Oncological Emergencies Flashcards Preview

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Flashcards in Oncological Emergencies Deck (30)
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1
Q

Mx of neutropenic sepsis (4)

A

Take culture before Abx

IV Abx w/i 1 hr:

  • tazocin+/-gent
  • if pen allergic (rash), give meropenem/cetazidine+gent
  • if pen anaphylaxis give cipro+gent/amikacin

Will also want to perform rest of sepsis 6

Also need to identify source of infection, bloods for FBC and CXR.

NB don’t give G-CSF (filgrastim) in NS.

2
Q

Common causes of SVC obstruction (6)

A
NSCLC-most common
SCLC
lymphoma
germ cell tumours>mediastinal enlargement
thymus malignancy
metastatic ca.
3
Q

Signs and Sx of SVC obs (8)

A
SOB-main one
cough
syncope
headache
facial plethora/facial/arm oedema
distended neck veins/superficial chest veins
hoarseness
\+ve pemberton's sign-lift up arm for 1min>congestion and cyanosis

(NB only emergency i there is airway compromise)

4
Q

Mx of SVC obs (6)

A

Unless there is airways obs, find cause before Rx

high dose dex which buys time for:

  • contrast-enhanced CT
  • biopsy and histology

radiotherapy for primary Rx of tumour, chemo if sensitive

can stent palliatively but do this after systemic Rx to prevent stent slipping out.

5
Q

Common Ca. causing cord compression (4)

A

Breast
Lung
Prostate
Kidney, thyroid, melanoma

6
Q

Common sites for cord compression (3)

A

Thoracic (60%)
Lumbar (30%)
Cervical (10%)

7
Q

Pathology and prognosis of cord compression

A

compression>oedema, venous congestion and demyelination>vascular injury>cord infarction

recovery unlikely after infarction

if there is slow onset of Sx then recovery may be possible

8
Q

Presentation of cord compression (4)

A

Back pain often first Sx

Limb weakness

bladder/bowel dysfunction

sensory loss in a root distribution

9
Q

Ix for cord compression

A

urgent MRI of whole spine w/i 24hr of admission

10
Q

Mx of cord compression

A

urgent dexamethasone

Definitive Mx w/i 24hr:

  • Surgery+RT
  • radiotherapy for patients unfit for surgery or who have already completely lost sensation/motor function

important to keep pt. flat and perform log rolls w. neutral spine

11
Q

Commonest causes of brain mets and raised ICP (5)

A
Lung
Breast
Colorectal
Melanoma
Carcinoma of unknown origin

(seen in 40%, has poor prognosis)

12
Q

Presentation of brain mets and raised ICP (10)

A
headache-worse in morning/coughing/leaning forward
focal weakness
nausea/vomitting
ataxia
seizures
hemianopias
drowsiness/confusion
personality change
papilloedema
CN palsies
13
Q

Ix for brain mets (2)

A

CT w. contrast:

  • not good at imaging cerebellum and brainstem
  • if there are signs from these areas and a clear CT then do MRI

Another CT for staging

14
Q

Mx of brain mets (5)

A

Immediate steroids

valproate for seizures

MDT to decide between:

  • neurosurgery:=/<3mets, palliation for hydrocephalus of for biopsy
  • whole brain irradiation:can cause fatigue, alopecia, scalp erythema and impaired cognitive function
  • stereotactic radiosurgery: high dose RT delivered to local area
15
Q

Malignant causes of bowel obs (2)

A

colorectal ca.

gynae ca.: poorer prognosis as often have widespread abdominal disease

16
Q

Dx of bowel obs (3)

A

Hx+Ex

plain AXR

CT abdo

17
Q

Mx of bowel obs (3)

A

Conservative methods 1st line:

  • drip and suck
  • enemas for impaction

drugs:

  • steroids to reduce oedema
  • anti-emetics
  • motility agents

surgery:

  • consider if conservative measures not helping after 48hr
  • resection, bypass, stoma, stenting
18
Q

RFs for VTE in malignancy (5)

A
Ca. is a hyper-coagulable state
Chemotherapy
hormonal Rx
central venous catheters
Recent surgery

(VTE occurs in 20% of ca. and can precede Dx of ca. by several mo.)

19
Q

Mx of VTE in ca.

A

LMWH for 6mo, may need to be lifelong

do not use warfarin-hard to control lvls.

20
Q

Commonest malignant causes of hypercalcaemia (4)

A

Breast
Lung-squamous ca. secreting PTH-like hormone
multiple myeloma
lytic bone mets

(hypercalcaemia in malignancy is a v. poor prognostic indicator)

21
Q

Sx of hypercalcaemia (6)

A
(stones, bones, moans, groans)
lethargy
confusion
nausea
anorexia
constipation
polydipsia/polyuria
22
Q

Mx of hypercalcaemia (3)

A

acutely:

  • aggressive fluid rehab
  • IV bisphosphonates (pamidronate). NB adjust dose to renal function

May need IV bisphosphonate maintenance.

(poor prognosis)

23
Q

Features of carcinoma of unknown origin (2)

A

most present as emergency

tend to be more agressive and have very poor 1yr survival

24
Q

Ix for carcinoma of unknown origin

A

tumour markers NOT useful

PET-CT

25
Q

Rx of carcinoma of unknown origin

A

“best guess” chemo-often platinum containing

often don’t even survive 1st round of chemo

26
Q

Features of tumour lysis syndrome (3)

A

due to rapid cell death upon starting chemo for rapidly proliferating leukemia, lymphoma, myeloma and certain germ cell tumours

mainly seen in NHL

often present 72hr after commencing chemo

27
Q

Presentation of tumour lysis syndrome (4)

A

abdo pain
dysuria
Sx of hypocalcaemia-tetany, cramps, vomitting, seizures
Sx of hyperkalaemia-weakness, paralysis

28
Q

Ix for tumour lysis syndrome (2)

A

Bloods:

  • HYPOCALCAEMIA
  • raised urate, potassium, phosphate, LDH, blood urea nitrogen
  • > renal failure>raised Cr

ECG

(calcium lowered due to high phosphate binding free calcium>calcium phosphate precipitating into tissues)

29
Q

Prevention of tumour lysis syndrome (2)

A

start 24hr before chemo:

  • good hydration
  • allopurinol
30
Q

Rx of tumour lysis syndrome (3)

A

if renal failure:

  • haemodialysis
  • rasburicase-urolytic agent, CI in G6PD and pregnancy

Mx hyperkalaemia