Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

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Oncological Emergency	Clinical Presentation	Diagnostic Tests	Treatment
Spinal Cord Compression	Back pain, often worse at night and aggravated by coughing or straining. Neurological deficits including weakness, sensory loss, and autonomic dysfunction (e.g., bowel or bladder incontinence). Common in cancers with vertebral metastases (e.g., breast, lung, prostate).	MRI of the spine is the imaging modality of choice to assess the extent of compression. CT scan may be used if MRI is contraindicated. Neurological examination to assess the level and severity of spinal cord involvement.	Immediate corticosteroids (e.g., dexamethasone) to reduce swelling and prevent further neurological damage. Emergency radiation therapy or surgery depending on the severity and location of the compression. Pain management and supportive care, including physical therapy for rehabilitation. Consideration of oncological treatment (e.g., chemotherapy) for the underlying malignancy.
Superior Vena Cava (SVC) Syndrome	Facial swelling, neck vein distension, and upper extremity swelling. Dyspnoea, cough, hoarseness, and headache, often worse when bending forward or lying down. Commonly associated with lung cancer, lymphoma, or metastatic tumours compressing the SVC.	CT scan of the chest to identify the site of obstruction and evaluate the extent of disease. Chest X-ray may show widening of the mediastinum or pleural effusion. Venography or MRI may be used in unclear cases to assess the extent of SVC involvement.	Elevate the head of the bed and administer oxygen for symptomatic relief. Corticosteroids and diuretics to reduce swelling. Radiation therapy or chemotherapy to shrink the tumour causing the obstruction. Stent placement in the SVC may be considered in severe or refractory cases.
Tumour Lysis Syndrome (TLS)	Fatigue, nausea, vomiting, and muscle cramps. Signs of acute kidney injury, such as oliguria or anuria. Occurs after the initiation of chemotherapy in patients with high tumour burden (e.g., leukaemias, lymphomas).	Laboratory findings include hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Elevated serum creatinine and blood urea nitrogen (BUN) indicating renal impairment. Monitor electrolytes, renal function, and uric acid levels frequently after starting chemotherapy.	Aggressive IV hydration to promote renal excretion of electrolytes and uric acid. Allopurinol or rasburicase to prevent or treat hyperuricemia. Management of hyperkalemia, hyperphosphatemia, and hypocalcemia with appropriate medications (e.g., insulin, calcium gluconate). Dialysis may be necessary in severe cases with refractory electrolyte imbalances or renal failure.
Hypercalcemia of Malignancy	Nausea, vomiting, constipation, and polyuria. Fatigue, weakness, confusion, and possible coma in severe cases. Commonly associated with cancers such as breast cancer, lung cancer, and multiple myeloma.	Elevated serum calcium levels (usually >12 mg/dL). Low or undetectable parathyroid hormone (PTH) levels. ECG may show shortened QT interval and other signs of hypercalcemia.	Aggressive IV hydration with normal saline to enhance renal calcium excretion. Bisphosphonates (e.g., zoledronic acid, pamidronate) to inhibit bone resorption. Calcitonin may be used for rapid but short-term reduction of calcium levels. Treat the underlying malignancy to prevent recurrence of hypercalcemia.
Neutropenic Fever	Fever (≥38.3°C or ≥38.0°C for more than one hour) in a patient with neutropenia (absolute neutrophil count <500/µL). Malaise, chills, and signs of infection, which may be subtle or absent due to neutropenia. Often occurs after chemotherapy in patients with hematological malignancies or solid tumours.	Complete blood count showing neutropenia. Blood cultures, urine cultures, and chest X-ray to identify potential sources of infection. Additional cultures (e.g., from central lines, wounds) based on clinical suspicion.	Immediate empirical broad-spectrum antibiotics (e.g., piperacillin-tazobactam, cefepime) initiated within 1 hour of presentation. Consider antifungal therapy if fever persists after 4-7 days of antibiotics and no source is identified. Granulocyte colony-stimulating factor (G-CSF) may be used to shorten the duration of neutropenia. Close monitoring for signs of sepsis and organ dysfunction, with supportive care as needed.
Pericardial Effusion with Cardiac Tamponade	Dyspnoea, chest pain, and orthopnea. Beck's triad: hypotension, muffled heart sounds, and jugular venous distension. May occur due to metastatic involvement of the pericardium, particularly in lung or breast cancer.	Echocardiography showing pericardial effusion with signs of tamponade (e.g., diastolic collapse of the right ventricle). Chest X-ray may show an enlarged cardiac silhouette. ECG may show low voltage QRS complexes or electrical alternans.	Immediate pericardiocentesis to relieve pressure on the heart. IV fluids to maintain blood pressure until definitive treatment. Radiation therapy or chemotherapy may be needed to address the underlying malignancy causing the effusion. Consider a pericardial window or pericardiectomy for recurrent cases.
Septic Shock in Oncology Patients	Fever, chills, and signs of infection, such as cough, dysuria, or cellulitis. Hypotension, tachycardia, and altered mental status indicating progression to septic shock. Commonly associated with immunosuppression due to chemotherapy or hematological malignancies.	Blood cultures, urine cultures, and other relevant cultures before starting antibiotics. Serum lactate levels elevated, indicating tissue hypoperfusion. Complete blood count (CBC), electrolytes, renal and liver function tests to assess the severity of the shock.	Early goal-directed therapy with IV fluids, broad-spectrum antibiotics, and vasopressors (e.g., norepinephrine) if needed. Source control, such as drainage of abscesses or removal of infected devices. Monitoring for complications, including organ dysfunction and disseminated intravascular coagulation (DIC). Supportive care in an ICU setting for severe cases.
Malignant Pleural Effusion	Dyspnoea, chest pain, and cough. Decreased breath sounds, dullness to percussion, and reduced chest expansion on the affected side. Commonly associated with lung cancer, breast cancer, and lymphoma.	Chest X-ray or ultrasound showing fluid in the pleural space. CT scan of the chest to evaluate the extent of disease and assess for lung involvement. Thoracentesis for pleural fluid analysis, including cytology to confirm malignancy.	Therapeutic thoracentesis to relieve symptoms and improve breathing. Chemical pleurodesis (e.g., talc) to prevent recurrence of the effusion. Indwelling pleural catheter for recurrent or symptomatic effusions. Treat the underlying malignancy with chemotherapy, radiation, or targeted therapy.

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