Oncologic Emergencies

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Oncologic Emergencies
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Oncologic Emergencies

• Neoplasm new and abnormal formation of tissue
  (tumor)
• Benign tumor Does not spread by infilatration
  of tissue
• Malignant tumor (cancer)
• Spreads from primary to distant sites
  (metastasis)
• Destroys host tissues

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Oncologic Emergencies

• Benign Tumors
• Structure typical of tissue of origin
• Slow rate of growth
• Mostly encapsulated
• Slightly vascularlized
• Does not metastasize
• Necrosis, ulceration unusual
• Rarely recurs after removal

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Oncologic Emergencies

• Malignant Tumors
• Structure atypical of tissue of origin
• Rapid rate of growth
• Loosely or not encapsulated
• Moderately to highly vascularlized
• Metastasizes
• Necrosis, ulceration common
• Frequently recurs after removal

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Oncologic Emergencies

• Types of malignant tumors
• Epithelial tissues Carcinomas
• Melanocytes of skin Melanomas
• Connective tissues Sarcomas
• Lymphatic tissues Lymphomas
• Glial tissues of CNS Neurogliomas
• Granular leukocytes Leukemias
• Plasma cells Multiple myeloma

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Oncologic Emergencies

• Consequences of tumor growth
• Destruction of invaded tissue
• Obstruction of organs
• Compression of adjacent structures
• Abnormal hormone production
• Nutritional deficiencies, starvation
• Hemorrhage
• Infection

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Upper Airway Obstruction

• Late result of tumors of
• Oropharynx
• Neck
• Superior mediastinum

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Upper Airway Obstruction

• Suspect in afebrile patients with
• Stridor
• Palpable neck masses
• History of voice change

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Upper Airway Obstruction

• Acute compromise may be caused by
• Infection
• Hemorrhage
• Trapped secretions
• Remove or bypass obstruction

10
Upper Airway Obstruction

• Management
• Remove or bypass obstruction
• Suction
• Endotracheal intubation
• Surgical airway

11
Laryngectomy Patient

• Patient breathes through stoma at base of neck
• May be complete or partial

12
Laryngectomy Patient

• Ventilate through opening in midline at base of
  neck
• Ignore other openings
• Seal mouth/nose in partial laryngectomy

13
Acute Spinal Cord Compression

• Compression from
• Tumor
• Collapse of vertebrae
• Hemorrhage
• Infection

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Acute Spinal Cord Compression

• Suspect if patient with malignancy develops
• Paraparesis
• Paraplegia
• Sensory deficits
• Urinary incontinence
• Acute urinary retention

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Acute Spinal Cord Compression

• Focal or nerve root pain may occur
• Pain localized to involved vertebrae may be
  present

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Acute Spinal Cord Compression

• Management
• Immobilize spine
• Steroids
• Emergency surgical decompression or radiotherapy
  indicated

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Pericardial Effusion

• Causes
• Effusion from pericardial metastasis
• Secondary hemorrhage
• Infection
• Chemotherapeutic agents
• Radiation-induced pericarditis

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Pericardial Effusion

• Effects depend on volume, speed of fluid
  accumulation

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Pericardial Effusion

• Signs
• Resistant hypotension
• Narrow pulse pressure
• Jugular vein distension
• Diminished heart sounds
• Pulsus paradoxus

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Pericardial Effusion

• Emergency pericardiocentesis may be needed

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Superior Vena Cava Syndrome

• Cause
• Obstruction of superior vena cava
• Increased venous pressure in
• Arms
• Neck
• Face
• Cerebrum

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Superior Vena Cava Syndrome

• Signs and Symptoms
• Headache
• Syncope
• Feeling of head congestion and fullness in
  neck/face
• Edema of face/arms
• Neck/upper chest vein distension
• Facial plethora
• Telangiectasia

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Superior Vena Cava Syndrome

• May produce
• Increased intracranial pressure
• Decreased preload and cardiac output

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Superior Vena Cava Syndrome

• Management
• Lasix
• Steroids

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Hemorrhage

• Causes
• Erosion of vessel walls by neoplasm
• Therapy-induced coagulation problems
• Thrombocytopenia

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Hemorrhage

• Management
• Control hemorrhage with standard techniques
• Treat hypovolemia

27
Chemotherapy Agent Release

• Can result from malfunction of ambulatory
  chemotherapy units
• Highly toxic
• Wash off skin immediately
• Report exposure to physician

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Vascular Access

• Do not start IVs in implants or shunts used for
  chemotherapy
• Implants may lead to areas other than vascular
  system
• Needles may damage implant or shunt