Oncological Emergencies Flashcards
(33 cards)
Define Neutropenic Sepsis
Potentially life threatening complication of anti cancer and immunosuppressive treatment
- Temp greater than 38 degrees
- any signs/sympotms of sepsis
- neutrophil count of <0.5x10^9
Define Febrile Neutropenia
Presence of fever in a person with Neutropenia
Two consecutive readings of more than 38 degrees for two hours
4 causes of neutropenic sepsis
Chemo
HSCT
Drugs (immunosuppressants, clozapine)
Bone marrow failure
How does Neutrophil count vary with chemotherapy?
Neutrophil count typically lowest 5-10 days after last chemotherapy dose and recovery is normally 5-10 days later
Normal infective organisms in neutropenic sepsis
S.pyogenes, S.aureus
4 risk factors other than chemo for neutropenic sepsis
Age (infants and over 60s)
Corticosteroids
Central venous access device
TPN
How should you assess a patient with suspected neutropenic sepsis
Temp history
Current symptoms
Cancer and chemo history
Recent ABx/steroid use
A to E
Sepsis 6 started how quickly
Within an hour
First line antibiotic in neutropenic sepsis
Tazocin
Meropenem (if pen allergy)
What is Spinal Cord Compression?
Occurs as a result of metastatic/spinal tumour growth that either directly or indirectly causes impingement of spinal cord
Name 5 cancers that have the highest incidence of spinal cord compression
Myeloma
Prostate
Nasopharynx
Breast
Lung
Describe the pathophysiology of Malignant Compression
Primary (Primary Bone Tumours, CNS malignancy)
Secondary (Metastatic, Non Metastatic - mechanical weakness secondary to cancer, paraneoplastic)
Name three non malignant causes of Spinal Cord Compression
Trauma
Disc Prolapse
Haematogenous
Describe the common distribution of Spinal Cord Compression
60% Thoracic
30% Lumbar
10% Cervical
How can a Spinal Cord Compression above L1/2 present?
95% severe progressive pain
85% weakness
Upper Motor Neurone lesion picture
May have peripheral paraesthesia
How would a Cauda Equina compression present?
LMN pattern (normally unilateral)
Saddle Anaesthesia, Reduced Anal Tone, Painless Urinary Retention, Impotence, Absent Ankle Jerk
Lower back pain
What is the gold standard investigation for Spinal Cord Compression?
MRI
Describe the general management of Spinal Cord Compression
Analgesia using WHO ladder
VTE Prophylaxis
Catheter for any bladder dysfunction
High dose Dexamethasone
Management of spinal cord compression
Surgical decompression and reconstruction ideally (if not then vertebroplasty and kyphoplasty)
+/- External Beam Radiotherapy or Stereotactic Body Radiotherapy
Define malignant Hypercalcaemia
Serum calcium >2.6mmol/l secondary to a malignant process
Name three hormones involved in the balance of Calcium
Vitamin D
Calcitonin
PTH
What three mechanisms cause Malignant Hypercalcaemia?
PTHrP (Breast and Non Hodgekins)
Osteolytic Mets
Increased Activation of Vitamin D (Hodgekins Lymphoma)
How do Osteolytic Metastases cause Hypercalcaemia?
Deposition of tumour cells leads to local production of inflammatory cytokines, causing osteoclast stimulation
How does mild hypercalcaemia present?
Dehydration
Kidney issues
GI problems
Weaker bones and muscles
Fatigue
Palpitations and fainting (cardiac)
