Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Oncology > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

(60 cards)

Start Studying
1
Q

What are the 4 main oncological emergencies?

A

Neutropenic sepsis
Spinal cord compression
Superior vena cava obstruction
Hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How are most chemotherapy regimes delivered?

A

3 weekly basis

Often at around day 7-14 of each 3 weekly cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal neutrophil count

A

> 1.5x109

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What neutrophil count is an increased risk of infection?

A

< 1 x 109

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Symptoms of infections

A

Feeling hot or feverish or feeling cold and shivery
Aching joints or muscles or flu like symptoms
Symptoms of focal infection (e.g. cough, sore throat, UTI etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Criteria for neutropenic fever or febrile neutropenia

A

Patient is febrile
Neutrophil count < 1.0 x109
No haemodynamic compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Criteria for diagnosing neutropenic sepsis

A

Evidence of sepsis

Prescence of neutrophil count < 1.0 x 109 (with or without fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pathogenic microbiological causes of neutropenic sepsis

A

85% endogenous flora (especially from gut, biliary and urinary tracts)
75% of cases are due to gram -ve bacilli
Fungal infection in patients with prolonged neutropenia (especially in haematological malignancies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of neutropenic symptoms

A 
Anorexia 
Malaise 
Lethargy 
Sweats 
Fever, chills rigors
Symptoms related to a focus of infection 
Symptoms related to 
- chest infection 
- GI tract
- UTI
- CNS infection 
- skin / abscess
- sore throat
- recent interventions e.g. dental work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What vital signs have to be checked if suspect neutropenic sepsis?

A 
Temp 
Pulse
BP
O2 sats 
RR 
Full examination for each system for potential source of infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations for neutropenic sepsis

A 
FBC, serum biochemistry 
CRP
Blood cultures
MSSU
Stool culture if diarrhoea
Throat swabs if suspected pharyngitis 
Sputum culture if productive cough 
Skin swabs of infected skin lesions 
CXR
Others as guided by clinical status e.g. LP, CT etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment of neutropenic sepsis

A 
Supportive care
- volume resuscitation 
O2 if indicated 
Mouthcare 
Broad spectrum Antibiotics 
- IV piperacillin with tazocin 
Consider G-CSF to boost neutrophil count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What broad spectrum antibiotics would be used to treat neutropenic sepsis stage 1?

A

Piperacillin/tazocin 4.5 IV every 6 hours plus gentamicin 7mg/kg IV (with level taken to determine dosing interval)
If mild penicillin allergy - use ceftazidime 2g IV every 8 hours plus gentamicin 7mg/kg IV
If severe penicillin allergy - consider vancomycin and gentamicin +/- metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would you consider transferring to ITU in neutropenic sepsis?

A

If hypotension does not resolve with supportive measures at ward level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What antibiotics would be used to treat neutropenic sepsis stage 2?

A

Meropenem 1g IV every 8 hours unless cultures suggest another more rational antibiotic regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is involved in reviewing the treatment in neutropenic sepsis?

A 
Fluid requirements
Response to antibiotic therapy 
Completion of antibiotic course
- at least 3 days IV 
- if improving and no longer neutropenic, a switch to oral ciprofloxacin is feasible, assuming cultures do not suggest a more rational regimen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is done to monitor response to antibiotic therapy?

A 
Temp
BP
HR
CRP 
Neutrophil count
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What cancers are malignant spinal cord compression (MSCC) most commonly seen in?

A

Cancers which typically spread to bone

  • breast cancer
  • carcinoma of the bronchus
  • prostate cancer
  • myeloma
  • renal cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does MSCC stand for?

A

Malignant spinal cord compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of MSCC

A

Vertebral collapse
or
Extradural metastases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Common site of MSCC

A

Thoracic spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presentation of MSCC

A 
Pain 
- thoracic back pain 
Sensory/motor symptoms 
- progressive leg weakness and sensory loss 
Autonomic symptoms
- urinary incontinence or retention 
- faecal incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Features of the pain in MSCC

A

Radicular in distribution
Worsening over the preceding weeks/months
Worse on coughing, sneezing, movement, weight bearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is radicular pain?

A

Radiating along the affected dermatome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Clinical signs of MSCC
Spinal tenderness UMN signs (hypertonia, hyperflexia, clonus, upgoing plantars) Sensory level i.e. loss of sensation below the dermatomal level of compression Bladder - urine retention/incontinence Reduced anal tone
26
Investigations of MSCC
MRI of whole spine CT scan may be required Check serum calcium
27
When would a CT scan be required when investigating MSCC?
MRI is contraindicated e.g. pacemaker | The patent is not previously known to have a diagnosis of cancer, in order to identify a primary site
28
Management of MSCC
``` Supportive Steroids - dexamethasone 8mg b.d. initially Surgery Radiotherapy Chemotherapy ```
29
Supportive management of MSCC
Keep patient lying flat until stability of spine determined Urinary catheter if urinary retention Monitor bowel function and commence bowel regimen if required (laxatives/enemas) Physio Consider prophylactic deltaparin if bed bound
30
What is deltaparin?
LMWH
31
What do steroids do when managing MSCC?
To reduce oedema around the lesion
32
What must be done when prescribing dexamethasone?
Prescribe with gastroprotectin (e.g. omeprazole) Monitor blood sugar (daily BM) Minimise duration of high dose steroids - aim to reduce dose once definitive therapy started
33
When is surgery preferred in MSCC?
Fit with low volume metastatic disease, with life expectancy > 3 months Isolated posterior cord compression (such that decompression laminectomy may suffice) Good sensory and motor function prior to this episode No prior history of cancer Remainder of the spine is sufficiently strong to allow stabilisation
34
Why is radiotherapy given after surgery in MSCC?
To reduce the risk of recurrence
35
When is surgery generally avoided in management of MSCC?
Frailer patients with large volume metastatic disease with prior poor mobility If anterior compression i.e. due to the tumour within the vertebral body compressing the spinal cord
36
How is radiotherapy delivered in MSCC?
Targeted at the level of spinal cord compression | Usually 4 fractions delivered over 4 consecutive days
37
When would primary chemotherapy be used in MSCC?
If primary tumour is highly chemosensitive e.g. - germ cell tumours - lymphoma No surgical or radiotherapy option
38
Prognosis of MSCC
If fully ambulant at diagnosis of cord compression, 90% remain ambulant If not fully weight bearing or mobile with walking aid, most unable to walk again independently If paraplegic, only 10% become ambulant after treatment
39
Causes of Superior vena cava obstruction
``` Bronchogenic carcinoma (typically non small cell lung cancer) Lymphoma Metastatic tumours e.g. - renal cancer - germ cell tumours SVC thrombosis Mediastinal fibrosis Goitre Aortic aneurysm ```
40
Presentation of SVC obstruction
Facial swelling/fullness of head Arm swelling Dysphagia and dyspnoea - may coexist due to mediastinal compression Other features of malignancy
41
Clinical signs of SVC obstruction
``` Distention of neck and chest wall veins Fixed (i.e. non pulsatile) elevated JVP Facial oedema / puffiness Oedema of the arms Plethora of the face Peripheral cyanosis Other signs of malignanc ```
42
Investigations of SVC obstruction
CXR CT Superior venocavogram Bronchoscopy if lung primary suspected
43
Management of SVC obstruction
``` Steriods and supportive measures Radiotherapy Chemotherapy Stenting of SVC Thrombolysis and anticoagulation if SVCO due to thrombosis of SVC ```
44
What supportive measures are used for SVC obstruction?
High dose corticosteriods - dexamethasone 8mg b.d. with gastroprotectin and daily BMs Encourage patient to sit up in bed (oedema will worsen on lying flat)
45
When would you do SVC stenting?
Recurrent SVCO | Benign causes
46
Treatment of catheter induced SVC thrombosis
Remove catheter Thrombolysis Anticoagulation
47
How do you work out corrected calcium?
Measured calcium + [0.02 x (40 - alb)]
48
Causes of hypercalcaemia
Bone mets | Paraneoplastic syndrome; production of PTH-rp (parathyroid hormone related peptide)
49
What is PTH-rp typically produced by?
Squamous cancer | HTLV-1 related T cell lymphomas
50
Presentation of hypercalcaemia
``` Osmotic features - dehydration - polydipsia - polyuria Cognitive impairment Fatigue Lethargy Psychosis Constipation Nausea and vomiting Renal failure Cardiac arrythmias ```
51
Management of hypercalcaemia
Check PTH if cause unclear Rehydration - 4-6 litres 0.9% saline / 24 hours if no contraindication - loop diuretic if required e.g. furesimide Biphosphonates - zoledronate 4mg IV if renal function normal Calcitonin rarely required Steriods may be of benefit
52
What would the PTH level be if there if hypercalcaemia caused by a PTH-rp producinig tumour?
PTH suppressed
53
What is tumour lysis syndrome?
Potentially deadly condition related to the treatment of high grade lymphomas and leukaemias
54
What can tumour lysis syndrome be trigged by?
Introduction of combination chemotherapy | however can occur in the absence of chemo
55
Prophylaxis of tumour lysis syndrome
High risk - IV allopurinol or IV rasburicase immediately prior to and the days following first chemo Lower risk - oral allopurinol during chemo cycles
56
Pathology of TLS
Breakdown of tumour cells and the subsequent release of chemicals from the cell
57
What does TLS result in?
Hyperkalaemia Hyperphosphataemia Hypocalcaemia
58
When should TLS be suspected?
Any patient presenting with an acute kidney injury in the prescence of a high phosphate and high uric acid level
59
What is clinical TLS?
Laboratory tumour lysis syndrome plus one of; - increased serum creatinine 1.5x normal - cardiac arrhythmia or sudden death - seizure
60
Prophylaxis of neutropenic sepsis
If neutrophil count < 0.5x10^9; give flouroquinolone

Oncology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions