Cancer Emergencies
·
Spinal Cord Compression:
o Irreversible damage occurs quickly. Even if poor prognosis from cancer mobility makes a key difference to quality of life and to ease of nursing at home, etc
o Symptoms: pain (often dermatomal at the level of the lesion), weakness,
autonomic dysfunction, sensory loss
o 95% is extramedullary compression.
Thoracic > lumbosacral > cervical
o Primary tumours: lung, breast, prostate, lymphoma (very radiation
sensitive), myeloma, kidney
o Differential: infective or mechanical
o Contraindications to Radiotherapy: previous RT (already irradiated to spinal tolerance), radio-resistant tumour (eg myeloma), no tissue diagnosis (ie don‟t know what you‟re treating)
o Contraindications to surgery: widespread systemic disease, multiple
levels, vertebral body collapse, known radio-sensitive tumour
o CXR usually done but MRI is investigation of choice
·
Cauda Equina syndrome
·
Superior Vena Cava Syndrome:
o Compression causing thoracic and neck vein distension, facial and arm (maybe unilateral) oedema
o Causes: CNS symptoms (Headache, visual disturbance, dizziness, blackout, altered conscious state), venous thrombosis
o Usually due to lung cancer, also lymphoma and metastases. Benign causes
include goitre, fibrosis, sarcoidosis, syphilis, etc
o Investigations: examination, CXR, CT (rather than MRI), biopsy (maybe US
guided)
o Treatment:
§ Anticoagulant + thrombolysis if established clot (eg neck veins not
compressible)
§ Endovascular stent if recurrent
§ Chemotherapy: small cell lung cancer (80% response), Hodgkin‟s Lymphoma
or Non-Hodgkin‟s lymphoma
§ Radiotherapy: any other malignant cause (80% response)
·
Hypercalcaemia: stones, groans
and moans, also thirst. Tx: Rehydrate +
Bisphosphonates
·
Pathological fracture:
orthopaedic referral to stabilise
·
Haemorrhage: tumours bleed
easily, erosion into an artery
· Obstruction:
o Trachea ® stridor. Mainly extrinsic compression.
Options: RT, steroids (¯oedema), tracheostomy
· Bronchus: dyspnoea
·
Oesophagus: Dysphagia. Usually
progressive not an emergency. Lodged bolus can present acutely
·
Bowel
·
Ureter
Related Topics
Privacy Policy, Terms and Conditions, DMCA Policy and Compliant
Copyright © 2018-2023 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.