Flashcards in Oncological Emergencies Deck (42):
When is neutropenic sepsis most likely to occur?
7-14 days post-chemo
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
What is febrile neutropenia?
60-70% of fevers during neutropenia have no identifiable ateology
How is neutropenic sepsis managed?
Broad spectrum antibiotics within 1 hour
What is a MASCC score?
Assessment of the risk of complications during a febrile neutropenic episode
What tumours is hypercalcaemia most common in?
Breast, lung, prostate, SCC, myeloma
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
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)
What is transforming growth factor alpha?
What does it do?
Stimulator of cell growth, produced by many tumour cells
Stimulates bone resorption
What is PTH related peptide
Stimulates bone resporption & increases plasma calcium
Hypercalcaemia presentation: GI
Nausea & vomiting
Hypercalcaemia presentation: Cardiac
Hypercalcaemia presentation: other
What ECG changes may you see in hypercalcaemia?
Short QT interval
Wide T wave
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
Give 2 examples of bisphosphonates
Side effects of bisphosphonates
Osteonecrosis of the jaw
How do bisphosphonates work?
Inhibit osteoclastic bone resorption, reducing amount of calcium from bones released into blood
How are seizures/ arrhythmias from hypercalcaemia managed?
How are they given?
Calcitonin & corticosteroids
S/C calcitonin with oral prednisolone
What is the pathophysiology of MSCC?
Direct compression by vertebral collapse
Or direct extension of malignancy
Which part of the spine is MSCC most common in?
Which cancers is MSCC most common in?
Prostate, breast, lung, myeloma, lymphoma
What % of people with MSCC have no pain?
How is the pain from MSCC usually described?
What is the initial management for suspected MSCC?
16 mg dexamethasone (+ PPI)
Urgent MRI (within 24 hours)
How does dex help in MSCC?
Reduces swelling & oedema around the tumour & reduces pressure on the spinal cord
What are the 3 definitive treatment options for MSCC?
when is surgery indicated for MSCC?
Single site & good prognosis, few co-morbidities
How is radiotherapy given for MSCC?
Single fraction of radiotherapy
Mainstay of treatment for MSCC
When would you give chemo for MSCC?
In a very chemosensitive cancer
e.g. SCLC, germ cell tumour, lymphoma
If patients are treated in <24 hours, how many are able to walk again?
What is the pathophysiology of SVC obstruction?
Extrinsic compression, thrombosis or invasion of the wall of the SVC
What is the most common cause of SVC obstruction?
Extensive lymphadenopathy in the upper mediastinum
What cancers most commonly cause SVC obstruction?
Lung cancer & lymphoma
How does SVC obstruction present?
Breathlessness, headache, swelling in the face, neck or arm
Distented neck & chest veins
What are the features of headache in SVC obstruction
Worse on coughing & worse in the morning
What is the immediate management of SVC obstruction?
16mg dexamethasone daily
What procedure is needed urgently in SVC obstruction?
Urgent vascular stenting
What treatment is needed following stenting?
Radiotherapy or chemotherapy
What should be done if SVC obstruction is the initial presentation of a cancer?
Biopsy (N.B. tumour likely to progress rapidly)