Oncological Emergencies Flashcards Preview

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Flashcards in Oncological Emergencies Deck (42):
1

When is neutropenic sepsis most likely to occur?

7-14 days post-chemo

2

What is neutropenic sepsis defined as?

Patients undergoing treatment whose neutrophil count is <1x10^9, with either:
1. Temperature >38
2. Other signs consistent with sepsis

3

What is febrile neutropenia?

60-70% of fevers during neutropenia have no identifiable ateology

4

How is neutropenic sepsis managed?

Broad spectrum antibiotics within 1 hour

5

What is a MASCC score?

Assessment of the risk of complications during a febrile neutropenic episode

6

What tumours is hypercalcaemia most common in?

Breast, lung, prostate, SCC, myeloma

7

What is normal calcium homeostasis when there is an increase in blood calcium?

Thyroid releases calcitonin

Promotes osteoblasts to deposit calcium in bones & reduces absorption in the kidneys

Calcium blood level falls

8

What is normal calcium homeostasis when there is a decrease in blood calcium?

Parathyroid releases PTH

Promotes osteoclasts to release calcium from bones (resorption)

Stimulates absorption by the kidney

Activates vitamin D (stimulates bowel to absorb calcium)

9

What is transforming growth factor alpha?

What does it do?

Stimulator of cell growth, produced by many tumour cells

Stimulates bone resorption

10

What is PTH related peptide

Mimics PTH

Stimulates bone resporption & increases plasma calcium

11

Hypercalcaemia presentation:
CNS

Confusion
Seizures
Proximal neuropathy
Hyporeflexia
Coma

12

Hypercalcaemia presentation: GI

Nausea & vomiting
Constipation
Dyspepsia
Abdo pain

13

Hypercalcaemia presentation: Cardiac

Bradycardia
ECG changes
Arrhythmia
Hypertension

14

Hypercalcaemia presentation: other

Dehydration
Weakness
Fatigue
polyuria
Bone pain

15

What ECG changes may you see in hypercalcaemia?

Short QT interval

Wide T wave

Prolonged PR

16

How is hypercalcaemia managed?

1. Normal saline quarter hourly for 24 hours (then 6 hourly for 48-72 hours with adequate K+)

2. IV Bisphosphonates

17

Give 2 examples of bisphosphonates

Pamindronate

Zolendronic acid

18

Side effects of bisphosphonates

Oesophagitis

Osteonecrosis of the jaw

19

How do bisphosphonates work?

Inhibit osteoclastic bone resorption, reducing amount of calcium from bones released into blood

20

How are seizures/ arrhythmias from hypercalcaemia managed?

How are they given?

Calcitonin & corticosteroids

S/C calcitonin with oral prednisolone

21

What is the pathophysiology of MSCC?

Direct compression by vertebral collapse

Or direct extension of malignancy

22

Which part of the spine is MSCC most common in?

Thoracic

23

Which cancers is MSCC most common in?

Prostate, breast, lung, myeloma, lymphoma

24

What % of people with MSCC have no pain?

40% painless

25

How is the pain from MSCC usually described?

'Band-like' pain

26

What is the initial management for suspected MSCC?

16 mg dexamethasone (+ PPI)

Urgent MRI (within 24 hours)

27

How does dex help in MSCC?

Reduces swelling & oedema around the tumour & reduces pressure on the spinal cord

28

What are the 3 definitive treatment options for MSCC?

Spinal surgery
Radiotherapy
Chemotherapy

29

when is surgery indicated for MSCC?

Single site & good prognosis, few co-morbidities

30

How is radiotherapy given for MSCC?

Single fraction of radiotherapy

Mainstay of treatment for MSCC

31

When would you give chemo for MSCC?

In a very chemosensitive cancer

e.g. SCLC, germ cell tumour, lymphoma

32

If patients are treated in <24 hours, how many are able to walk again?

60%

33

What is the pathophysiology of SVC obstruction?
(3)

Extrinsic compression, thrombosis or invasion of the wall of the SVC

34

What is the most common cause of SVC obstruction?

Extensive lymphadenopathy in the upper mediastinum

35

What cancers most commonly cause SVC obstruction?
(2)

Lung cancer & lymphoma

36

How does SVC obstruction present?

Breathlessness, headache, swelling in the face, neck or arm
Distented neck & chest veins
Cyanosis
Visual disturbance

37

What are the features of headache in SVC obstruction

Worse on coughing & worse in the morning

38

What is the immediate management of SVC obstruction?

16mg dexamethasone daily

39

What procedure is needed urgently in SVC obstruction?

Urgent vascular stenting

40

What treatment is needed following stenting?

Radiotherapy or chemotherapy

41

What should be done if SVC obstruction is the initial presentation of a cancer?

Biopsy (N.B. tumour likely to progress rapidly)

42

Give two alternative causes of SVC obstruction

Goitre
Aortic aneurysm