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Oncologic Emergencies: Symptoms and Management

Learn about types of malignant tumors, upper airway obstruction, spinal cord compression, pericardial effusion, superior vena cava syndrome, and how to manage hemorrhage and chemotherapy agent release in oncologic emergencies.

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Oncologic Emergencies: Symptoms and Management

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  1. Oncologic Emergencies

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. Upper Airway Obstruction • Late result of tumors of • Oropharynx • Neck • Superior mediastinum

  8. Upper Airway Obstruction • Suspect in afebrile patients with • Stridor • Palpable neck masses • History of voice change

  9. 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

  14. Acute Spinal Cord Compression • Suspect if patient with malignancy develops: • Paraparesis • Paraplegia • Sensory deficits • Urinary incontinence • Acute urinary retention

  15. Acute Spinal Cord Compression • Focal or nerve root pain may occur • Pain localized to involved vertebrae may be present

  16. Acute Spinal Cord Compression • Management • Immobilize spine • Steroids • Emergency surgical decompression or radiotherapy indicated

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

  18. Pericardial Effusion • Effects depend on volume, speed of fluid accumulation

  19. Pericardial Effusion • Signs • Resistant hypotension • Narrow pulse pressure • Jugular vein distension • Diminished heart sounds • Pulsus paradoxus

  20. Pericardial Effusion • Emergency pericardiocentesis may be needed

  21. Superior Vena Cava Syndrome • Cause • Obstruction of superior vena cava • Increased venous pressure in • Arms • Neck • Face • Cerebrum

  22. 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

  23. Superior Vena Cava Syndrome • May produce • Increased intracranial pressure • Decreased preload and cardiac output

  24. Superior Vena Cava Syndrome • Management • Lasix • Steroids

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

  26. 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

  28. Vascular Access • Do not start IV’s in implants or shunts used for chemotherapy • Implants may lead to areas other than vascular system • Needles may damage implant or shunt

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