Oncological Emergencies in Palliative Care

Oncological Emergencies in Palliative Care Superior Vena Cava Syndrome Spinal Cord Compression Hypercalcemia Superior Vena Cava Syndrome     Caused by tumor pressing on superior vena cava in mediastinum Most commonly associated with lung cancer (75% SVC - 3% of lung ca pts) Lymphoma (15%) Other solid tumors eg. Breast (10%) SVC: Early Signs     Facial, trunk, and upper extremity edema Pronounced venous pattern on trunk Neck vein distention Cough SVC: Late Signs      Hoarseness, stridor Engorged conjunctiva, visual disturbances Headache, dizziness Change in mental status Respiratory distress SVC: Treatment Possibilities     Radiation Diuretics Steroids Comfort measures Spinal Cord Compression    Caused by tumor encroachment upon spinal cord or cauda equina Most common in cancers that involve bone mets Lung, breast, prostate Spinal Cord Compression: Early Signs     Back pain, radicular or localized Motor weakness Sensory loss May occur gradually or suddenly Spinal Cord Compression: Late Signs     Motor loss Urinary retention, overflow, incontinence Difficulty expelling stool, constipation, incontinence Poor sphincter control Spinal Cord Compression: Diagnosis    Myelogram CT scan MRI Spinal Cord Compression: Treatment     Radiation Steroids Surgery Comfort measures Hypercalcemia     Occurs in 10%- 20% all cancer pts Most common in Breast Cancer & Myeloma Also lung, renal cancers, lymphomas, leukemias, prostate, ovarian, gastric ca May occur with any cancer Hypercalcemia: Factors in Production     Increased osteoclast activity* Increased calcium reabsorption by kidneys* Decreased renal clearance of calcium Tumor secretion of peptides Hypercalcemia  Symptoms – – – – – Lethargy, Confusion Muscular weakness, Incoordination Polyuria, Thirst Nausea, Vomiting, Constipation Cardiac toxicity- arrhythmia Hypercalcemia  TREATMENT – – – IV rehydration Diuretics Bisphosphonates