Oncological Emergencies

 

• Conditions

  • Neutropenic sepsis.
  • Spinal cord compression.
  • Superior vena cava obstruction.
  • Hypercalcaemia.
  • Tumour lysis syndrome.
  • ↑Intracranial pressure.

• Neutropenic sepsis

  Aka febrile neutropenia.

  Definition and epidemiology

  Definition:

  • Neutrophils <0.5 x 109/L or...
  • {Neutrophils <1 x 109/L} plus {temperature >38°C OR rigors OR unexplained ↓BP/↑HR}.

  Common causes:

  • Chemotherapy
  • Bone marrow irradiation.
  • Malignant infiltration of bone marrow.
  • See pancytopaenia for more.

  Leading cause of death due to chemotherapy.

  Signs and symptoms

  • Infection symptoms.
  • May present as acute abdomen.
  • Poor prognosis if: ↓BP, coagulopathy, diarrhoea, organ failure.

  Investigations

  • Careful history and examination, but no rectal or vaginal exam, as this may risk spreading infection into bloodstream.
  • Septic screen including line cultures.

  Management

  • Start empirical antibiotics stat: piperacillin/tazobactam IV is 1st line.
  • Isolation and barrier nursing.

• Tumour lysis syndrome

  Pathophysiology

  • Chemotherapy causes tumour lysis, releasing urate, PO43- (leading to ↓Ca2+), and K+.
  • Most commonly occurs in treatment of Burkitt's and other high grade lymphomas, ALL with high blast count, and accelerated CML.

  Signs and symptoms

  • AKI
  • Arrhythmias
  • Encephalopathy

  Management

  • Prevention: in high risk patients, give fluids and allopurinol, starting 24 hours before chemo
  • Acute management: fluids and allopurinol, and consider sodium bicarbonate and dialysis.