38 Questions
What is the primary cause of Tumor Lysis Syndrome?
The rapid destruction of cancer cells due to chemotherapy
What type of oncologic emergency is characterized by the compression of the spinal cord?
Mechanical or Obstructive problems
What is the term for a group of disorders that occur when a cancerous tumor produces hormones or other substances that affect distant organs?
Paraneoplastic Syndromes
What is the term for a blockage of the superior vena cava, which is a major vein that carries blood from the upper body to the heart?
Superior Vena Cava Syndrome (SVCS)
A patient with cancer in the liver most likely has a metastatic cancer from another organ, which is an example of what type of oncologic emergency?
Mechanical or Obstructive problems
Which type of cancer is most likely to be associated with paraneoplastic syndromes?
Small cell lung cancer
What is the clinical manifestation of superior vena cava (SVC) obstruction?
Superior Vena Cava Syndrome
What is the most common site of malignant spinal cord compression?
Thoracic spine
What is the primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors?
Radiation therapy
What is the mechanism of hypercalcemia caused by cytokine disruption in cancer patients?
Systemic effects of tumor-released proteins
What is the diagnostic test of choice for evaluating spinal cord compression in patients with cancer?
MRI
What is the corrected calcium formula in patients with cancer?
Corrected calcium = measured calcium – measured albumin + 4
What is the characteristic physical finding in patients with Superior Vena Cava Syndrome?
All of the above
What is the primary goal of treatment in patients with Spinal Cord Compression?
Restoration of neurologic function
What is the common symptom of Hypercalcemia that can be differentiated from disk disease?
Worsening pain when supine
Why is the calcium level not a reliable indicator of hypercalcemia in cancer patients?
Because of malnutrition and liver dysfunction, which affect albumin levels
What is the initial step in emergency management of hypercalcemia?
IV administration of 0.9% saline
Why is treatment of hypercalcemia less vigorous in patients with late-stage, resistant tumors?
Because high calcium levels can have a mild sedating effect
What is the predictable consequence of cytotoxic chemotherapeutic agents on bone marrow function?
A characteristic nadir count of each cell type
What is the clinical presentation of febrile neutropenia?
Fever and neutropenia
What is the primary goal of treating hypercalcemia in patients with a good chance of effective tumor therapy?
To vigorously control hypercalcemia while awaiting the results of definitive therapy
What is the primary reason why patients with a known cancer diagnosis may experience a common oncologic emergency condition?
Because of the cancer diagnosis itself
What is the primary concern when a patient with cancer is experiencing Tumor Lysis Syndrome?
The patient will be metabolically damaged
Which of the following oncologic emergencies is classified as a metabolic or hormonal problem?
Paraneoplastic Syndromes
What is the characteristic of cancer in the liver?
It is a metastatic cancer from another organ
What is the primary reason for the clinical presentation of superior vena cava syndrome?
Obstruction of the superior vena cava
What is the primary benefit of treating hypercalcemia vigorously in patients with a good chance of effective tumor therapy?
It enhances the effectiveness of antitumor therapy
Which type of cancer is most likely to cause paraneoplastic syndromes?
Small cell lung cancer
Why is IV 0.9% saline used in the emergency management of hypercalcemia?
To ensure rehydration with brisk urinary output
What is the primary treatment for superior vena cava syndrome caused by non-small-cell lung cancer and other metastatic solid tumors?
Radiation therapy
What is the predictable consequence of cytotoxic chemotherapeutic agents on bone marrow function?
Inhibition of bone marrow stem cells
What is the mechanism of hypercalcemia caused by vitamin D–mediated osteoabsorption?
Vitamin D–mediated osteoabsorption
What is the primary reason why the calcium level is not a reliable indicator of hypercalcemia in cancer patients?
Cancer patients often have a low albumin level
What is the primary goal of treating hypercalcemia in patients with late-stage, resistant tumors?
To alleviate the symptoms of hypercalcemia
What is the corrected calcium formula in patients with cancer?
Corrected calcium = measured calcium – measured albumin + 4
What is the characteristic presentation of febrile neutropenia?
Fever and neutropenia
What is the characteristic physical finding in patients with superior vena cava syndrome?
Dilated neck veins
What is the common symptom of hypercalcemia that can be differentiated from disk disease?
Localized back pain exacerbated by movement
Study Notes
Oncologic Emergencies
- Oncologic emergencies are classified into three groups: mechanical/obstructive, metabolic/hormonal, and treatment-related complications.
- Patients can present with a common oncologic emergency condition, leading to a cancer diagnosis.
Classifications of Oncologic Emergencies
Mechanical/Obstructive
- SVCS (Superior Vena Cava Syndrome)
- MSCC (Malignant Spinal Cord Compression)
- Neutropenia
- Tumor Lysis Syndrome
Metabolic/Hormonal
- Hypercalcemia
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
- Bleeding Disorders
- Malignant Effusions
- Paraneoplastic Syndromes
Treatment-Related
- Anemia
- Pulmonary Embolism
- Thrombocytopenia
- Urinary Obstruction
- Clotting Disorders
Paraneoplastic Syndromes
- General problems observed in many patients with advanced or widespread metastatic cancer include anorexia, malaise, and weight loss.
- Symptoms are due to aberrant tumor production of hormones, peptides, or cytokines or to the body’s immune attack on normal tissues due to shared antigens with tumor tissues.
- Small cell lung cancer (SCLC) is the one type of cancer most likely to be associated with paraneoplastic syndromes.
Superior Vena Cava Syndrome (SVCS)
Pathophysiology
- SVCS is the clinical manifestation of superior vena cava (SVC) obstruction.
- Malignant tumors (lung cancer, lymphoma, metastatic tumors) are responsible for the majority of SVCS cases.
Presentation
- Patients present with neck and facial swelling, dyspnea, and cough.
- Other symptoms include hoarseness, tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope, and lethargy.
Diagnostic Workup
- Diagnosis of SVCS is clinical.
- Chest radiograph (CXR) is the first step, showing widening of the superior mediastinum.
- CT provides the most reliable view of the mediastinal anatomy.
Treatment
- Radiation therapy is the primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors.
- Diuretics with a low-salt diet, head elevation, and supplemental oxygen may produce temporary symptomatic relief.
Spinal Cord Compression (MSCC)
Pathophysiology
- MSCC is defined as compression of the spinal cord and/or cauda equina by an extradural tumor mass.
- Thoracic spine is the most common site (70%), followed by lumbosacral spine (20%), and cervical spine (10%).
Presentation
- Most common initial symptom is localized back pain and tenderness.
- Pain is exacerbated by movement and by coughing or sneezing and can be differentiated from the pain of disk disease by the fact that it worsens when the patient is supine.
Diagnostic Workup
- Patients with cancer who develop back pain should be evaluated for MSCC as quickly as possible.
- Plain films of the spine and MRI are used in diagnosis.
Treatment
- Treatment is aimed at relief of pain and restoration/preservation of neurologic function.
- Management requires a multidisciplinary approach.
- Radiation therapy plus glucocorticoids is the initial treatment of choice for most patients with MSCC.
Hypercalcemia
Pathophysiology
- Elevated levels of calcium in the blood (>10.5 mg/dL).
- Hypercalcemia affects 20–30% of patients with cancer at some point during their illness.
- Most common cancers causing hypercalcemia are myeloma, breast carcinoma, and NSCLC.
Presentation
- Symptoms and signs can be subtle; more severe symptoms occur with higher levels of hypercalcemia and with a rapidly rising calcium level.
- Early symptoms include anorexia, nausea, fatigue, constipation, and polyuria.
Diagnostic Workup
- Corrected calcium level is calculated to account for low albumin levels in cancer patients.
- Ionized calcium level is a more specific and sensitive test.
- ECG in hypercalcemia often shows a shortening of the QT interval.
Treatment
- Emergency management begins with IV 0.9% saline to ensure rehydration with brisk urinary output.
- For moderate or severe hypercalcemia, treatment with bisphosphonate is indicated.
- Treatment is then directed to control of the tumor; reduction of tumor mass usually corrects hypercalcemia.
Oncologic Emergencies
- Oncologic emergencies are classified into three groups: mechanical/obstructive, metabolic/hormonal, and treatment-related complications.
- Patients can present with a common oncologic emergency condition, leading to a cancer diagnosis.
Classifications of Oncologic Emergencies
Mechanical/Obstructive
- SVCS (Superior Vena Cava Syndrome)
- MSCC (Malignant Spinal Cord Compression)
- Neutropenia
- Tumor Lysis Syndrome
Metabolic/Hormonal
- Hypercalcemia
- SIADH (Syndrome of Inappropriate Antidiuretic Hormone)
- Bleeding Disorders
- Malignant Effusions
- Paraneoplastic Syndromes
Treatment-Related
- Anemia
- Pulmonary Embolism
- Thrombocytopenia
- Urinary Obstruction
- Clotting Disorders
Paraneoplastic Syndromes
- General problems observed in many patients with advanced or widespread metastatic cancer include anorexia, malaise, and weight loss.
- Symptoms are due to aberrant tumor production of hormones, peptides, or cytokines or to the body’s immune attack on normal tissues due to shared antigens with tumor tissues.
- Small cell lung cancer (SCLC) is the one type of cancer most likely to be associated with paraneoplastic syndromes.
Superior Vena Cava Syndrome (SVCS)
Pathophysiology
- SVCS is the clinical manifestation of superior vena cava (SVC) obstruction.
- Malignant tumors (lung cancer, lymphoma, metastatic tumors) are responsible for the majority of SVCS cases.
Presentation
- Patients present with neck and facial swelling, dyspnea, and cough.
- Other symptoms include hoarseness, tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope, and lethargy.
Diagnostic Workup
- Diagnosis of SVCS is clinical.
- Chest radiograph (CXR) is the first step, showing widening of the superior mediastinum.
- CT provides the most reliable view of the mediastinal anatomy.
Treatment
- Radiation therapy is the primary treatment for SVCS caused by non-small-cell lung cancer and other metastatic solid tumors.
- Diuretics with a low-salt diet, head elevation, and supplemental oxygen may produce temporary symptomatic relief.
Spinal Cord Compression (MSCC)
Pathophysiology
- MSCC is defined as compression of the spinal cord and/or cauda equina by an extradural tumor mass.
- Thoracic spine is the most common site (70%), followed by lumbosacral spine (20%), and cervical spine (10%).
Presentation
- Most common initial symptom is localized back pain and tenderness.
- Pain is exacerbated by movement and by coughing or sneezing and can be differentiated from the pain of disk disease by the fact that it worsens when the patient is supine.
Diagnostic Workup
- Patients with cancer who develop back pain should be evaluated for MSCC as quickly as possible.
- Plain films of the spine and MRI are used in diagnosis.
Treatment
- Treatment is aimed at relief of pain and restoration/preservation of neurologic function.
- Management requires a multidisciplinary approach.
- Radiation therapy plus glucocorticoids is the initial treatment of choice for most patients with MSCC.
Hypercalcemia
Pathophysiology
- Elevated levels of calcium in the blood (>10.5 mg/dL).
- Hypercalcemia affects 20–30% of patients with cancer at some point during their illness.
- Most common cancers causing hypercalcemia are myeloma, breast carcinoma, and NSCLC.
Presentation
- Symptoms and signs can be subtle; more severe symptoms occur with higher levels of hypercalcemia and with a rapidly rising calcium level.
- Early symptoms include anorexia, nausea, fatigue, constipation, and polyuria.
Diagnostic Workup
- Corrected calcium level is calculated to account for low albumin levels in cancer patients.
- Ionized calcium level is a more specific and sensitive test.
- ECG in hypercalcemia often shows a shortening of the QT interval.
Treatment
- Emergency management begins with IV 0.9% saline to ensure rehydration with brisk urinary output.
- For moderate or severe hypercalcemia, treatment with bisphosphonate is indicated.
- Treatment is then directed to control of the tumor; reduction of tumor mass usually corrects hypercalcemia.
This quiz covers the classification of oncologic emergencies into mechanical/obstructive, metabolic/hormonal, and treatment-related complications, and their diagnosis.
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