Oncological Emergencies Flashcards
4 common oncological emergencies
Sepsis (neutropenic)
Spinal cord compression
Hypercalcaemia
Superior Vena Cava Obstruction (SVCO)
Expected presentation of a patient with sepsis
5-12 days following chemotherapy treatment High temperature High HR High RR Low BP General malaise/fatigue Bloods - low WCC (neutrophils)
Management for neutropenic sepsis
ABC approach
Investigate and treat sepsis aggressively
3in
- oxygen
- IV antibiotics (broad spectrum tazocin or meropenem)
- fluids
3 out
- blood cultures
- VBG/ABG (lactate)
- catheterise (urine output)
Presentation of spinal cord compression
Known metastatic cancer
Worsening (thoracic) back pain
Difficulty walking
Bilateral leg weakness
Red Flags for back pain
R -referred pain (multi segmental/band like)
E -escalating pain, poorly responsive
D -differnent character/site to previous symptoms
F -funny feelings/odd sensations
L -lying flat increases pain (also laughing/coughing)
A -agonising pain
G -gait disturbance/unsteadiness (first sign may be difficulty climbing stairs)
S -sleep disturbance (pain worse @ night)
How common is spinal cord compression?
Present in 5% of all cancer patients
For how many patients is metastatic spinal cord compression their first presentation?
20%
How commonly is thoracic spine affected?
60%
Management of spinal cord compression
High dose steroids - dexamethasone 16mg stat then 8mg BD
Flat bed rest
Investigate with MR whole spine within 24 hours - assess spinal stability- bed rest/mobilisation
CT chest abdomen and pelvis to help inform decision about surgery
Organise definitive treatment
Presentation of SVCO
Dyspnoea
Neck and face swelling
Headache
Blurred vision
Where is cancer causing SVC obstruction most commonly found?
Right upper lobe
Upper mediastinum
Primary lung tumour or lymph node
How is SVCO confirmed?
Contrast CT
Management of SVCO
ABC
High dose steroids (16mg Dex stat, 8mg BD)
Ongoing management depends on underlying diagnosis/prognosis
Stents sometimes used
Chemotherapy/radiotherapy
Presentation of hypercalcaemia
Acute abdomen
Nausea
Dehydration
Confusion
Causes of hypercalcaemia
Primary hyperparathyroidism Cancer Drugs Granulomatous diseases Endocrine Familial