Cancer and its treatment may lead to a range of potentially life-threatening conditions that require urgent action to correct them. Most oncological emergencies can be classified as metabolic, haematological, structural, or treatment-relatedFebrile neutropenia is most often seen as an effect of cytotoxic therapy. The neutrophil count usually reaches its lowest level 5 to 10 days after the last dose of chemotherapy. Febrile neutropenia is defined as an oral temperature ≥38.5°C or two consecutive readings of ≥38.0°C for two hours and an absolute neutrophil count ≤0.5 x 109/L. Up to 80% of patients receiving chemotherapy for haematological malignancies will develop neutropenic fever at least once during the course of therapy. Patients with solid tumors are reported to develop neutropenic fever at a rate of 10-50% during the course of chemotherapy. The likelihood of fever increases with the duration and the severity of neutropenia as well as the rate of decline of the absolute neutrophil count.

1. Introduction
Oncological
emergencies
DR MONA QUENAWY
LECTURER OF CLINICAL ONCOLOGY
AIN SHAMS UNIVERSITY

2. Agenda
Definition
Types
Metabolic
Structural
Management
Prevention

3. Introduction

Oncological emergencies are defined as any
acute possible morbid or life-threatening
events in patients with cancer either because
of the malignancy or because of their
treatment.

These events may occur at any time during
malignancy, from symptoms present to end-stage
disease

4. Definitions and
classifications

5. Hypercalcemia Metabolic
Hypercalcemia is a total serum calcium concentration > 10.4 mg/dL (> 2.60 mmol/L) or
ionized serum calcium > 5.2 mg/dL (> 1.30 mmol/L). Principal causes include
hyperparathyroidism, vitamin D toxicity, and cancer.

6. 
Fatigue
lethargy
polyuria
constipation
stupor
coma
renal failure
cardiac arrhythmia
Metabolic

Clinical presentation Metabolic

7. Signs
Metabolic

8. Metabolic

cab Metabolic
Calcitonin
Bisphosphonate
Denosumab
Prednisone
Iv fluids and diuretics
Treatment

9. Tumor lysis syndrome
Metabolic

10. Pathogenesis

11. Clinical presentation
Metabolic

12. Metabolic
Management in brief

13. Metabolic

Management cont.,

14. Metabolic
SIADH

15. Metabolic
Metabolic

pathogenesis

16. Metabolic
Clinical presentation

17. Metabolic
Management

18. structural

S.V.C compression

19. structural

Clinical presentation

20. 
Signs of S.V.C syndrome :

21. structural

Management

22. structural

24. structural

26. structural

27. structural

28. structural

29. structural
structural

30. structural
structural

31. structural

32. structural

33. Neutropenia is characterized by a reduction in neutrophils
below normal counts, usually occurring within 7 to 12 days
following cancer chemotherapy
It is diagnosed with a blood test that confirms an absolute
neutrophil count (ANC) of less than 500 cells per microliter
following cytotoxic chemotherapy, or by an ANC expected to
decrease to less than 500 cells per microliter within 48 hours.

34. Due to reduced levels of neutrophils in circulation, patients
with neutropenia may have an impaired ability to fight
infections.
Hence, even a minor infection for patients with neutropenia
may become very serious.

36. It is crucial to monitor
patients for signs and
symptoms of infection, which
may present as fever, chills,
or sweats. Other signs and
symptoms of infection for
patients with FN are
provided

Management

37. MASCC Scoring Index
Characteristic/Score
The burden of illness: no or mild symptoms/5
The burden of illness: none or mild/5
The burden of illness: moderate symptoms/3
The burden of illness: severe symptoms/0
No hypotension (systolic BP greater than 90
mmHg)/5
No chronic obstructive pulmonary disease/4

38. Type of Cancer
Solid tumor/4
Lymphoma with previous fungal infection/4
Hematologic with previous fungal infection/4
No dehydration/4
Outpatient status (at the onset of fever)/3
Age less than 60 years/2

39. Management cont
In low-risk patients, oral empiric therapy with a
fluoroquinolone plus amoxicillin/clavulanate is recommended in
the outpatient setting.
Clindamycin can be used for those with penicillin allergies. If
the patient remains febrile for 48 to 72 hours, the patient will
require admission

40. For high-risk patients presenting with neutropenic fever, an
intravenous antibiotic therapy should be given within 1 hour
after triage and be monitored more than 4 hours before
discharge.
The Infectious Disease Society of America (IDSA) recommends
monotherapy with antipseudomonal beta-lactam agents such
as cefepime, carbapenems, or piperacillin and tazobactam.
Vancomycin is not recommended for initial therapy but
should be considered if suspecting catheter-related infection,
skin or soft tissue infections, pneumonia, or hemodynamic
instability.
If patients do not respond to treatments, coverage should be
expanded to include resistant species

41. Methicillin-resistant Staphylococcus aureus (MRSA):
vancomycin, linezolid, and daptomycin
Vancomycin-resistant enterococci (VRE): linezolid and
daptomycin
Extended-spectrum beta-lactamase (ESBL)-producing
organisms: carbapenems
Klebsiella pneumoniae: carbapenems, polymyxin, colistin,
or tigecycline

42. Fluoroquinolones as
prophylaxis for
patients who are high
risk Taxotere therapy
Antifungal prophylaxis
with an oral triazole
with patients with
profound neutropenia
Recommendation for prevention of infection in
neutropenic patients:

43. Prevention cont.:
Yearly influenza vaccination is recommended for all patients
receiving chemotherapy.
Treatment with a nucleoside reverse transcription inhibitor is
recommended for patients at high risk of hepatitis B virus
reactivation.
Herpes simplex virus- seropositive patients undergoing allogeneic
HSCT or leukemia induction therapy should receive prophylaxis.
In the National Comprehensive Cancer Network (NCCN) guidelines, it
it is recommended that patients at a high risk of neutropenic fever
can benefit from granulocyte-colony stimulating factors (G-CSFs).

44. Thank you