Type of pain associated with spinal cord compression?
Pain in spine/radicular band-like distribution
Worse on coughing/straining
Symptoms of malignant cord compression? (5)
Back pain Leg weakness Altered sensation Urinary retention Constipation/faecal incontinence
Investigation to confirm diagnosis in malignant cord compression?
Urgent MRI of spine
Interim treatment of malignant cord compression?
Dexamethasone (16mg IV loading dose, 8mg oral bd)
Definitive treatment of malignant cord compression? (2)
Radiotherapy (mainstay of treatment)
Swelling of neck/face/arms + distended veins + SOB
Superior vena cava obstruction
Signs of SVCO? (3)
Puffy neck, neck veins don’t collapse when pressed
Possible causes of SVCO? (4)
Foreign body e.g. line
Tumour in vessel
Extrinsic compression from mass
Investigations for SVCO?
CXR, venogram, CT chest
SVCO as a result of extrinsic compression can be treated with?
Steroids (widely used but little evidence)
Stenting (relieves compression but doesn’t treat cause)
Causes of hypercalcaemia in malignancy? (3)
Parathyroid hormone related peptide secretion by tumours
Local bone destruction
Production of vitamin D analogues by tumour
Which group of tumours are especially prone to secreting Vitamin D analogues?
Hypercalcaemia and no known malignancy- investigation?
urea and electrolytes, creatinine, serum/urine electrophoresis
Treatment of malignant hypercalcaemia?
Why is it important that patients are rehydrated prior to bisphosphonates?
Can cause renal failure