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Stage 2: Cancer and Clinical Genetics > Oncological Emergencies > Flashcards

Oncological Emergencies Flashcards

1
Q

What are the 6 oncological emergencies?

A

1) Brain mets
2) Neutropenic sepsis
3) Spinal cord compression
4) SVC syndrome
5) Malignancy-associated hypercalcaemia
6) Tumour lysis syndrome

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2
Q

What are the diagnostic features of neutropenic sepsis?

A
  • Temp > 38

- Neutrophils < 0.5

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3
Q

When should you suspect neutropenic sepsis?

A

In all patients unwell after < 6 weeks of chemo

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4
Q

How to you treat neutropenic sepsis?

A
  • Take blood cultures

- Empirical IV abx e.g. tazobactam/piperacillin

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5
Q

Which 4 cancers typically metastasise to the brain?

A
  • Lung
  • Breast
  • Colorectal
  • Melanoma
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6
Q

What are symptoms of brain mets?

A
  • Headache - worse in the morning/cough/bending over
  • Focal neurological symptoms
  • Ataxia
  • Fits
  • Signs of raised ICP (N&V, papilloedema)
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7
Q

What is first line management of brain mets?

A
  • Urgent CT/MRI

- Dexamethasone 16mg/24h to reduce cerebral oedema

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8
Q

What is definitive treatment for brain mets?

A
  • Refer to oncology
  • Stereotactic radiotherapy
  • Neurosurgery esp. if large lesion or associated hydrocephalus
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9
Q

What is spinal cord compression in the context of oncology?

A

Collapse/compression of vertebrae due to bony metastases (common) or direct extension of tumour into vertebral column (rare)

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10
Q

Which cancers typically cause spinal/bony mets?

A
  • Lung
  • Prostate
  • Breast
  • Myeloma
  • Melanoma
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11
Q

What are the symptoms of spinal cord compression?

A
  • Back pain esp. cervical/thoracic and nocturnal pain/pain with straining
  • Limb weakness
  • Bowel/bladder dysfunction
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12
Q

What investigation do you do for spinal cord compression?

A

Urgent MRI whole spine (<24h) + admit for bed rest

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13
Q

What is first line treatment for spinal cord compression?

A

Urgent treatment to preserve neurological function and relieve pain

  • Dexamethasone 16mg/24h PO with GI prophylaxis (PPI) + blood glucose monitoring
  • ± thromboprophylaxis (compression stockings, LMWH) if reduced mobility
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14
Q

What is definitive treatment for spinal cord compression?

A

Refer urgent to oncology

- Radiotherapy within 24h of MRI diagnosis ± decompressive surgery

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15
Q

What is tumour lysis syndrome?

A

Cell death and release of cellular components into circulation due to cytotoxic treatment for rapidly proliferating tumours

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16
Q

In which cancers is tumour lysis syndrome common?

A

Haematological malignancy (leukaemia, lymphoma, myeloma)

17
Q

What are symptoms of tumour lysis syndrome?

A
  • N&V
  • Diarrhoea
  • Muscle weakness and cramps
  • Abdominal pain
18
Q

What are complications of tumour lysis syndrome?

A
  • Arrhythmia

- Renal failure (AKI)

19
Q

What investigations do you do in tumour lysis syndrome?

A
  • Bloods

- ECG

20
Q

What would you see on blood test results in tumour lysis syndrome?

A
  • Increased urate
  • Hyperkalaemia
  • Hyperphosphateaemia
  • Hypocalcaemia
21
Q

How do you manage/treat tumour lysis syndrome?

A
  • Fluid resuscitation with IV 0.9% sodium chloride

- Prevent with hydration and uricolytics (allopurinol, rasburicase)

22
Q

What is superior vena cava (SVC) syndrome?

A

Decreased venous return from head, neck and upper limbs

  • > 90% due to SVCO (extrinsic compression by malignancy)
  • Some due to venous thrombosis
23
Q

What are the commonest cancers causing SVCO?

A
  • Lung
  • Lymphoma
  • Breast met
  • Thymoma
  • Germ cell
24
Q

What are symptoms of SVC syndrome?

A
  • SOB
  • Orthopnoea
  • Stridor
  • Plethora/cyanosis
  • Face/neck/arm oedema
  • Neck/chest/abdo vascular distension - non-pulsatile raised JVP
  • Cough
  • Headache
25
Q

What test is positive in SVC syndrome?

A

Pemberton’s test

26
Q

How do you diagnose SVC syndrome?

A

Clinical diagnosis ± CT

27
Q

What is first line management for SVC syndrome?

A

Prop up ± O2 if hypoxic + IV dexamethasone

28
Q

How do you definitively treat SVC syndrome?

A
  • Balloon valvuloplasty + SVC stenting

- Refer to oncology - radio or chemo

29
Q

What is the most common cancer causing malignancy-associated hypercalcaemia?

A

Myeloma

30
Q

How do you define malignancy-associated hypercalcaemia?

A

Ca > 2.6

31
Q

What causes malignancy-associated hypercalcaemia?

A
  • Tumour production of PTH-related protein (squamous cell lung carcinoma)
  • Tumour production of calcitriol (lymphoma or granulomatous diseases as sarcoidosis or TB)
  • Local osteolysis (myeloma)
32
Q

What are the symptoms of malignancy-associated hypercalcaemia?

A
  • Stones - abdo pain
  • Groans - constipation
  • Moans - confusion
  • Bones - bone pain
33
Q

What are complications of malignancy-associated hypercalcaemia?

A
  • Renal failure

- Ectopic calcification

34
Q

What investigation do you do for malignancy-associated hypercalcaemia?

A

Bloods

35
Q

How do you treat malignancy-associated hypercalcaemia?

A

1) IV fluids FIRST - aggressive rehydration
2) Bisphosphonates (if eGFR > 30) e.g. IV zoledronic acid OR calcitonin (short term - more rapid, 2h)
3) Refer to oncology - control of underlying malignancy

36
Q

What is the most common metabolic abnormality in cancer pts?

A

Malignancy-associated hypercalcaemia - poor prognostic sign

37
Q

What do you need to check first in SVC syndrome?

A

That the airway is not compromised - if is, this needs urgent treatment

38
Q

When are patients unlikely to recover from spinal cord compression?

A

If they have loss of motor function after > 48h

Stage 2: Cancer and Clinical Genetics (18 decks)

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