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Cancer care > Oncological emergencies > Flashcards

Oncological emergencies Flashcards

1
Q

Criteria for neutropenic sepsis

A

Patient undergoing systemic anti cancer therapy
Temperature >38
Neutrophil <0.5

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2
Q

When does neutropenic sepsis normally occur

A

10-14 days after systemic anticancer therapy

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3
Q

Risk factors for neutropenic sepsis

A 
Prolonged neutropenia (>7 days)
Lower neutrophil count
Significant comorbidities
Progressive cancer
Central line in situ
Mucosal disruption
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4
Q

Frequent pathogens causing neutropenic sepsis

A 
Staph aureus
Staph epidermidis 
Enterococcus
Streptococcus 
MRSA
VRE
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5
Q

Investigations for neutropenic sepsis

A 
Bloods - FBC, U+Es, LFTs, CRP, lactate
Blood cultures
Urine dip
Sputum culture
Swabs of any lines and wounds
ABG
Imaging
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6
Q

Management of neutropenic sepsis

A 
Empiric IV abx within 1 hour
Fluid resuscitation
Call SpR/consultant
Consider ITU
GCSF if severe (avoid in AML)
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7
Q

Changes to chemo cycles after neutropenic sepsis

A

Dose reduction
Prophylactic GCSF
Consider stopping chemo

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8
Q

How to prevent neutropenic sepsis

A

Patient education

Alert card

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9
Q

What antibiotics are given for neutropenic sepsis

A

Meropenem
Tazocin
Vancomycin for suspected line infection
Gentamicin for hypotension

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10
Q

Pathophysiology of metastatic spinal cord compression

A

90% Collapse or compression of a vertebral body with metastatic disease. 10% from primary tumour.
Cord compression causes oedema leading to venous congestion and demyelination (reversible)
Prolonged cord compression leads to vascular injury and cord necrosis (irreversible)

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11
Q

Presentation of metastatic spinal cord compression

A

> 90% back pain
75% limb weakness
50% sensory level
40% bladder and anal sphincter dysfunction

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12
Q

Describe the pain experienced in MSCC

A

Radicular or spinal

Exacerbated by straight leg raising, coughing, sneezing and straining

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13
Q

Examination findings in MSCC

A 
Acutely flaccid paralysis 
Hyperreflexia and hypertonia below level of compression 
Babinski reflex positive
Sensory loss below level of compression
Palpable bladder
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14
Q

Management of MSCC signs

A 
Treatment within 24 hours!!
Admit
Bed rest - if severe back pain or MRI shows pedicle involvement 
MRI <24 hours
Dexamethasone 16mg 
PPI
Analgesia 
Surgery or supportive care
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15
Q

When should you seek advice before giving high dose dexamethasone

A

Lymphoma

Call haematology

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16
Q

When do you treat MSCC with supportive care

A 
No motor function for >48 hours
Not fit for surgery - significant comorbidities 
Multiple spinal levels involved
Low performance status
Visceral mets 
Prognosis <3 months
17
Q

What is the supportive treatment for MSCC

A 
Radiotherapy of abnormal vertebra + 1-2
Analgesia
Laxatives (cord compression, analgesia, poor mobility)
Bladder care
Monitor BMs (high dose steroids)
VTE prophylaxis 
PT/OT
18
Q

What is the definitive treatment for MSCC

A

Surgery to remove tumour from vertebral body and relieve cord compression
Re-stabilise spine

19
Q

How does radiotherapy work for MSCC

A

Causes cell death of rapidly dividing cells in the vertebra which relieves cord compression
Relieves pain

20
Q

Prognosis of MSCC

A

Median survival:
Not walking 1-3 months
Walking 5-8 months

21
Q

Causes of hypercalcaemia in cancer

A

80% paraneoplastic syndrome - PTHrP release
20% osteolytic mets - cytokine release
Lymphomas produce activated vitamin D

22
Q

Most common cancers to cause hypercalcaemia

A

Squamous cell e.g lung, renal, cervical, head+neck

Spread to bone - lung, myeloma, breast, thyroid, renal

23
Q

Common symptoms of hypercalcaemia

A 
Thirst
Nausea
Anorexia
Constipation
Confusion
Polyuria
24
Q

Treatment of hypercalcaemia

A

Rehydration: at least 3 bags normal saline in 24 hours
Bisphosphonates: 60-90mg pamidronate IV

25
Q

What is tumour lysis syndrome

A

Massive tumour cell death leading to release of large amounts of potassium, phosphate and uric acid

26
Q

Electrolyte disturbances in tumour lysis syndrome

A 
Hyperuricaemia 
Hyperkalaemia
Hyperphosphataemia
AKI
Hypocalcaemia
27
Q

Which tumours have a higher risk of tumour lysis syndrome

A

High grade lymphomas
Leukaemia
Bulky chemo-responsive tumours

28
Q

Patient risk factors for tumour lysis syndrome

A 
Preexisting renal dysfunction
Preexisting hyperuricaemia
Pre-treatment high LDH
Hypovolaemia (pre-treatment diuretic use)
Urinary tract obstruction
29
Q

Presentation of tumour lysis syndrome

A 
Day 3-7 post-chemo
N+V
Diarrhoea
Anorexia
Lethargy
Haematuria->Anuria
HF
Arrhythmia/cardiac arrest
30
Q

Prevention of tumour lysis syndrome

A 
Pre-hydration
Vigorous hydration during treatment 
Monitor electrolytes 
Monitor fluid balance 
Allopurinol to reduce hyperuricaemia 
Rasburicase to convert uric acid to allantoin
31
Q

Treatment of tumour lysis syndrome if rasburicase doesn’t cure tumour lysis syndrome

A

Haemodialysis

32
Q

Causes of SVCO

A

80% lung cancer
10% lymphoma
5% SVC thrombus e.g central line

33
Q

Signs and symptoms of SVCO

A 
SOB
Facial and neck swelling 
Plethoric face 
Trunk and upper limb swelling 
Dilated veins on chest wall 
Choking sensation
Chest pain 
Headache
Cough
Dyspnoea
Stridor
34
Q

Investigation for SVCO

A

CT with contrast

35
Q

Treatment for SVCO

A

Steroids frequently prescribed but no evidence for benefit
Stent if not radio/chemo-sensitive
Chemo - small cell lung cancer, lymphoma, teratoma
Radiotherapy - other malignant cancers

Cancer care (12 decks)

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