Oncological Emergencies Flashcards Preview

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Flashcards in Oncological Emergencies Deck (29)
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1
Q

What are the three main metabolic oncological emergencies?

A
  1. Hypercalcaemia
  2. Tumour Lysis Syndrome
  3. Syndrome of innappropriate ADH secretion
2
Q

What are the two main neurological oncological emergencies?

A

Spinal cord compression

Raised ICP/Brain mets

3
Q

What are the two min cardiovascular oncological emergencies?

A

Malignant pericardial effusion

Superior vena cava syndrome

4
Q

What are the three main haematological oncological emergencies?

A

Hyperviscosity
Hyperleukocytosis
DIC

5
Q

What are the main infectious oncological emergencies?

A

Neutropenic sepsis

Septic shock

6
Q

What is the definition of hypercalcaemia in cancer patients?

A

Corrected calcium of over 2.5 associated with malignant tumours . It is usually associated with troblesome symptoms.

7
Q

What cancers commonly cause hypercalcaemia?

A
Myeloma 
Squamous cell lung cancer
Renal cancer
Breast cancer 
Squamous cell head and neck cancer
8
Q

What is the pathophysiology of malignant hypercalcaemia?

A
  1. Osteolytic metastases with local cytokine release
  2. Tumour secretion of PTH. This will stimulate osteoclats to reabsord bone, increase calcium reabsorption from the distal tubules and increase vitamin D production
  3. Tumour production of calcitriol
9
Q

What are the symptoms of malignant hypercalcaemia?

A
Dehydration 
Anorexia 
Itching 
Weight loss
Fatique 
Nausea, constipation 
Ileus 
Pancreatitis 
Dyspepsia 
Hypotonia
Weakness
10
Q

What changes will you see on an ECG of malignant hypercalcaemia?

A
Bradycardia 
Short QT 
Prolonged PR intercal 
Wide T wave 
Arrhythmia
11
Q

How do you treat malignant hypercalcaemia?

A
  1. 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)
  2. Bisphosphonates as a longer term solution once the patient is rehydrated
12
Q

What cancer is most associated with SIADH?

A

Small cell lung cancer

13
Q

What are the sodium levels like in SIADH?

A

Low (less than 133)

14
Q

What is the criteria for SIADH?

A

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

15
Q

Where is the most common part of the spine to get spinal cord compression?

A

Thoracic spine (70%)
Lumbosacral (20%)
Cervical (10%)

16
Q

What is the investigation for suspected spinal cord compression?

A

MRI whole spine

17
Q

How do you manage spinal cord compression?

A

Neurosurgical reviews
Steroids (Dexamthasone)
Radiotherapy

18
Q

What is the treatment for raised intacranial pressure due to brain metastases?

A

Neurosurgical review

Steroids

19
Q

Are malignancy pericardial effusions usually transudive or exudive?

A

Exudative

20
Q

What is the most common cancer that causes superior vena cava syndrome?

A

Adenocarcinoma of the lung

21
Q

What is superior vena cava syndrome?

A

Obstruction of blood flow through the superior vena cava

22
Q

How do you manage superior vena cava syndrome?

A

Stenting
Radiotherapy
Chemotherapy (small cell lung cancer)
Dalteparin

23
Q

What is the definition of neutropenic fever?

A

Anyone having chemotherapy who has a neutrophil count of less than 0.5 and a temperature over 38

24
Q

What are the most common organisms casuing neutroenic sepsis?

A

E Coli

Pseudomonas

25
Q

Which bacteria infect indwelling lines?

A

Staph aureus

Coagulase negative staph

26
Q

What is the treatment of neutropenic sepsis?

A

IV Tazocin QDS +/- gentamycin

IV fluids

27
Q

What is the initial management of someone who you expect has spinal cord compression

A

8mg oral dexamethasone

Urgent MRI

28
Q

What is tumour lysis syndrome?

A

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

29
Q

What medication is used to prevent tumour lysis syndrome?

A

Allopurinol