Oncological Emergencies.pdf - Oncological Emergencies ONCOLOGICAL EMERGENCIES 0 ACUTE SPINAL CORD COMPRESSION TUMOR LYSIS SYNDROME SUPERIOR VENA CAVA

Oncological Emergencies.pdf - Oncological Emergencies...

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Oncological Emergencies
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ONCOLOGICAL EMERGENCIES 0 A CUTE S PINAL C ORD C OMPRESSION 2 T UMOR L YSIS S YNDROME 3 S UPERIOR V ENA C AVA S YNDROME 4 H YPERCALCEMIA 5 F EBRILE N EUTROPENIA 7 S YNDROME OF I NAPPROPRIATE ADH S ECRETION 9 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
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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:
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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.
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