What are the four main oncology emergencies?
superior vena cava obstruction
neutropenic sepsis
spinal cord compression
hypercalcaemia
what is the difference between neutropenic sepsis and neutropenic fever?
there is no haemodynamic compromise in neutropenic fever
what bacteria most commonly causes neutropenic sepsis?
endogenous flora
is most of endogenous flora that causes neutropenic sepsis gram + or -?
gram - bacilli
what three things are required to make a diagnosis of neutropenic sepsis ?
fever
neutrophils <1x10^9
haemodynamic compromise (hypotension, tachycardia)
what investigations should be done for netropenic sepsis ?
FBC, blood cultures, coagulation screen CRP, U&Es MSSU, stool culture sputum culture, throat swab CXR
what is the treatment for neutropenic sepsis?
IV fluids
O2
broad spectrum Abs (pipercilliin, tazobactam, gentamicin)
what are some causes of superior vena cava obstruction ?
bronchogenic tumour lymphoma metastatic tumours SVC thrombosis mediastinal fibrosis (from RT/chemo)
what is the presentation of neutropenic sepsis ?
hypotension, tachycardia
asymptomatic
fever
what is the presentation of SVC obstruction?
headache dyspnoea plethora swollen arms/face engorged neck veins
what investigations should be done for SVC obstuction?
CXR, CT
superior venocavogram
bronchoscopy
what is pembertons sign?
arms raised above head for >1min
- facial plethora
- increased JVP
- inspiratory stridor
what causes pembertons sign?
narrowing of thoracic inlet
what is the management of SVC obstruction ?
steroids RT/chemo stenting thrombolysis anticoagulation
what two things need to be considered before giving steroids ?
monitor glucose
give gastric protection
what locations of cancer commonly spread to bone?
breast lung prostate myeloma renal
what investigations should be done for spinal cord compression?
whole spine MRI
check Ca
what symptoms does spinal cord compression have?
back pain/tenderness (usually the first sign - try and catch early) weakness UMN pattern (hyporeflexia/tonia, brisk reflexes) bladder and bowel dysfunction radicular pain along dermatome (worse when coughing and sneezing)
what can occur if the spinal cord compression is above T6?
spinal shock can occur
- sympathetic response disruption causing vasodilation and hypotension
what is the treatment for spinal cord compression?
lie flat steroids RT surgery (laminectomy) chemo
what are the main causes of hypercalaemia ?
bony mets
paraneoplastic syndrome
what investigations should be done for hypercalaemia ?
Ca, PTH, CXR, isotope bone scan
state some signs of hypercalcaemia ?
stones, bones, groans, moans
renal stones, polyuria, polydipsia
pathological fractures
fatigue, abdo pain, constipation
depression, confusion
what is the treatment for hypercalcaemia ?
rehydrate (0.9% saline)
diuretics to increase fluid intake
bisphosphonates (give PPI)
what prophylaxis is used for neutropenic sepsis ?
co-trimoxazole
what is a complication of tumour lysis syndrome ?
renal failure
what are the levels of K, urate, PO4 and Ca in tumour lysis syndrome ?
↑K, ↑urate, ↑PO4, ↓Ca
→ renal failure