People with cancer are at risk for developing medical emergencies caused by complications of the disease itself or its treatments.
Oncological emergency is an emergency condition caused by cancer or its treatment, which requires rapid intervention to prevent death or severe permanent disability.
Emergencies in cancer patients can be broadly divided into three groups:
- Structural or local effect caused by tumors: superior vena cava obstruction, pericardial effusion, spinal cord compression.
- Metabolic or hematological effects: hypercalcemia, syndrome of inappropriate anti diuretics, venous thromboembolism.
- Complications secondary to treatment effect: neutropenic fever, tumor lysis syndrome
- Superior vena cava obstruction occurs commonly in cancer patients due to partial or complete obstruction of the superior vena cava, preventing the return of blood flow to the right atrium from the head, neck, and upper limbs.
- It will lead to severe complications like elevated venous pressure, increased intracranial pressure, and laryngeal edema.
Table of Contents
Superior vena cava obstruction
Clinical manifestation:
- Hoarseness of voice
- Headache
- Nasal fullness and bleeding
- Haemoptysis, dysphagia
- Dizziness
- Management
- Supplementation of oxygen
- Diuretics, intravenous steroids
- Radiation therapy
- Chemotherapy
- Balloon angioplasty, surgical bypass
Pericardial effusion
- Pericardial disease from malignant causes occurrence. It is usually associated with advanced lung or breast cancer, leukemia, or lymphoma. The spectrum of malignant pericardial involvement includes pericarditis, pericardial effusion, constrictive pericarditis
- Clinical manifestation
- Dyspnea
- Orthopnoea
- Low blood pressure
- Pericardial rub
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Spinal cord compression
- Epidural spinal cord compression occurs in 2 to 7% of oncology patients with breast cancer, lung cancer, prostate cancer, non-Hodgkin’s lymphoma, renal cell carcinoma, multiple myeloma, and sarcoma are other significant causes of malignant myeloma and sarcoma are reasons for malignant spinal cord compression.
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Sign and symptoms
- Urinary incontinence
- Retention of urine
- Constipation
- Back pain
- Coughing
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Management
- Treatment should be high-dose IV steroids such as dexamethasone serving to relieve pain and reduced spinal cord edema.
- Analgesics, bed rest should be required.
- Radiotherapy
- Chemotherapy
- Hypercalcaemia
- Hypercalcaemia is an elevated serum calcium level above 11.0 mg/dl.
- It is a common metabolic disorder that affects more than 10 % of cancer patients.
- This malignancy mainly for the head, neck, kidney.
Hypercalcaemia
- Hypercalcaemia is an elevated serum calcium level above 11.0 mg/dl. It is a common malignancy.
- It is associated with the lung, breast, head, and neck.
Sign and symptoms
- Polydipsia
- Polyuria
- Anorexia
- Constipation
- Lethargy
- Drowsiness
- Lethargy
Management
- Rehydration for 12-24 hrs with 4-6 liter of normal saline.
- Loop diuretics like frusemide 40-80 mg IV.
- Biphosphonate play an integral role in the management of hypercalcaemia.
Syndrome of inappropriate secretion of antidiuretic hormone
- It is associated with malignancy ( small cell lung cancer), CNS disease, pulmonary disease.
- Inappropriate ADH level leads to 1- 2% of cancer patients, leading to hyponatremia in patients.
- Symptoms
- Irritability
- Anorexia
- Depression
- Weakness
- Behavioral changes
Management
- Diuretics to replace the sodium and potassium lost in the urine.
- Diuretics for maintaining fluid-electrolyte balance.
- Dialysis for acute renal failure
Venous thromboembolism
- Abnormal blood composition with an increased level of clotting factors and procoagulants factors.
- Patients have an increased risk of thrombosis due to chemotherapy.
- Sign and symptoms
- Pulmonary embolism leads to dizziness, dyspnoea, hemoptysis.
- Signs include tachycardia, tachypnoea, hypotension
Management
- Elastic stockings
- Low molecular heparin
- Anticoagulants
Neutropenic fever
- The most common organism is gram-positive cocci like staphylococci, viridans, and gram-negative organism like escherichia coliand pseudomonas, which increase the risk of developing a neutropenic fever.
Sign and symptoms
- Temperature more than 38 c
- Infection
- Hyperuricaemia, hyperkalemia, hyperphosphataemia, hypocalcemia, and acute renal failure.
Management
- Antibiotics: first-line antibiotics like ciprofloxacin, gentamycin, piperacillin
- Tumor lysis syndrome
- This syndrome is due to the effect of treatment of malignancy. cellular lysis occurs due to the destruction of the tumor.
Tumor lysis syndrome
- This syndrome is due to the effect of treatment of malignancy. There is a reaction to the sudden and extensive release of cellular lysis products caused by tumor destruction.
Sign and symptoms
- Hyperuricaemia
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
- Acute renal failure.
Management
- Diuretics for maintaining fluid-electrolyte balance.
- Dialysis for acute renal failure
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