Oncological Emergencies Flashcards
What cancers cause MSCC + how?
Commonly breast, bronchus + prostate
Due to tumour in vertebral body or paraspinal region pressing on spinal cord
Where does MSCC usually occur?
2/3 in thoracic region, remainder in cervical or lumbar spine
Consequences of MSCC
Paraparesis, paraplegia, incontinence
Symptoms of MSCC
Back pain, nerve root pain
Worse on movement, coughing or lying flat
Motor weakness
Sensory disturbance (walking on cotton wool)
Bladder/ bowel dysfunction (late) - urinary retention
Signs of MSCC
Weakness/ paraparesis/ paraplegia Changes in sensation Increased reflexes Clonus Painless bladder distension
Investigations for MSCC
Whole spine MRI
Management of MSCC
Dexamethasone stat
Surgery favoured when there is mechanical collapse of vertebral body
Can use RT or chemo
SVC obstruction causes
Extrinsic compression, thrombosis, invasion of wall of SVC
Commonly due to extensive lymphadenopathy in upper mediastinum - usually with lung cancer or lymphoma
Symptoms of SVC obstruction
Headache, fullness in head Facial swelling - periorbital oedema SOB - worse on lying flat Cough Hoarse voice
Signs of SVC obstruction
Facial/ upper limb oedema
Prominent blood vessels on neck, trunk, arms
Cyanosis
Management of SVC obstruction
Dexamethasone relieves symptoms
Urgent vascular stenting followed by RT or chemo
Causes of hypercalcaemia
Commonly seen in breast, lung, squamous cell carcinomas + myeloma
Due to PTpH
Symptoms of hypercalcaemia
Develop insidiously Early: Lethargy Anorexia Polyuria Thirst N+V Constipation
Late:
Confusion, drowsiness
Fits
Coma
Investigations for hypercalcaemia
Calcium corrected for serum albumin
Management of hypercalcaemia + max response time
Rehydration with saline + IV bisphosphonate (pamidronate or zolendronic acid)
Max response seen after 6-11 days
