Flashcards in Oncology Emergencies Deck (16):
What emergencies fall into each of the following categories?
- right now this minute
-if not today, tomorrow
right now: neutropenic fever, tamponade, cord compression, CNS mets w/ sx
Today: coagulopathies, tumor lysis, leukostasis, hyperviscosity, severe thrombocytopenia, INR over 9
if not today, tomorrow: SVC syndrome, most hypercalcemia, most CNS mets w/o edema, INR 5-9
Spinal Cord Compression
-MC cancers causing this
-usually arise in which vertebrae?
-describe CA metastases to the spine
MC presentation is BACK PAIN!!! make sure to always get XRAY when seeing for 1st time.
-inflammation, paraesthesias, autonomic dysfunction follows motor/sensory
MC cancers causing this: breast, prostate, lung, and MM. They like to go to the bone.
Mets usually arise in the thoracic vertebrae.
mets: travel here through venous plexus and invades the epidural space and thecal sac.
Spinal Cord Compression:
-best initial evaluation?
Best initial evaluation is MRI of WHOLE SPINE! next best step is CT myelogram.
-Radiation therapy IF multiple levels
CNS metastases w/ Sx:
-signs and sx
-MC from what types of CA?
signs and sx:
-HA, seizures, altered mental status, focal deficits
MC from lung*, breast*, kidney, colorectal, and melanoma.
-MRI of whole brain
-decadron if edema
-dilantin if seizures
-surgery plus radiation therapy for isolated mets.
What is the MC type of brain tumor?
What is the MC intracranial tumor in adults?
Brain METASTATIC CA!!!!
Vascular events- Hyperviscosity:
-serum viscosity level
sx: sombolence, HA, blurry vision, dizziness
MC cause: Waldenstroms
others: polycythemia vera, essential thrombocytosis, MM
Serum viscosity is usually greater than 5cP
-apheresis for IgM plus chemotherapy
-phlebotomy for polycythemia vera
-Hydroxyurea (chemotherapy) and aspirin for essential thrombocytosis
Vascular Events- Leukostasis:
-MC associated with what type of CA?
-What is this?
MC associated with AML w/ WBC greater than 100,000
sx: altered mental status, coma, hypoxia, renal insufficiency
WHat: blood is thick with tones of white cells that are behaving inappropriately.
-quinton access(central catheter) (renal) and chemotherapy (onc)
-LP for cytology to rule in/out CNS leukemia
(Hydrate to dilute the blood since its very viscous. ; need rapid cytoreduction via chemotherapy. Will need prophylaxis for tumor lysis syndrome.)
-most commonly associated with which CA?
MC associated with Lung and breast CA
-big heart on CXR
-left/right sided failure
--distended neck veins
--muffled heart sounds (rub-velchro)
-electrical alternans, low voltage, ST elevation
Dx: echo and cytology from pericardiocentesis
- catheter drainage of fluid
-subxiphoid pericardial window or balloon pericardiotomy
Superior venacava syndrome:
-MC associated with what CA?
MC associated with lung (bronchogenic*)(Pancoast) CA, lymphoma, breast CA, mediastinal tumors
Sx: facial edema, symmetric or asymmetric upper extremity edema
*edema is worse in the AM and gets better as the day progresses.
-pulse ox (not hypoxic)
-chemo for CA
-heparin or corticosteroids
Tumor Lysis syndrome:
-when does this occur?
-MC with which CA??
When: occurs in tumors with high body burden and high chemosensitivity, occurs d/t therapy
Associated with : high grade lymphomas(Burketts) or leukemias, small cell, germ cell less common
Sx: few clinical sx other than being ill with obvious lab abnormalities due to RENAL FAILURE.
-blood in urine
-correct conditions that make effects worse: dehydration, renal obstruction, IV contrast
-D5 with 1/2 NS and insulin(drives K+ into cells)
-allopurinol (keeps uric acid production down)
-Kayexalate (lowers K)
-may use dialysis
-MC associated with what CA?
MC associated with breast, lung, MM, squamous CA (make PTH-rP)
Sx: fatigue, n/v, constipation, anorexia, apathy, decreased consciousness
-IV pamidronate ( slows down the breakdown of bone)
-MC CA associated
-sx at serum Na levels
--less than 120
--less than 110
MC associated with small cell
-less than 120: anorexia, irritability, n/v, constipation, muscle weakness, myalgia
-less than 110: seizure, death, coma, abnormal relfexes, papilledema
-treat the underlying tumor
-limit fluid intake to 500-1000ml/day
-parenteral Na replacement with severe neurological sx
-duration of neutropenia determines organism,
Sx: initially subtle, then rapid development of hypotension, dyspnea, sepsis
Short term: gram -
Long term: fungal, viral, opportunistic
Cause: chemotherapy, usually 10-15 days after chemo is given
-treat the source of the problem or you treat emperically.
-Cefipime, moxifloxacin, Pip/gent, aztreonam
Cause: idiopathic. immune
-mucosal bleeding, epistaxis, gingival bleeding, bullous hemorrhage
-cutaneous bleeding, petechiae, ecchymoses
-be sure its not TTP, DIC, HIT, Hellp
-check smear, LDH, PT/PTT, fibrinogen, CBC, any heparin use?
-if actively bleeding you transfuse (hgb less than 7)
-Prednisone if pt well
-IVIG if ill