Cancer Emergencies

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