Oncological Emergencies Flashcards
(25 cards)
What are the features of malignant SCC (spinal cord compression)?
Pain in spine Weakness Sensory changes Urinary retention Constipation
What is the pain like in SCC?
Worse on coughing and straining
Radicular pain - band like
Burning
Precedes weakness
What is the immediate management of suspected malignant SCC?
Urgent MRI spine
16mg dexamethasone IV STAT
- then 8mg oral bd
What are the management options for malignant SCC?
Surgery
Radiotherapy (mainstay)
When should surgery be considered for management of malignant SCC?
Single vertebral region of involvement No evidence of widespread mets RT resistant primary e.g. renal Previous RT to site Unknown primary (get tissue sample)
How is RT given for malignant SCC?
20 Gray, 5 fractions
Abnormal area plus 1-2 vertebra
What are the symptoms of a SVC obstruction?
Swelling of face, neck, one or both arms Distended veins Shortness of breath Headache Lethargy
What might be causing SVC obstruction?
Within vessel: - clot (DVT) - foreign body (e.g. line) - tumour in vessel (e.g. renal cancer) Outwith vessel: - extrinsic compression from mass
Which initial investigations should be done in suspected SVC obstruction?
CXR - mass?
Venogram - clot?
CT chest
If SVC is caused by a clot, what is the management?
Thrombolysis - alteplase
Anti-coagulation - LMWH or warfarin
What are the management options for SVC obstruction caused by extrinsic compression?
Steroids (no evidence)
Chemotherapy (SCLC, lymphoma, teratoma)
Radiotherapy (other malignancies)
Stent (rapid relief but doesn’t treat cause)
Where is the tumour likely to be if it’s causing SCV obstruction?
Right lung
What is the most common electrolyte abnormality seen in cancer patients?
Hypercalcaemia
What might be causing hypercalcaemia in a cancer patient?
High PTH
Local bone destruction esp lung, breast, myeloma
Tumour production of vitamin D analogues esp lymphomas
What are the symptoms of hypercalcaemia?
Nausea, anorexia Thirsty Polydipsia + polyuria Constipated Confused Poor concentration Drowsy
Which investigations should be done for suspected hypercalcaemia in a cancer patient?
Calcium + corrected calcium
U&Es –> dehydration
Phosphate (low in hyperparathyroidism)
Myeloma screen (if no known malignancy)
What is the management for malignant hypercalcaemia?
Rehydration first –> may need several litres of normal saline
Bisphosphonates
Systemic management of malignancy
How are bisphosphonates given in the management of malignant hypercalcaemia?
e.g. 60-90mg pamidronate IV over 2 hours
Can cause renal failure so MUST ensure properly rehydrated first
Takes up to a week to work
What are the symptoms of malignant pericardial tamponade?
Primarily SOB Fatigue Palpitations Symptoms of pericarditis (chest pain improved by sitting forward) Symptoms of advanced cancer
What are the signs of malignant pericardial tamponade?
Beck’s triad:
- raised JVP
- muffled heart sounds
- low BP (weak pulse or narrow pulse pressure)
Which investigations should be done for malignant pericardial tamponade?
CXR - enlarged cardiac silhouette
ECG - reduced complex size
Echo - rim of pericardial fluid
Cytology of pericardial fluid
What is the treatment for malignant pericardial tamponade?
Pericardiocentesis - drain into pericardium
Pericardial window - operation to allow fluid to drain into pleural cavity
Systemic management of malignancy
What is the definition of neutropenic sepsis?
Sepsis + neutrophil count < 0.5
or < 1.0 if chemo given within last 21 days
How should a patient with suspected neutropenic sepsis be managed?
Assess within 15 mins
If chemo within 3 weeks AND temp >37.5 OR clinically septic –> initiate antibiotics within 1 hour
DO NOT WAIT for blood results/to perform full septic screen
