complications of cancer ad its therapy

1. CommonCommon
Complications ofComplications of
CancerCancer
Dr. Shad Salim AkhtarDr. Shad Salim Akhtar
MB, MD, FRCP(Edin)
Fellow UICC .
Consultant Medical Oncologist
Asst. Director
Prince Faisal Oncology Centre
KFSH, Buraidah, Al-Qassim

2. Therapy
Advanced cancer
Common ComplicationsCommon Complications
of Cancerof Cancer

3. Common Complications of
Cancer
• Acute
– Nausea, vomiting
– Diarrhoea
– Extravasations
– Hypersensitivity reactions
Therapy related

4. • Immediate
– Alopecia
– Febrile Neutropenia
– Pulmonary toxicity
– Neurological
• Late
– Cardiac
– Reproductive
Common Complications of
Cancer
Therapy related

5. 0
10
20
30
40
50
60
100 100-500 500-1000 1000-1500 1500
Severe infection
All infections
Common Complications of Cancer
%age of days spent due to infection
Neutrophil Count
%dayswithinfection

6. • Could be a medical emergency
• Fever >380
(2 spikes) or 38.50
• Elderly patients may react differently
• ANC <500 or rapidly falling
• Assess general condition of the patient
• Infection screen
• Broad spectrum antibiotics
Common Complications of
Cancer
Febrile neutropenia

7. Common ComplicationsCommon Complications
of Cancerof Cancer
• Neurological
• Skeletal
• Haematological
• Gastrointestinal
• Endocrine
• Respiratory
• Effusions
– Increase with disease progression
Advanced cancer

8. • A middle aged man
– Lassitude, backache, generalized weakness
– Constipation, vomiting, somnolence
• Pale, dehydrated, kyphosis with
tenderness
• Anaemia, raised ESR, BUN, Cr, TP
• X-ray
Common ComplicationsCommon Complications
of Cancerof Cancer
• Serum Calcium 3.2 mmol/l

9. Common ComplicationsCommon Complications
of Cancerof Cancer
• 15-20% patients affected
• Epidural cord compression
• Raised intracranial pressure
• Status epilepticus
• Intracerebral haemorrhage
• Delirium
Neurological

10. Neurological
Complications
• May be the first sign of malignant disease
•Often present as a true emergency
•In patients known to have cancer
•Diagnosis may be easy
•Rapid diagnosis therapy can preserve function

11. • A young lady with a breast mass
• Responded to repeated hormonal therapies
• Relapse managed with chemotherapy
• Responded well
• Progressive disease in spite of different
modalities of therapy
• Admitted with backache
Neurological
Complications
Case History

12. Epidural CordEpidural Cord
CompressionCompression
• Compression of thecal sac by tumour
– Spinal cord
– Cauda equina
• One of the most common neurological
emergencies in oncology
• App 5% of all cancer pts affected
• Incidence increasing with improved survival

13. Epidural CordEpidural Cord
CompressionCompression
– Prostate
– Lung
– Breast
– Lymphoreticular malignancies
– Sarcoma
– Renal cell carcinoma
– Gastrointestinal cancers
– Melanoma
Causes

14. • Cervical (10)%
• Thoracic (70%)
• Lumbosacral (20%)
• 10-38% multiple non-contiguous sites
Lung
Breast
Colon
Pelvic
Location
Epidural CordEpidural Cord
CompressionCompression

15. • Direct extension from vertb body (90%)
– 71% lytic
– 21% mixed
– 8% blastic
• Paravertebral gutter
• Direct to epidural space
Hematogenous
Batson’s plexus
Retroperitoneal
Lymphomas
Routes of spread
Epidural CordEpidural Cord
CompressionCompression

16. Clinical features
Epidural Cord
Compression
• Pain
– First symptom in 96% pts
– Median duration ~7 wks (hrs to months)
– Localized initially to back
– Midline

17. Pain
• May mimic disc disease except:
– Exacerbated by recumbence
– Improves by upright position
• Radicular
– Less frequent
– Localizing
• Referred
Epidural Cord
Compression

18. Neurological dysfunction
– Three quarters-weakness
– 50% --sensory loss+autonomic
• Weakness
– 2nd
most common symptom
– Typically lower limbs
• Irrespective of site
– Proximally more marked
– Paraplegia may be abrupt
Epidural Cord
Compression

19. Sensory symptoms
• Concurrent with weakness-usually
• Begin in the toes and ascend
• Cauda equina—dermatomal loss
• Bilateral
• Perianal area
• Posterior thigh
• Lateral aspect of leg
Epidural Cord
Compression

20. Epidural Cord
Compression
• Late
• Impotence
• Horner’s
• Absence of sweating
• Usually not the sole presenting symptom
• Ataxia-with pain
Autonomic dysfunction

21. Diagnosis
• MRI the best diagnostic tool
• Myelography under special circumstances
• Image the entire spine
• High index of suspicion
Epidural Cord
Compression

22. Epidural cord compression
– Tumour
– Abscess
– Haematoma
– Disc herniation
– Vertebral haemangioma
Differential diagnosis
Spinal Cord
Dysfunction

23. Intramedullary processes
• Metastasis
• Abscess
• Hematoma
• Syrinx
Differential diagnosis
Spinal Cord Dysfunction

24. Myelopathy
– Radiation
– Intrathecal chemotherapy
– Paraneoplastic
Leptomeningeal metastasis
Spinal arachnoiditis
Spinal Cord
Dysfunction

25. • Palliative
Corticosteroids
• Radiation
• Surgery
Cytotoxic
Hormonal
Adjunctive
Treatment
Epidural Cord
Compression

26. • Pain relieving
• Oncolytic
• Anti-inflammatory
• Anti-oedema
• Dose, duration, timing?
Corticosteroids
Epidural Cord
Compression

27. Dexamethasone
• Dose
– 10mg bolus then 16mg/d
– 100mg bolus then 96mg/d
Randomised trials lacking
Epidural Cord
Compression

28. • Undefined role
• Laminectomy
– Destabilises the spine
– Poor access to ant. tumors
• Anterior resection may be better
• Mortality-6-10% (comp 48%)
Surgery
Epidural Cord
Compression

29. Epidural Cord
Compression
• No history or remote h/o cancer
• Spinal instability
• Bony compression
• Compression in irradiated area
• Ideal candidate
Good performance status
Treatable malignancy
Single level disease
Surgery- Indications