, as many as 85% of APL patient experience this

Tissue factor is released by promyelocytes

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8
Q

What causes the hypercoagulation in DIC?

A

Release of tissue factor leases to release of thrombin leads to plasminogen to convert to plasmin, causing fibrinolysis which leads to excessive fibrin degradation products (FDPs) which leads to bleeding.

Simultaneous hemorrhage and clot formation compromised blood supply to vital organs

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9
Q

What is the hallmark sign of DIC?

A

Bleeding simultaneously from at least 3 unrelated sites

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10
Q

What do the labs look like in DIC?

A

Decreased platelets, fibrinogen, antithrombin III, plasminogen, alpha-2 antiplasma level, protein C

Increased FDPs, D-dimer, thrombin time, fibrinopeptide A level

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11
Q

What is the treatment for DIC?

A

Treat the underlying condition

Chemo, hormonal therapy, abx, blood products

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12
Q

What are the symptoms in chronic DIC?

A

Minimal bleeding and diffuse thrombosis (most often with solid metastatic mucin outs adenocarcinoma (prostate & breast)

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13
Q

What S&S are these for: Bleeding, acidosis, hematuria, oliguria, uterine hemorrhage, dyspnea, hemoptysis, cough, tachypnea, dim breath sounds, pleural friction rub, jaundice, Petechiae, skin necrosis of lower limbs, thrombosis, fever?

A

DIC

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14
Q

What are late stage symptoms
of DIC?

A

Thrombus formation - may manifest as organ dysfunction or failure (infarct, ischemia, necrosis)

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15
Q

What is thrombotic thrombocytopenia purpura?

A

Excessive clot formation throughout body causing thrombocytopenia as platelets are consumed in the clotting process

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16
Q

What gene is TTP linked to?

A

ADAMTAS13 (breaks down vonWillebrand factor that clumps together with platelets to form clots and lodges itself in blood vessels)

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17
Q

What are these S&S linked to: bruising, petechiae, pale or jaundice, fatigue, fever, tachycardia, tachypnea, oliguria, neurologic changes?

A

TTP

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18
Q

What labs do you see in TTP?

A

Decreased RBCs, platelets and ADAMTS13, negative Coombs test, schistocytes on smear, elevated LDH and bili

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19
Q

What would you be highly suspicious for in a patient with an elevated LDH and thrombocytopenia?

A

TTP

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20
Q

What is the treatment for TTP?

A

Inherited : FFP
Acquired: plasmapheresis

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21
Q

What is the treatment for refractory TTP?

A

Corticosteroids and/or rituximab or splenectomy

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22
Q

What cancers are most often associated with SIADH?

A

Bronchogenic lung cancer (mainly SCLC), mesothelioma, thymoma, head and neck, lymphoma, Ewing’s sarcoma, GI, GU, CNS tumors

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23
Q

What other risk factors are there for SIADH?

A

Advanced age, severe pain, anxiety, stress

24
Q

Which chemos can induce SIADH?

A

Cyclophosphamide, vinblastine, cisplatin, carboplatin, vincristine, melphalan, bortezomib, ifosfamide

25
Q

What oncologic emergency are these S&S related to: Hyponatremia, increased urine osmolality, decreased serum osmolality

A

SIADH

NO signs of fluid overload. Normal BP, HR, no edema

26
Q

What are mild symptoms of SIADH?

A

Maybe asymptomatic, muscle cramps, fatigue, headache, anorexia, nausea, vomiting, thirst

27
Q

What are moderate symptoms of SIADH?

A

Weight gain, confusion, irritability, lethargy, abdominal cramping, diarrhea, oliguria/concentrated, hypoactive reflexes, extrapyramidal symptoms, Na 126-130

28
Q

What are severe symptoms of SIADH?

A

Cerebral edema, papilledema, ataxia, seizures, psychosis, coma, death, Na <120

29
Q

What is the treatment plan for SIADH?

A

If possible, eliminate the drug causing it.

Fluid restriction 500-1000ml/day
Treat malignancy
If severe, hypertonic saline 3% - limit correction to 8-12 during 1st 24H, monitor Na levels q1-3H, frequent euro checks, loop diuretics

30
Q

The presence of two or more of what indicates SIRS?

A

T>38 or <36
HR>90
RR>20 or PaCO2 <32mmHg
WBC >12,000, <4,000 or >10% bands

31
Q

What are risk factors for developing SIRS?

A

Presence of granulocytopenia, <1yo or >65yo, long ICU stays, loss of skin or mucosal injury, malignancy-related immunosuppression, humoral immunity modifications, MM, CLL, Waldenstroms, diabetes, comorbid organ dysfunction, presence of CVAD

32
Q

What are early S&S of SIRS?

A

Increased cardiac output and BP, capillary leaks: edema develops, subsequent hypotension, nausea

33
Q

What are severe S&S of SIRS?

A

Vasodilation (hypotension, bounding pulse), normal or elevated temp, warm/flushed, tachypnea, tachycardia, N/V, decreased platelets, fibrinogen, increased WBCs, PT/PTT, FDP, hyperglycemia, lactic acidosis, oliguria, mental status changes

34
Q

What % of patients with septic shock will develop ARDS?

A

50%

35
Q

Because of immunosuppression, what may be the only symptom neutropenic patients have with SIRS?

A

Fever

36
Q

When is TLS most common?

A

48-72 hrs after treatment

37
Q

Which cancers are typical to develop TLS?

A

Leukemias with high WBC, NHL, bulky, rapid growing treatment-responsive tumors

Pretreatment elevated LDH or preexisting renal dysfunction are strong indicators

38
Q

Which drugs typically cause TLS?

A

Cisplatin, cytarabine, etoposide, paclitaxel, fludarabine, hydroxyurea, IT MTX

Immunotherapy: interferons, interleukins, rituximab, TNFs

Hormonal: tamoxifen

39
Q

What oncologic emergency are these S&S for: N/V, abd pain, distension, dyspnea, dysrhythmias, edema, lethargy, muscle or joint pain, twitching?

A

TLS

40
Q

What are some progressive S&S of TLS?

A

Increased GI symptoms, oliguria, hematuria, azotemia, anuria, CHF, HTN, then tachy then Brady then ventricular arrhythmias, progressive muscle weakness, parasthesias, tetany, seizures

41
Q

What lab values are you watching for for TLS?

A

K>6
Phos >4.5
Uric acid >8
Calcium <7

Or 25% different from baseline

42
Q

Which drugs have a high potential for hypersensitivity reactions?

A

L-asparaginase, taxanes, platinums, epipodophyllotoxins

43
Q

What calcium level is considered hypercalcemia?

A

Ca>10.5mg/dL

44
Q

What cancers are most often associated with hypercalcemia?

A

Solid tumor, such as breast, squamous cell lung cancer - they comprise of >50% of HCM

45
Q

How does hypercalcemia occur?

A

Excessive osteoclast activity results in bone destruction which releases large quantities of Ca into the circulation and overwhelms the kidneys

46
Q

What level of Ca do people usually show symptoms by?

A

14

47
Q

What are mild symptoms of hypercalcemia?

A

<12
Restlessness, lethargy, difficulty concentrating, anorexia, N/V, fatigue, weakness, hyporeflexia, polyuria, polydipsia, pruritus, HTN, orthostatic hypotension

48
Q

What are moderate symptoms of hypercalcemia?

A

12-15
Confusion, somnolence, abd pain, constipation, weaker, bone pain, acidosis, dehydration, renal calculi, thirst, poor skin turgor, HTN, EKG changes, dysrhythmias

49
Q

What are severe symptoms of hypercalcemia?

A

> 15
Obtunded, seizures, coma, death, worse abd pain, progressing to obstipation, ileus, skeletal pain, pathological fracture, renal failure, oliguria, cardiac arrest

50
Q

Which cancers are the majority of SVC syndrome due to?

A

SCLC or NSCLC

51
Q

What are risk factors for SVC syndrome?

A

Men 50-70 with mediastinal disease, previous radiation to the mediastinum, CVCs or pacemakers (b/c clot risk), aortic aneurysms or TB

52
Q

What are S&S of SVC syndrome?

A

Dyspnea, coughing, swelling of face, neck, upper trunk and extremities

Rare: hoarseness, chest pain, dysphasia, hemoptysis, unilateral pros is of eye/constricted pupil (Horner syndrome)

53
Q

What is the gold standard of treatment for SC and NSC related SVC syndrome?

A

Radiation

54
Q

Which cancers have the highest incidence of malignant bowel obstruction?

A

Ovarian, colon

55
Q

What drugs are DNA-binding vesicants?

A

Anthracyclines sucks as doxorubicin, nitrogen mustard, miromycin

56
Q

Which drugs are non-DNA binding vesicants?

A

Plant alkaloids, paclitaxel

OCN Review (8 decks)

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