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Oncology Emergencies

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Spinal Cord Compression

  • New/escalating back pain at rest, may progress to motor/sensory neurologic deficits

  • MRI whole spine

  • Treat with steroids, and consider surgery/radiotherapy

Superior Vena Cava Obstruction

  • Lung cancer, lymphoma

  • Treat symptoms (SOB, pain, anxiety)

  • Treat with steroids, radiotherapy, chemotherapy, stents

Hypercalcemia

  • Multiple myeloma, breast, NSCLC

  • Symptomatic (weakness, confusion, coma) above corrected calcium >3mmol/L

  • Treatment

    • Stop calcium intake (supplements)

    • IV hydration (eg. NS 200-300mL/h for urine output of 100-150mL/h)

    • Severe if calcium>3.5mmol/L and symptomatic

      • Consider calcitonin +/- zoledronic acid/pamidronate

        • Consider denosumab in longterm control

      • Consider glucocorticoids in lymphomas, sarcoid, granulomatous

      • Consider calcimimetic and hemodialysis if renal failure or calcium >5mmol/L

Pericardial Tamponade

  • Percutaneous or surgical drainage of pericardial effusion

Tumor lysis syndrome

  • Myalgia, dark urine, seizure, AKI

    • Supportive care

      • Hydration, follow potassium, creatinine, phosphate, calcium and uric acid

    • Consider rasburicase for uric acid

Febrile neutropenia

  • T>38, ANC<0.5

    • Empiric antibiotics and pan-culture

 

 

References:

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