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Oncologic Emergencies
Just Stuff. (Can you tell I'm starting to hate studying for this?!)
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11/04/2012

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Term
Types of Oncologic Emergencies
Definition
Mechanical, Infectious, Hematologic, Metabolic
Term
Mechanical Emergencies
Definition
Cardiopulmonary, Cardiac tamponade, Central nervous systems,abdominal, obstructive uropathy, extravasation
Term
Cardiopulmonary emergencies
Definition
Pericardial effusions
Term
Cardiac tamponade emergencies
Definition
Superior vena cava syndrome, Airway obstruction
Term
Central nervous system emergencies
Definition
spinal cord compression, carcinomatous meningitis, seizures, cerebral herniation
Term
Abdominal emergencies
Definition
acute diarrhea
Term
Obstructive uropathy emergencies
Definition
pancreatitis, hemorrhagic cystitis
Term
infectious emergencies
Definition
neutropenic fever, sepsis
Term
hematologic emergencies
Definition
thrombosis, DIC
Term
metabolic emergencies
Definition
hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, adrenal failure, lactic acidosis
Term
Set of metabolic abnormalities that result from acute destruction of neoplastic cells and release of their inracellular contents into circulation
Definition
Tumor Lysis Syndrome
Term
TLS leads to
Definition
hyperuricemia, hyperphosphatemia and hypocalcemia, hyperkalemia, ureteral obstruction
Term
TLS can lead to this without proper prevention and treatment (50% mortality rate!)
Definition
renal failure, uric acid nephropathy and nephrolithiasis
Term
Malignancy type
Definition
proliferation rate, size, sensitivity to therapy
Term
risk of TLS depends on
Definition
malignancy type, extent of disease, type of treatment
Term
baseline considerations for TLS
Definition
Renal function, hydration, pre-existing metabolic abnormalities
Term
TLS is most commony associated with
Definition
Leukemia, high grade lymphomas
Term
in TLS, less common but ocurs with solid tumors
Definition
small cell lung cancer, breast cancer, multiple myeloma, squamous-cell carcinomas
Term
Prevention of Tumor Lysis Syndrome
Definition
IV fluids, urinary alkalinzation, allopurinol, serum electrolytes
Term
Block tubular reabsorption of uric acid
Definition
aspirin, radiographic contrast, probenecid, thiazide diuretics, salicylates, etc
Term
treatment of Tumor Lysis Syndrome
Definition
Alkalinization of urine, Allopurinol, Rasburicase
Term
inhibits xanthine oxidase from converting purine breakdown into uric acid
Definition
Allopurinol
Term
enzyme that catalyzes the oxidation of uric acid into allantoin
Definition
Rasburicase
Term
Patients with this deficiency are unable to neutralize hydrogen peroxide and therefore cannot take Rasburicase
Definition
glucose 6 phosphate and dehydrogenase (G6PD)
Term
Most frequent metabolic emergency in cancer patients
Definition
Hypercalcemia of malignancy
Term
Hypercalcemia of malignancy
Definition
rate of calcium mobilization from bone exceeds renal ability to excrete
Term
>80% of cancer patients with hypercalcemia have this
Definition
osseous metastases
Term
stimulates cancer cells to produce osteolytic prostaglandins that leads to increased bone resorption
Definition
Hormone therapy
Term
May occur when treating with Rasburicase
Definition
Methemoglobinemia
Term
Hypercalcemia of malignancy occurs most frequently in:
Definition
breast cancer, multiple myeloma, lung cancer
Term
Acute signs/symptoms hypercalcemia malignancy
Definition
nausea, vomiting, constipation, polyuria, polydipsia, muscle weakness, acute renal insufficiency, mental status change, EKG changes
Term
Chronic hypercalcemia malignancy symptoms
Definition
kidney stones, bone pain, depression, weight loss, fatigue, lethargy
Term
Treatment of hypercalcemia malignancy
Definition
hydration and diuresis, bisphosphonate, calcitonin
Term
inhibit osteoclast activity, usually need to help sustain lowered calcium levels
Definition
bisphosphonates
Term
Bisphonate given IV over 2-24 hours
Definition
Pamidronate
Term
Bisphonate given IV bolus over 5 min or 15 min infusion
Definition
Zoledronate
Term
Zoledronate
Definition
higher response rates compared to pamidronate, longer druation of responses (Several weeks)
Term
Bisphonate given IV bolus -- similar response rates but longer time period to relapse
Definition
Ibandronate
Term
Bisphonates
Definition
take 1-2 days to see response with maximum response around 7 days
Term
Side effects of bisphonates
Definition
renal insufficiency, fever, skeletal pains, FSGS
Term
begins to lower calcium in 1-2 hours
Definition
Calcitonin
Term
side effects of calcitonin
Definition
facial flushing, nausea/vomiting, allergic reaction, caution tachyphylaxis (should be given with a glucocorticoid)
Term
Tumor growth that develop into epidural metastases
Definition
spinal cord compression
Term
Spinal cord compression can be due to
Definition
non-mechanical causes (radiation myelopathy, toxicity of cytotoxic drugs, carcinomatous myopathy)
Term
SCC most often occurs in
Definition
carcinomas of the breast, lung, and prostate
Term
Signs/Symptoms of spinal cord compression
Definition
Pain-- acute or gradual, central or radicular back pain, worsened in recumbency, weight-bearing, coughing, sneezing, valsalva maneuver, and is relieved by sitting up
Term
Treatment of spinal cord compression
Definition
corticosteroids, radiation therapy, surgery, chemotherapy
Term
dexametasone
Definition
corticosteroid treatment for SCC
Term
radiation therapy
Definition
usually done in conjunction with steroid therapy. predictable responses of prostate, lung and breast carcinomas
Term
when obstructed leads to venous blockages producing pleural effusions, facial, arm and tracheal edema
Definition
superior vena cava syndrome
Term
signs/symptoms superior vena cava syndrome
Definition
facial edema, venous engorgement, impaired consciousness
Term
treatment of superior vena cava syndrome
Definition
radiation therapy, chemotherapy, intravascular stenting/angioplasty, anticoagulation (controversial), diuretics and elevation of head
Term
leakage of IV drugs from the vein into the surrounding tissue
Definition
extravasation
Term
drug or other agent that is not corrosive but can cause a reversible inflammatory effect by chemical action at the site of contact
Definition
irritant
Term
substance that causes tissue blistering
Definition
vesicant
Term
Prevention of this is key to avoidance of detrimental effects
Definition
TLS
Term
Has several benefits over other bisphosphonates in treatment of hypercalcemia of malignancy
Definition
Zoledronate
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