Oncological Emergencies in Palliative Care

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Oncological Emergencies in Palliative Care

• Superior Vena Cava Syndrome
• Spinal Cord Compression
• Hypercalcemia

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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)

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SVC Early Signs

• Facial, trunk, and upper extremity edema
• Pronounced venous pattern on trunk
• Neck vein distention
• Cough

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SVC Late Signs

• Hoarseness, stridor
• Engorged conjunctiva, visual disturbances
• Headache, dizziness
• Change in mental status
• Respiratory distress

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SVC Treatment Possibilities

• Radiation
• Diuretics
• Steroids
• Comfort measures

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Spinal Cord Compression

• Caused by tumor encroachment upon spinal cord or
  cauda equina
• Most common in cancers that involve bone mets
• Lung, breast, prostate

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Spinal Cord Compression Early Signs

• Back pain, radicular or localized
• Motor weakness
• Sensory loss
• May occur gradually or suddenly

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Spinal Cord CompressionLate Signs

• Motor loss
• Urinary retention, overflow, incontinence
• Difficulty expelling stool, constipation,
  incontinence
• Poor sphincter control

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Spinal Cord Compression Diagnosis

• Myelogram
• CT scan
• MRI

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Spinal Cord Compression Treatment

• Radiation
• Steroids
• Surgery
• Comfort measures

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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

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Hypercalcemia Factors in Production

• Increased osteoclast activity
• Increased calcium reabsorption by kidneys
• Decreased renal clearance of calcium
• Tumor secretion of peptides

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Hypercalcemia

• Symptoms
• Lethargy, Confusion
• Muscular weakness, Incoordination
• Polyuria, Thirst
• Nausea, Vomiting, Constipation
• Cardiac toxicity- arrhythmia

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Hypercalcemia

• TREATMENT
• IV rehydration
• Diuretics
• Bisphosphonates