oncological emergencies Flashcards
(36 cards)
what percentage of spine tumors are metastatic?
95%
what are the three most common primary sources of metastatic spinal tumors?
breast
lung
prostate
what are characteristic signs of spinal cord copmression due to metastatic dz?
pain that worsens when lying down
pain that worsens with percussion of vertebral bodies
incontinence
loss of sensory function
what part of the spine is most commonly affected?
thoracic
what is epidural spinal cord compression caused by?
a tumor compressing the dural sac
examination findings in epidural spinal cord compression
pain mimicked by percussion over the affected vertebra pain worsened upon valsalva DTRs may be increased lower extremity spasticity may develop babinski's sign may be positive
signs and symptoms of cauda equina syndrome
lower extremity weakness diminished DTRs lower extremity flaccidity leg and perianal sensory loss urinary retention constipation
if neurological symptoms are present (due to spinal cord compression) the patient should receive IV ____
steroids
treatment of spinal cord compression
immediate radiation therapy
surgical intervention
signs and symptoms or primary and metastatic brain lesions
altered mental status
new onset headache or headache with increasing intensity or frequency
visual field changes
focal neurologic deficits such as weakness, diminished function or sensation
persitent nausea and vomiting
stroke
seizures
most common cancers that lead to brain mets
lung breast renal cell colon melanoma
superior vena cava syndrome
direct obstruction of the SVC by malignancies such as compression of the vessel wall by lung cancer
what is the most common malignancy causing SVCS
bronchogenic carcinoma
signs and symptoms of SVCS
SOB facial or arm swelling headache venous distention in neck lightheadedness cough
sequelae of SVCS
cerebral edema
altered state of consciousness
seizures
airway obstruction
horner’s syndrome
ptosis
anhydrosis
myosis
tx for SVCS
steroids diuretics bed rest with elevation of head chemo with or without radiation intravenous stents
signs and symptoms of febrile neutropenia
temp of 101 or more
absolute neutrophil count less than 500 per mm3
tx for cancer pts with febrile neutropenia
inpatient tx with empiric abx until the ANC reaches a level greater than or equal to 500 per mm3 for 72 hours
intial lab evaluation for febrile neutropenia
CBC metabolic panel renal and liver functions U/A targeted cultures
tx for cardiac tamponade
removal of fluid from pericardial space pericardiocentesis sclerotic therapy surgical placement of a pleuropericardial window or pericardiectomy low dose RT
bone lysis and resorption are most commonly due to which two types of cancer
metastatic breast
prostate
effects of hypercalcemia
stones (renal/biliary) bones (bone pain) groans (abdominal pain, N/V) thrones (constipation, polyuria) psychiatric overtones (depression, anxiety, cognitive dysfunction, coma)
cancer related hypercalcemia increases or decreases prognosis
dramatically decreases
