Oncological Emergencies Flashcards Preview

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Flashcards in Oncological Emergencies Deck (18):
1

What cancers cause MSCC + how?

Commonly breast, bronchus + prostate
Due to tumour in vertebral body or paraspinal region pressing on spinal cord

2

Where does MSCC usually occur?

2/3 in thoracic region, remainder in cervical or lumbar spine

3

Consequences of MSCC

Paraparesis, paraplegia, incontinence

4

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

5

Signs of MSCC

Weakness/ paraparesis/ paraplegia
Changes in sensation
Increased reflexes
Clonus
Painless bladder distension

6

Investigations for MSCC

Whole spine MRI

7

Management of MSCC

Dexamethasone stat
Surgery favoured when there is mechanical collapse of vertebral body
Can use RT or chemo

8

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

9

Symptoms of SVC obstruction

Headache, fullness in head
Facial swelling - periorbital oedema
SOB - worse on lying flat
Cough
Hoarse voice

10

Signs of SVC obstruction

Facial/ upper limb oedema
Prominent blood vessels on neck, trunk, arms
Cyanosis

11

Management of SVC obstruction

Dexamethasone relieves symptoms
Urgent vascular stenting followed by RT or chemo

12

Causes of hypercalcaemia

Commonly seen in breast, lung, squamous cell carcinomas + myeloma
Due to PTpH

13

Symptoms of hypercalcaemia

Develop insidiously
Early:
Lethargy
Anorexia
Polyuria
Thirst
N+V
Constipation

Late:
Confusion, drowsiness
Fits
Coma

14

Investigations for hypercalcaemia

Calcium corrected for serum albumin

15

Management of hypercalcaemia + max response time

Rehydration with saline + IV bisphosphonate (pamidronate or zolendronic acid)
Max response seen after 6-11 days

16

Management of major haemorrhage

Keep green towels close
IM of SC midazolam as sedative

17

What is Pemberton's sign?

Bilateral arm elevation causes facial plethora
Used to evaluate SVC obstruction

18

What cancers commonly cause SVC?

Lung, germ cell (testicular) + lymphoma