Oncological Emergencies
Febrile Neutropenic patients
These pts can get ill v quickly in hours.
Diagnosis
Assume neutropenic sepsis if:
-
Have received chemo in last 4m, or
-
Acute haematological malignancy eg AML, ALL or
-
Neutrophil count ≤0.5×10^9 /l
(normally 1.8 - 7) or
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Temp > 38 or
-
Any of above and signs of clinical deterioration, such as:
shock (BP<90), HR>100, raised RR, respiratory distress,
hypoxia or
-
Multiple organ failure
Treatment
-
Tazocin (IV) + Gentamicin for a minimum of 5d and 24h
afebrile
-
Consult microbiologist
-
Deterioration: change to imipenem
Spinal Cord Compression
Causes
Extradural mets typically
Clinical
Back pain with root distribution, weakness, sensory loss, bowel and
bladder dysfunction
Investigation
Urgent MRI of whole spine
Treatment
Dexamethasone. Discuss with neurosurgeon or clinical oncologist
immediately.
SVC obstruction with airway compromise
Causes
Lung Ca mainly. Rarer: mediastinal enlargement (eg. GCT), ↑LNs, thymus
malignancy, thrombotic disorders (eg Behcets), thrombus around IV
central line, hamartoma.
Signs/Symptoms
Dyspnoea, orthopnoea, swollen face and arms, cough, plethora/cyanosis,
headache, engorged Veins
Pemberton's test
: lifting the arms over the head for
>1m gives facial plethora/cyanosis, raised JVP, inspiratory
stridor
Investigation
Sputum cytology, CXR, CT, venography
Treatment
Tissue diagnosis soon if undiagnosed. Dexamethasone. Consider balloon
venography and SVC stenting. Radiotherapy.
Hypercalcaemia
10-29% of those with cancer, especially myeloma
Aetiology
Lytic bone mets, production of osteoclast activating factor
Symptoms
Lethergy, anorexia, nausea, polydipsia, polyuria, constipation,
dehydration, confusion, weakness
Treatment
Rehydrate w IV saline over 24h. Avoid diuretics. Bisphosphonates IV.
Raised Intracranial Pressure
Due to primary or secondary
Clinical
Headache (classically worse in morning), nausea/vomiting, papilloedema,
fits, focal neuro signs
Investigation
Urgent CT: expanding mass, cystic degeneration, haemorrhage, oedema,
hydrocephalus
Treatment
Dexamethasone, radiotherapy, surgery if approp
Tumour Lysis syndrome
Rapid cell death on starting chemo for rapidly proliferating leukaemia,
lymphoma, myeloma, and some GCTs can cause hyperkalaemia,
hyperphosphatataemia and renal failure
Prevention
Hydration, allopurinol 24h before chemo. Haemodialysis may be needed in
renal failure.
