Oncological Emergencies

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Oncological Emergencies

  1. 1. ONCOLOGICAL EMERGENCIES• PRESENTATION• BY• Dr Mohd Shafi Moona, MD
  2. 2. Oncological Emergencies:• 1). Structural_obstructive oncological emergencies.• 2). Metabolic emergencies.• 3). Treatment related emergencies.
  3. 3. Superior vena cava syndrome• Obstruction of SVC.• 90% SVCS cases are due to malignant tumors(lung cancer, lymphoma & metastatic tumors).• Lung cancers (small cell & squamous cell)_ 85% cases.• Metastatic tumours to the mediastinum (testicular & breast cancer).
  4. 4. Other Causes:• Benign tumors.• Aortic aneurysm.• Thyroid enlargement.• Thrombosis.• Fibrosing mediastinits.
  5. 5. Presentation• Headache.• Dizziness.• Epistaxis.• Tongue swelling.• Cough.• Dyspnea.• Haemoptysis.• Neck & facial swelling.• Dysphagia.
  6. 6. Physical Findings.• Dilated neck veins.• Incresed number of collateral veins.• Edema of face arms & chest.
  7. 7. • Recent obstruction ( malignant in origin).• Long standing obstruction(non_malignant)• In SVC thrombosis: Development of symptoms & signs is rapid.
  8. 8. Diagnosis.• Clinical.• X Ray chest.• CT scan.
  9. 9. Treatment.• Radiation therapy (non_small cell lung cancer & other metastatic solid tumors).• Chemotherapy (germ cell, small cell & lymphoma).• Expandable vena cava stents.• Thrombolysis for occlusive SVC thrombosis• Fluoroscopy guided baloon dilation for SVC stenosis.
  10. 10. Spinal cord compression• Seen in 5_10% of patients with cancer.• Epidural tumours_10% of cases as Ist manifestation of malignancy.• Majority of malignant cord compression_ Due to metastatic breast, lung & prostate cancer.• Exophytic metastasis to vertebral body: 80_90% of cases.• Remaning due to epidural metastasis & vertebral fractures.
  11. 11. Other causes:• Tumors primary to spine.• Vascular malformation.• Infection.• Multiple myeloma.
  12. 12. Clinical Presentation• Back pain• Tenderness.• Exacerbation of pain due to movement.• Radicular pain.• Sensory parasthesia.• Motor symptoms.
  13. 13. Diagnosis• MRI.• Contrast CT scan.• X-Rays.
  14. 14. Management.• Steroids.• External beam radiation.• Surgical or image guided biopsy.
  15. 15. Indication for surgical intervention• Need for tissue diagnosis.• Resection of radioresistant tumors.• Vertebral burst fracture causing bony impingement on the cord.
  16. 16. Systemic Therapy( Hormonal orchemotherapeutic agents)• Androgen blockade for cord compression due to prostatic cancer.• High dose Ketokonazole rapidly reduces testosterone level.• Combination of Ketokonazole and Flutamide.• GnRH agonist.
  17. 17. Cardiac Tamponade.• Increased intracardial pressure secondary to fluid accumulation .• Most frequent aetiolgies (idiopathic & neoplastic).• Malignant pericardial disease is found at autopsy in 5- 10% of patients with cancer(lung cancer, lymphoma & leukaemia)• The origin is not malignancy in about 50% of cancer patients.
  18. 18. Other causes:• Drug induced pericarditis.• Irridiation.• Hypothyroidism.• Idiopathic pericarditis.• Infection.• Autoimmune disease.
  19. 19. • Radiation Pericarditis:• A) Acute inflammatoty effusive pericarditis.• B) Chronic effusive pericarditis.
  20. 20. Clinical Presentation• Dyspnea.• Chest pain.• Orthopnea.• Symptoms of Rt heart failure.
  21. 21. Signs.• Becks triad.• Kussmauls sign.• Pulsus paradoxius.
  22. 22. Diagnosis:• Chest X- Ray.• ECG.• Echo.• CT scan.• MRI.• Cytology will be +ve only in 65_85% of cases of malignant involvement of pericardium.• Pericardial biopsy.
  23. 23. Treatment• Assymptomatic. (No treatment).• Symptomatic (Pericardiocentesis)• Surgical pericardial window.• Pericardial sclerosis (Bleomycin, Doxycycline)
  24. 24. • Thank You

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