Summary of Emergency Conditions in Oncology
Related Subjects:
|Hypercalcaemia
|Multiple Myeloma
|Oncological emergencies
|Hypophosphataemia
|Cardiological Emergencies
|Dermatology Emergencies
|ENT emergencies
|Endocrine Emergencies
|Flight Emergencies Crib Sheet
|Gastrointestinal Emergencies
|Geriatric Medicine Emergencies
|Haematology Emergencies
|Hepatology Emergencies
|Obstetrics and Gynaecology Emergencies
|Oncological emergencies
|Ophthalmic Emergencies
|Paediatric emergencies
|Renal and Urology Emergencies
|Respiratory Emergencies
🚨 Emergency Conditions in Oncology
🦴 Spinal Cord Compression
- 🔎 Presentation: Back pain (worse at night, cough/strain), neuro deficits (weakness, sensory loss, bladder/bowel dysfunction). Common in vertebral mets (breast, lung, prostate).
- 🧪 Diagnosis: MRI spine (gold standard), neuro exam; CT if MRI contraindicated.
- 💊 Treatment: Immediate dexamethasone; urgent radiotherapy or surgery; analgesia, physio, oncological therapy for primary cancer.
🫁 Superior Vena Cava (SVC) Syndrome
- 🔎 Presentation: Facial swelling, venous distension, upper limb oedema, dyspnoea, headache (worse lying down).
- 🧪 Diagnosis: CT chest (site of obstruction), CXR (mediastinal widening), venography/MRI if uncertain.
- 💊 Treatment: Elevate head, O₂, steroids & diuretics, urgent chemo/radiotherapy, endovascular stent if severe.
⚡ Tumour Lysis Syndrome (TLS)
- 🔎 Presentation: Nausea, vomiting, cramps, oliguria/anuria after chemo in high tumour burden (leukaemia, lymphoma).
- 🧪 Diagnosis: ↑ uric acid, K⁺, phosphate; ↓ Ca²⁺; renal impairment (↑ creatinine, BUN).
- 💊 Treatment: Aggressive IV hydration, allopurinol/rasburicase, correct electrolytes (insulin, Ca gluconate), dialysis if refractory.
🧪 Hypercalcaemia of Malignancy
- 🔎 Presentation: Nausea, constipation, polyuria, confusion, coma if severe. Often in breast, lung, myeloma.
- 🧪 Diagnosis: ↑ serum calcium (>12 mg/dL), low PTH, ECG = short QT.
- 💊 Treatment: IV saline hydration, bisphosphonates (zoledronic acid, pamidronate), calcitonin for rapid effect, treat underlying cancer.
🧬 Neutropenic Fever
- 🔎 Presentation: Temp ≥38.3°C or ≥38.0°C for >1 hr, with neutrophils <500/µL. Malaise, chills; signs may be subtle.
- 🧪 Diagnosis: FBC (neutropenia), blood & urine cultures, CXR, line/wound cultures if suspected.
- 💊 Treatment: IV broad-spectrum antibiotics within 1 hr (piperacillin-tazobactam / cefepime). Consider antifungals if persisting >4–7 days. G-CSF may shorten neutropenia. Monitor closely for sepsis.
❤️ Pericardial Effusion with Cardiac Tamponade
- 🔎 Presentation: Dyspnoea, chest pain, orthopnoea; Beck’s triad = hypotension, muffled heart sounds, JVP ↑. Often from lung/breast mets.
- 🧪 Diagnosis: Echo = effusion with RV collapse; CXR = enlarged heart silhouette; ECG = low voltage or electrical alternans.
- 💊 Treatment: Urgent pericardiocentesis, IV fluids for BP support, treat malignancy (chemo/radiation). Pericardial window if recurrent.
