NUR 2214C_Oncological Emergencies-3-1 (1)

Oncological Emergencies

Life threatening emergencies from cancer complications or treatment that can occur anytime.

Types of Emergencies

• Obstructive Emergencies: Caused by tumor obstruction of organs or blood vessels.

  • Superior Vena Cava (SVC) Syndrome: Compression or obstruction leads to blood congestion.

  • Spinal Cord Compression (SCC): Tumor or bone degradation compresses the spinal cord.

  • Third Space Syndrome: Fluid shifts from vascular to interstitial spaces.

  • Intestinal Obstruction: Mechanical blockage due to tumors.

• Metabolic Emergencies: Caused by ectopic hormone production or metabolic issues due to cancer.

  • Syndrome of Inappropriate Antidiuretic Hormone (SIADH): Excessive ADH leads to hyponatremia.

  • Hypercalcemia: High serum calcium levels.

  • Tumor Lysis Syndrome (TLS): Rapid cell destruction leads to electrolyte imbalances.

  • Sepsis: Severe infection in neutropenic patients.

  • Disseminated Intravascular Coagulation (DIC): Abnormal clotting and bleeding.

• Infiltrative Emergencies: Cancer infiltrating major organs or due to treatment effects.

  • Cardiac Tamponade: Fluid accumulation around the heart.

  • Carotid Artery Rupture: Bleeding due to tumor invasion or treatment.

Obstructive Emergencies

Superior Vena Cava (SVC) Syndrome

• Mechanism: SVC returns blood from the head and upper body. Obstruction causes congestion.

  • Causes: Often in lymphoma, lung, and breast cancer; central venous catheter increases risk.

  • Manifestations: Facial edema, headaches, upper body erythema, dyspnea, cyanosis, hypotension.

  • Diagnosis: CT scan/MRI.

  • Interventions: Stent insertion, effective cancer treatment.

Spinal Cord Compression (SCC)

• Overview: Neurological complications from tumors.

  • Signs: Back pain, numbness, tingling, possible paralysis.

  • Diagnosis: MRI.

  • Treatment: Corticosteroids, radiation, pain management, surgical intervention if necessary.

Third Space Syndrome

• Definition: Fluid shift from vascular to interstitial spaces.

• Causes: Immunotherapy, septic shock, extensive surgery.

• Signs: Hypotension, tachycardia, decreased urine output.

• Treatment: Fluid and electrolyte replacement.

Intestinal Obstruction

• Causes: Mechanical blockage from tumors affecting bowel motility, especially in GI-specific cancers.

• Treatment Strategies: Palliative surgery vs. medical management; prioritize GI decompression.

Metabolic Emergencies

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

• Overview: Excess ADH secretion may be induced by certain cancers or treatments.

• Symptoms: Weight gain, confusion, hyponatremia potentially leading to seizures.

• Management: Fluid restriction, salt tablets, IV saline, diuretics, and treating underlying cancer.

  • Safety: Monitor for fluid overload signs (bounding pulse, crackles).

Hypercalcemia

• Epidemiology: Occurs in ~1/3 of cancer patients, especially those with bone involvement.

• Symptoms: Fatigue, skeletal pain, renal issues, severe manifestations include muscle weakness.

• Interventions: Hydration, diuretics, bisphosphonates, dialysis if life-threatening.

Tumor Lysis Syndrome (TLS)

• Description: Rapid destruction of tumor cells results in electrolyte imbalances: hyperkalemia, hyperuricemia.

• Presentation: Can lead to cardiac issues and acute kidney injury.

• Prevention/Treatment: Aggressive hydration, manage hyperkalemia, and monitor electrolytes post-treatment.

Sepsis

• Nature: Severe infection in neutropenic patients due to impaired immune function.

• Management: Immediate antibiotic therapy is crucial to prevent septic shock.

Disseminated Intravascular Coagulation (DIC)

• Cause: Often caused by sepsis, leads to extensive clotting and bleeding.

• Symptoms: Bleeding from multiple sites, decreased blood flow to organs.

• Management: Anticoagulants in early stages; clotting factors in later stages.

Infiltrative Emergencies

Cardiac Tamponade

• Definition: Accumulation of fluid in the pericardial sac due to tumor or radiation therapy.

• Symptoms: Chest heaviness, dyspnea, tachycardia, anxiety.

• Interventions: Pericardial window, catheter insertion, hydration, oxygen therapy.

Carotid Artery Rupture

• Overview: Tumor invasion or erosion of arterial walls, primarily in head and neck cancers.

• Symptoms: Oozing to complete hemorrhage.

• Management: IV fluids, blood products, surgical ligation.