What are the three main metabolic oncological emergencies?
- Hypercalcaemia
- Tumour Lysis Syndrome
- Syndrome of innappropriate ADH secretion
What are the two main neurological oncological emergencies?
Spinal cord compression
Raised ICP/Brain mets
What are the two min cardiovascular oncological emergencies?
Malignant pericardial effusion
Superior vena cava syndrome
What are the three main haematological oncological emergencies?
Hyperviscosity
Hyperleukocytosis
DIC
What are the main infectious oncological emergencies?
Neutropenic sepsis
Septic shock
What is the definition of hypercalcaemia in cancer patients?
Corrected calcium of over 2.5 associated with malignant tumours . It is usually associated with troblesome symptoms.
What cancers commonly cause hypercalcaemia?
Myeloma Squamous cell lung cancer Renal cancer Breast cancer Squamous cell head and neck cancer
What is the pathophysiology of malignant hypercalcaemia?
- Osteolytic metastases with local cytokine release
- Tumour secretion of PTH. This will stimulate osteoclats to reabsord bone, increase calcium reabsorption from the distal tubules and increase vitamin D production
- Tumour production of calcitriol
What are the symptoms of malignant hypercalcaemia?
Dehydration Anorexia Itching Weight loss Fatique Nausea, constipation Ileus Pancreatitis Dyspepsia Hypotonia Weakness
What changes will you see on an ECG of malignant hypercalcaemia?
Bradycardia Short QT Prolonged PR intercal Wide T wave Arrhythmia
How do you treat malignant hypercalcaemia?
- Rehydration (2.5 - 4L saline in 24 hours) and monitor urine output
(if renal/cardiac failure loop diuretics may be used if renal or cardiac failure) - Bisphosphonates as a longer term solution once the patient is rehydrated
What cancer is most associated with SIADH?
Small cell lung cancer
What are the sodium levels like in SIADH?
Low (less than 133)
What is the criteria for SIADH?
Normovolaemia
Normal renal, adrenal and thyroid function
Urine not dilute (osmolality over 100)
Urine sodium over 30
No diuretics causing this
Improvement in sodium following water restriction
Where is the most common part of the spine to get spinal cord compression?
Thoracic spine (70%)
Lumbosacral (20%)
Cervical (10%)
What is the investigation for suspected spinal cord compression?
MRI whole spine
How do you manage spinal cord compression?
Neurosurgical reviews
Steroids (Dexamthasone)
Radiotherapy
What is the treatment for raised intacranial pressure due to brain metastases?
Neurosurgical review
Steroids
Are malignancy pericardial effusions usually transudive or exudive?
Exudative
What is the most common cancer that causes superior vena cava syndrome?
Adenocarcinoma of the lung
What is superior vena cava syndrome?
Obstruction of blood flow through the superior vena cava
How do you manage superior vena cava syndrome?
Stenting
Radiotherapy
Chemotherapy (small cell lung cancer)
Dalteparin
What is the definition of neutropenic fever?
Anyone having chemotherapy who has a neutrophil count of less than 0.5 and a temperature over 38
What are the most common organisms casuing neutroenic sepsis?
E Coli
Pseudomonas
Which bacteria infect indwelling lines?
Staph aureus
Coagulase negative staph
What is the treatment of neutropenic sepsis?
IV Tazocin QDS +/- gentamycin
IV fluids
What is the initial management of someone who you expect has spinal cord compression
8mg oral dexamethasone
Urgent MRI
What is tumour lysis syndrome?
A potentially lethal condition related to the treatment of high grade lymphoma and leukemias. It is usalluy triggered by chemotherapy. It occurs from the breakdown of tumour cells and the subsequent release of chemicals. It leads to high potassium, high phosphate and low calcium. It can cause AKI, seizures and arrhythmia
What medication is used to prevent tumour lysis syndrome?
Allopurinol