???? ???? ????? ??? ??????? Oncologic :

1
?????????? ???????? ???? ????
2
-Spinal cord compression -Pericardial
tamponade -Hypercalcemia (eg, adult T cell
leukemia-lymphoma) -Superior or inferior vena
cava obstruction -Hyperleukocytosis (eg, B or T
cell lymphoblastic leukemia/lymphoma) -Acute
airway obstruction (eg, mediastinal
lymphoma) -Lymphomatous meningitis and/or CNS
mass lesions
???? ???? ????? ??? ??????? Oncologic
???? ???? ????? ??? ??????? Oncologic
???? ???? ????? ??? ??????? Oncologic
???? ???? ????? ??? ??????? Oncologic
DIC
DIC
DIC
DIC
?????????
?????????
?????????
?????????
?????? ????? ????
?????? ????? ????
?????? ????? ????
?????? ????? ????
???????? ????
???????? ????
???????? ????
???????? ????
??? ?????
??? ?????
??? ?????
??? ?????
????? ???? ???? ?????
????? ???? ???? ?????
????? ???? ???? ?????
????? ???? ???? ?????
????? ???? ???? ??????
????? ???? ???? ??????
????? ???? ???? ??????
????? ???? ???? ??????
SIADH
SIADH
SIADH
SIADH
????? ???
????? ???
????? ???
????? ???
3
-Hyperuricemia and tumor lysis syndrome -Hypervisc
osity syndrome (eg, lymphoplasmacytic
lymphoma with Waldenstrom macroglobulinemia) -Inte
stinal obstruction, intussusception -Ureteral
obstruction, unilateral or bilateral
hydronephrosis -Severe hepatic dysfunction -Venous
thromboembolic disease -Severe autoimmune
hemolytic anemia and/or thrombocytopenia (eg,
small lymphocytic lymphoma)
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????? ??? ?????? Tumor Lysis Syndrome (TLS)
8
(TLS) ????? ??? ?? ????? ??? ?????
???? ?????? ???????? ????????? ?????? ??
?? ????? ???? ???? ???????? ????? ? ????? ??
???? ?? ???
9
????? ??? ??? ????? ???? ??
??????????? ??????????? ??????????? ?????????? ??
????? ???? ????? ????? ? ??????? ??? ????
10
????? ????? ????? ?? ?? ???? ???? ????? 1- ???
?????????? 2- ??? ???????
11
???? ???? ????? ?????? ? ??? ??????? ?? ????????
?????????? ???????? ??? ???? ????? ??? ??????
????? ??? ???? ????? ? ??????? ???? ?? ??? ??
25 ?? ???? 4 ??? ??? ??????? ???? ??????. ?-????
???? ????? ??? ?? ??? ?? 25 ???? ?????
??? ?????????? ????? ???? ???? ????? ?????? ?
??? ??????? ?? ???????? ?????????? ????
????? ??? ?????? ????? ??? ???? ????? ?
??????? ???? ?? ??? ?? 25 ?? ???? 4 ??? ???
??????? ???? ??????. ? ???? ???? ????? ??? ??
??? ?? 25 ???? ?????
12
??? ??????? ?????TLS ??? ??????? ????? ?????
????? ?????? ???? ? ???? ??? ? ????? ? ?? ??????
??? ?????????? ????? ????? . ???? ?????
?????????? ???? ????? ?????? ??? ?? ????? ??? ???
??? ???? ?? ???. 1- ??? ?????? ??? ?? ?????? ??
mmol/l 6 2- ??? ??????? ??? ?? ???????? mmol/l
221 3- ??? ????? ??? ?? ???? ?? mmol/l 5/ 1 4-
?????? ?????? ??? ????? ????? ??? ????? ?
?? ???? ???? ???? ?? ????.
13
???? ???? ????? ????? ?????????? ??? ????? ??
???? 42 ????? ????? ????? . ???? ????? ?????
??????? ??? ????? ?? ???? 6 ????? ?? ?? ?????
???? ?????? ??? ?????????? ?????? ?? ??????
????? ??? ?????? ?? ???high grade ?
Intermediat ???? ?????.
14
????????? ?? ????? ????? ?? ?????? ??? ???? ????
?? Poorly differentiated lymphoma Burkitt's
lymphoma ????? ??? ??? ?????? ALL ???? AML
?? ???? ??? ??? ????? ?? ????? ????? ??????
????? ? ???????????? ?????? ?? ? ????? ??????
? ???????? ?? ???????? ??? ? ????? ??? ??
??????? ???? ? germ cell tumors ?? ???? ???? ??
???. ???? ????? ?????? ????? ???? ?????? ???
????? ???? ?? ??? ? ???? ??? ?? ?????
??????????????? ?? ?????? ?? ????? ?? TLS
?????? ??? ??? .
15
?????? 33 ???? ????? ????? ?? ????? ?????? ??
??????????? ?????? ?????????? ???? ?????? ??
????? ?? ?? ??? ??? ???
61 ??????? ???? ?????? ????? 2 ????? ??? ??????
????? ?? ?? ????? ???? ?????? ????.
45 ??????? ???? ???? ??????? ???? (??? ?? 5
???? ??? ????) ( mmol/L /1) ?? ?????? ???? ?? ???
??? ??? ????? ?? ?? ?????.
???? ?????? ( ??? ?? 8 ???? ??? ???? ) (
476umol/L ) ?? 21 ???? ?? ??? ?? 6/10 ????
??? ???? ????? ????
5 ???? ???? ??????? ??? ???? ?????? ????? ??????
?? ???? 4/6 ??? 5/9 ???? ??? ?? ?? ( 2.05 to
2.85 mmol/L ) .
7 ???? ?? 13 ???? ?????? ?? ?????? LDH ?? 30
????? ?? ????? ??? ????? ??? ?? ?? ???? ?? 19
????? ??? ??????? ???? ?? .
16
?? ?? ?????? ( 3) ???????? ????? ????? ?????
?? 102 ????? Intermediate , high grade
lymphoma ???? ??????
???????? ?????????? ?? 42 ??????? ???? ???
?????? ?? ???????? ?? ?????? ??? ?? ????? ??????
?????? ??.
???? ???????? ????? ?????? 34 - 25 ??????? ??
??? ??8 ???? ??? ???? ?????? ????(3) .
???? ???????? ????? ?? ??? ?? 25 ????? ?? ??
???? ?????? ???? ??? ??? ??????? ????? ????? ???
?? ?????? ?? 8???? ???/100?? 9 ???? ?????? ????
??4 ???? ??????????? ????? ?? ??????? ??? ????
???? ????.
?? 28 ???? ????? ???? ???? ????????? ?? ??? ??
25 ????? ?????? ????. ???? ????????? ?? ??????
?? 15 ???? ??? ???? ( 893 umol/L ) ?? 3 ??????
??????? ??? ???? ?? ?? ???? ????? ???. ????
???????? ?????? ?? 4 ???? ?? ??? ?? 5/5 meg/L
?????? ???? ?? ??? ??????? ????? ??????? ????
?????? ??? ??????.
17
?? ????? ??? ????? LDH
????? LDH ??? ?? ????? ?? ????? ???? ????? ????
????? ????? ????? ????? ???. 7 ???? ?? 13 ????
?????? ?? ?????? LDH ?? 30 ????? ?? ????? ??
?????? ?? ????? ?? ??? ?? ???? ????? ??? ?????
??? ?? ?? ???? ?? 19 ????? ??? ??????? ???? ?? .
?????? LDH ??? ?? ????? ???? ????? ??????
???? ?????? ? ?????????? ? ???? ??????? ??? ??
????? ???.
18
??????? ??? ???? ??????? ??? ???? ??? ??
???? ? ??? ?? ???? ?????? ????? ???? ???????????
?? ????? ?? ? ????? ?? ???? ??? ??? ( 1) ? ?? ??
???? ????? ???? ????? ????? ??? ??????? ??? ?????
?????? ?? ( 18 )
19
??? ??????? ??? ???? ????? ????? ?????? ?????
?? ?????? ?? ????? ???????? ???? ????? ????? ??
???? ??????? ??? ???? ?? ???? . ???
???????????(??? ?? 15 ???? ???/100 ?? 893
?????????? ???? ) ??????????? ( ??? ?? 8 ????
??? ???? ?? 2056 ???? ??? ?? ???? ???).
???????? ??? ???? ?? ??????????? ????? ???? ??
?????? ??? ???? ???? ? ????? ???. ?????? ?????
???? ?? ??? ???? ????? ?? ???? ????? ????? ??
????? ?????? ???? ?????? ?? ????? ???? ??????
???? ???? ?? ????? ???? ???????Adenosine ??
??????? ?????????? ??? (19) .
20
???????? ??? ?? ??? ?????? ????????? ????? ??
???? ????????? ????? ?? ???.
???? ???? ????? ???? ?? ????? ?? ????? ????? ????
????? ????? ?? ??????? ???? . ?????? ????? ??
???? ????? ???? ????????? ????? ?? ???????
????? ???? ??? ?????? ?? 1 ???? . ? ??? ?????
?????? ??????? ???? ??? ???? ?? ???? ?? 6 /0
??? 75/ 0 ?? ???.
21
????? ????? ??? ????? ??????? ??????
???? ????? ????? ??? ????? ???? ?? 1- ???????
??????? 2- ?????? ???? ?? ????.
22
??????? ?????????? ????? ?? ?? ??? ??? ?? ?????
????????? ?? ??? ?????? ?? ??? ?????? ?? ( ????
600 ??? 900 ???? ??? ?? ???) ????? ?? ??????
?????? ??? ?? ?? ? ??? ???? ?? 24 ???? ?? ?????
????? ????? ? ???? ??????? ??? ????? ???? ???
(14). ?????????? ? ?? ???????? ??????? ?????
???????? ???? ??? ?????? ????? ????? ? ?? ?????
??? ????? ????? ????
23
?? ?????? ???? ????? ?? ????? ??????????? ? ??
?????? ???? ?? ???? ???? ??? ??? . ?????? ????
????? ???? ????? ????????? ?? ????? ????? ??
?????? ????? ? ??? ????? ???? ???? ???? ????? ??
???
?????? ???? ????? ????? ????? ???? ????? ?????
?????? ?? ??????? ?? ???? ??????? ???? ???? ? ???
?? ???? ????? ????? ??? ????.
24
????? ???????? ??? ???? ?????? ?????? ???? ??????

????????? ?????? ?????? ????? ???????
?? ????????? ?????? ?????
25
????????? ?????? ????? ??????
contionus arteriovenus hemodialysis ( CAVHD ) ??
????? ????? ???????? ???? ? ?? ??? ??????
????????????? ????? ?????? ?? ?????? ??????? ???
???? ?????? ???? ????? ? ?? ?????????? ???? ????
??? .
??????? ???? ???? ??? CAVHD ?? 40???? ???? ??
????? ?? ???????? 4 ???? ?? ???? ??????
????(16). ?? ??? ??? ?? ???? ?????? ??? ?? 10
??? ???? ?? ??? ?? ?????? ???? ???? ???? ?????
???? ????? ??????????? ( ?? ????? ?? ?????????
????????? ????? ?? ??? ) ???? ??? .
26
 Lymphoma and SVC.syndrome SVC syndrome
develops in 2 to 4 percent of cases of lymphoma,
almost all occurring in patients with
non-Hodgkin's lymphoma (NHL) Despite its common
presentation with mediastinal lymphadenopathy,
Hodgkin's disease is rarely a cause of SVC
syndrome . Lymphomas typically cause SVC syndrome
by extrinsic compression by enlarged lymph nodes.
27
Malignant cause of SVC syndrome
Lung cancer is the most common malignant cause of
the SVC syndrome , followed by lymphoma.
Bronchogenic carcinoma and lymphoma together are
responsible for 94 percent of cases of SVC
syndrome . Other malignancies that metastasize
to the mediastinum can also be responsible.
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Infections are major causes of morbidity and
mortality in patients with cancer. The risk
of infection is principally related to the
intensity and duration of immunosuppressive
chemotherapy.
Infections are major causes of morbidity and
mortality in patients with cancer.
31
Other emergencies

• Sepsis and Septic Shock
• Definition
• Pathophysiology
• Assessment and Diagnosis
• Treatment

32
Infections are major causes of morbidity and
mortality in patients with cancer. The risk
of infection is principally related to the
intensity and duration of immunosuppressive
chemotherapy.
The risk of infection is principally related
to the intensity and duration of
immuno-suppressive chemotherapy.
33

• Immune Defects present in neoplastic diseases
• Impaired phagocytic function.
• Phagocyte mobilization.
• Neutropenia.
• Impaired cell mediated immunity
• Decreased antibody levels
• Corticoesteroides therapy
• Chemotherapy
• Radiotherapy

34
Infection in Patients with Cancer
Exagenous infections
In the hospital setting Pseudomonas
aeruginosa Serratia marcescens Klebsiella Staph
ylococci human carriers Enterococci
Aspergillus Varicella zoster virus
aerosols Respiratory syncytial v.
adenovirus Influenza virus
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Infection in Patients with Cancer Endogenous
Infections
Escherichia coli S.Aureus , coagulase neg
staph. Candida , Corynebacterium Gram-Negatiye
rods There are the most common catheter
associated pathogens.
36
Central Nervous System Infections

1. Meningitis
2. Brain Abscess
3. Encephalomyelitis

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• Disseminated Intravascular Coagulation
• Definition
• Pathophysiology
• Assessment and Diagnosis
• Treatment

39
Cancer-Related Hemolytic Uremic Syndrome
mitomycin-C and 5-fluoruracil as the most
frequent
bleomycin, cisplatin, cytosine arabinoside,
daunomycin, deoxycoformycin, estramustine, and
methyl-CCNU (1-(2-chloroethyl)-3-cyclohexyl-1-nitr
osourea).45
bone marrow transplant
40
Cancer-Related Hemolytic Uremic Syndrome
adenocarcinomas of the breast, lung, pancreas,
prostate, and stomach, it has also been reported
in patients with lymphomas as well as other
malignancies.
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Hypercalcemia and Cancer
breast, kidney, lung, and head and neck
Hypercalcemia is the most common paraneoplastic
syndrome, occurring in about 10 to 20 of
patients with advanced cancer.
focal bone destruction (osteolytic), or more
frequently as a humoral paraneoplastic syndrome.
43
Osteoclast-activating factors (OAFs)
prathyroid hormone-related protein (PTHrP),
interleukin (IL)-1, IL-6, and tumor necrosis
factor
some lymphomas secrete the active form of vitamin
D
44
Table 2. Hypercalcemia of Malignancy Table 2. Hypercalcemia of Malignancy
Classification Calcium Level
Mild 11 mg/dL
Moderate 12-14 mg/dL
Severe 14-16 mg/dL
Life threatening gt16 mg/dL
45
Treatment of hypercalcemia Intravenous hydration
to correct dehydration and stimulate renal
excretion of calcium, often with furosemide
(Lasix) diuresis Bisphosphonate therapy to
inhibit bone resorption (Older agents with more
side effects than bisphosphonates that inhibit
bone resorption are calcitonin, glucocorticoids,
gallium, and plicamycin.) Dialysis for patients
with renal failure or congestive heart failure,
or who have failed more conservative treatment
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Spinal Cord Compression
Malignant epidural spinal cord compression is a
devastating complication affecting 5 to 10 of
cancer patients. In the majority of cases it
carries a grim prognosis but a substantial number
of patients, especially those with lymphoma,
myeloma, or prostate cancer
49

• Spinal Cord Compression
• Definition
• Pathophysiology
• Assessment and Diagnosis
• Treatment

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Risk factors for septic shock include Neutropenia
is the single most important risk factor. At
greatest risk are patients with an absolute
neutrophil count (ANC) below 500/mm4 Disruption
of anatomical barriers with invasive procedures
Alteration in microbial flora from chronic
antibiotic use Hospitalization Malnutrition Age
older than 65 years Steroid therapy Chemotherapy R
adiation therapy
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Lactic Acidosis and Cancer
90 of lactic acid is metabolized in the liver,
where it is converted to pyruvate, with the
remaining 10 metabolized or excreted by the
kidney.
compromise of liver function can occur when
extensive hepatic metastases replace a
substantial portion of the liver parenchyma.
55
Lactic Acidosis and Cancer
hematologic and lymphoid malignancies as well as
solid tumors
breast, colon, ovarian, and small-cell lung
cancer among others
56
Pulmonary Circulation
57
Definitions

• Atelectasis collapse of small segments of lung
• Hypoxia lack of oxygen
• Hypoxemia lack of oxygen in arterial blood

58
Upper Airway

• Nasal cavity
• Oral cavity
• Pharynx

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Respiratory Factors

• Factor

Effect
Stimulants
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