Oncological Emergencies.pdf - Oncological Emergencies...

Oncological
Emergencies

ONCOLOGICAL EMERGENCIES 0
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CUTE
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PINAL
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ORD
C
OMPRESSION
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T
UMOR
L
YSIS
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YNDROME
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S
UPERIOR
V
ENA
C
AVA
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YNDROME
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H
YPERCALCEMIA
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F
EBRILE
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EUTROPENIA
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S
YNDROME OF
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NAPPROPRIATE
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ECRETION
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Disclaimer: This document contains only a summary of the topic included in the spring AMB final of 2018-2019
Good Luck!
Done By: Norah AlRohaimi

Local Tumor Effects Biochemical Derangement Hematological Effects Cancer Therapy
Pathological fracture
Acute Spinal Compression
Superior Vena Cava Syndrome
Increased ICP
SIADH
Hypercalcemia
Adrenal Insufficiency
Tumor Lysis Syndrome
Febrile Neutropenia (MC)
Hyper viscosity Syndrome
Thromboembolism
Radiation pain
Nausea &Vomiting
2ndry to chemo
Dehydration
o Any cancer pt coming in with fever is febrile neutropenia until proven otherwise
Scenario:
o
56 year old man with history of osteoarthritis presents with back pain for one month.
Exam showed mild tenderness over L1. Lumbar Spine X-ray showed Some age related
degeneration. Pain does not resolve despite trying various forms of pain control
o
One month later, he wakes up in the morning and has difficulty supporting his weight
o Pt has objective leg weakness on physical examination
Acute Spinal Cord Compression
o Also known as Malignant Epidural Spinal Cord Compression (ESCC)
o Due to: neoplastic invasion of the epidural space
o Compression of the spinal cord
o Tumors that mets to the spine:
o Prostate + Breast + Lung Carcinoma (15-20%)
o Renal Cell + Non-Hodgkin Lymphoma + Myeloma (5-10%)
o Results in : irreversible loss of neurological function
o Location:
1. Thoracic (MC)
2. Lumbosacral - 30%
3. Cervical - 10%
o Clinical Presentation:
o Pain - first symptom
o Weakness - symmetrical + progressive
o Limb paresthesia
o Loss of gait --> paralysis
o Bowel + bladder disturbances are late findings
o Diagnosis:
o Physical Examination
•
Straight Leg Raise
•
Lack of anal tone
•
Saddle anesthesia
o MRI of the entire
•
1/3 will have multiple spinal metastases
o Management:

o Goals:
•
Pain control - analgesics + opiates
•
Avoid complications
•
Preserve ± improve neurological function
o Give dexamethasone to all pts
o Radiation Therapy:
•
Definitive choice
•
Relieves pain in most cases
o Chemotherapy : successful in chemo sensitive tumors
Scenario:
o A 23-year-old man is beginning chemotherapy for le ukemia. 3 days later, the patient’s starts C/O
muscle cramps, nausea, weakness and decreased urine output. His creatinine level rises, and he is
diagnosed with acute renal failure. Labs show high uric acid and potassium. Blood and urine
cultures are negative for bacteria. An abdominal radiograph fails to locate any pathology.