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)
Surgery
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
Conjunctival injection
Sedation/sleepiness
Possible causes of SVCO? (4)
Clot
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)
Radiotherapy
Chemotherapy
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?
Lymphomas
Hypercalcaemia and no known malignancy- investigation?
Myeloma screen
urea and electrolytes, creatinine, serum/urine electrophoresis
Treatment of malignant hypercalcaemia?
IV fluids
IV bisphosphonates
Why is it important that patients are rehydrated prior to bisphosphonates?
Can cause renal failure
