Oncological emergencies

Question 1

Type of pain associated with spinal cord compression?

Answer 1

Pain in spine/radicular band-like distribution

Worse on coughing/straining

Question 2

Symptoms of malignant cord compression? (5)

Answer 2

Back pain
Leg weakness
Altered sensation
Urinary retention
Constipation/faecal incontinence

Question 3

Investigation to confirm diagnosis in malignant cord compression?

Answer 3

Urgent MRI of spine

Question 4

Interim treatment of malignant cord compression?

Answer 4

Dexamethasone (16mg IV loading dose, 8mg oral bd)

Question 5

Definitive treatment of malignant cord compression? (2)

Answer 5

Surgery

Radiotherapy (mainstay of treatment)

Question 6

Swelling of neck/face/arms + distended veins + SOB

Answer 6

Superior vena cava obstruction

Question 7

Signs of SVCO? (3)

Answer 7

Puffy neck, neck veins don’t collapse when pressed
Conjunctival injection
Sedation/sleepiness

Question 8

Possible causes of SVCO? (4)

Answer 8

Clot
Foreign body e.g. line
Tumour in vessel
Extrinsic compression from mass

Question 9

Investigations for SVCO?

Answer 9

CXR, venogram, CT chest

Question 10

SVCO as a result of extrinsic compression can be treated with?

Answer 10

Steroids (widely used but little evidence)
Radiotherapy
Chemotherapy
Stenting (relieves compression but doesn’t treat cause)

Question 11

Causes of hypercalcaemia in malignancy? (3)

Answer 11

Parathyroid hormone related peptide secretion by tumours

Local bone destruction

Production of vitamin D analogues by tumour

Question 12

Which group of tumours are especially prone to secreting Vitamin D analogues?

Answer 12

Lymphomas

Question 13

Hypercalcaemia and no known malignancy- investigation?

Answer 13

Myeloma screen

urea and electrolytes, creatinine, serum/urine electrophoresis

Question 14

Treatment of malignant hypercalcaemia?

Answer 14

IV fluids

IV bisphosphonates

Question 15

Why is it important that patients are rehydrated prior to bisphosphonates?

Answer 15

Can cause renal failure