oncologic emergencies
Download
Skip this Video
Download Presentation
Oncologic Emergencies

Loading in 2 Seconds...

play fullscreen
1 / 28

Oncologic Emergencies - PowerPoint PPT Presentation


  • 355 Views
  • Uploaded on

Oncologic Emergencies. Shahina Qureshi State University of New York Downstate Medical Center. Oncologic Emergencies. Metabolic and Endocrine Tumor Lysis Syndrome, Hypercalcemia, SIADH Cardiothoracic Superior Vena Cava ,SMS, Pleural ,Pericardial Effusions, Pneumothorax, ATRA Abdominal

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Oncologic Emergencies' - lumina


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
oncologic emergencies

Oncologic Emergencies

Shahina Qureshi

State University of New York

Downstate Medical Center

oncologic emergencies1
Oncologic Emergencies
  • Metabolic and Endocrine
    • Tumor Lysis Syndrome, Hypercalcemia, SIADH
  • Cardiothoracic
    • Superior Vena Cava ,SMS, Pleural ,Pericardial Effusions, Pneumothorax, ATRA
  • Abdominal
    • GI, GU
  • Neurologic
    • Spinal Cord Compression, Seizures, CVA
  • Shock
    • DIC, Pancytopenia
tumor lysis syndrome
Tumor Lysis Syndrome
  • Potentially fatal metabolic complication due to rapid destruction of of tumor cells during or12-72 hrs after treatment. Leading to
    • Hyperuricemia [ uric acid > 15mg/dl ]
    • Hyperkalemia
    • Hyperphosphatemia [phos >8 mg/dl]
    • Hypocalemia
    • Renal Failure
tumor lysis syndrome risk factors
Tumor Lysis SyndromeRisk Factors
  • Elevated Leukocyte Count
  • High proliferation rate
  • Chemosensitivity
  • Large tumor burden
  • Elevated pretreatment uric acid and LDH levels [ Cohen et al Am j Med 1980]
  • Preexisting renal impairment, Dehydration
tumor lysis syndrome1
Highest risk

Moderate risk

Low risk

Lymphoblastic Lymphoma

Burkitts Lymphoma

ALL

Low grade lymphom

Breast cancer

Small cell lung cancer

Seminoma

Medulloblastoma

Adenocarcinoma of GI tract

Lymphoma treated with interferon

Tumor Lysis Syndrome
pathway of uric acid production
Pathway of Uric acid production

Purine catabolism

Hypoxanthine

Xanthine

Uric acid

Allantoin

Xanthine oxidase

Urate oxidase

tumor lysis syndrome management
Tumor lysis syndromeManagement
  • Hydration
  • Alkalinization
  • Diuresis
  • Uric acid reduction
  • Metabolic abnormalities
tls management
TLS Management
  • Hydration
    • 2-4 times maintainance fluid D5 I/4 NS+ 40 mEq/L NaHCO3
    • Maintain urine output>100 ml/m2/hr
    • Urine Sp Gr<1.010
tls management1
TLS Management
  • Maintain Urine pH at 7.0- 7.5
  • Diuresis with Furosemide [0.5 –1.0 mg/kg] ,Mannitol[ 0.5g/kg ]
  • Hyperkalemia
      • Na Polystyrene sulphonate1g/kg
      • Calcium gluconate 100-200mg/kg
      • Insulin0.1. Units/kg=25% Glucose 2ml/kg
  • Hyperphosphatemia
      • Aluminum hydroxide 15 ml q 4-8h
  • Hypocalcemia
      • Calcium Gluconate I.v only if symptomatic
tls indications for dialysis
TLS Indications for Dialysis
  • Volume overload [Effusions]
  • Renal failure
tls uric acid reduction
TLS Uric acid reduction
  • Allopurinol
      • Inhibits xanthine oxidase so decreases production of uric acid
      • Also inhibits p450
      • Interferes with metabolism of 6-MP
      • Takes 24 hrs to reduce uric acid level
      • P.O.dose 10mg/kg/day two days before chemotherapy
      • I.V. form approved in 2001 for pts unable to tolerate p.o 40-150mg/m2 q 8 h
tls uric acid reduction1
TLS Uric acid reduction
  • Urate Oxidase
      • Non Recomboinant[uricozyme] developed in France in 1992
      • Recombinant[rasburicase] developed in 1996
      • Oxidizes Uric acid to allantoin which is 5-10 times more soluble, does not need urine alkalinization.
      • Generates H2O2,not used in G6PD- def pts
      • Well tolerated 1% hypersensitivity, 5% antibody formation
      • 90% reduction of plasma uric acid in 4 hrs
      • 0.45 risk of new renal complications
comparison of iv allopurinol and rasburicase
I.V rasburicase

Year of study 1999-2002

No of pts 778

Duration of Tr 3 d

Tr success 98%

Prophlaxis success 100%

Comparison of IV Allopurinol and Rasburicase
oncologic emergencies superior vena cava syndrome
Oncologic EmergenciesSuperior Vena Cava Syndrome
  • Due to invasion or compression of SVC by:
      • Malignancy in 78-85%,e.g lung cancer, lymphoma
      • Infection
      • Thrombosis
superior vena cava syndrome signs and symptoms
Superior vena cavasyndromeSigns and Symptoms
  • Dyspnoea, cough 68%
  • Facial pain or swelling 12%
  • Wheezing 31%
  • Facial plethora
  • Venous distension in the neck and chest wall
  • Pleural effusion 50%
  • Pericardial effusion 19%

Ingram, Med Ped Onc 1990;18:476

superior vena cava syndrome diagnosis
Superior Vena cava SyndromeDiagnosis
  • Chest X-ray
  • Chest CT
  • Helical CT
  • MRI
  • Histologic Diagnosis , Sputum, Bone marrow, Bronchoscopy
superior vena cava syndrome treatment
Superior vena cava syndromeTreatment
  • Radiotherapy
  • Emergency Chemotherapy
  • IV methyl prednisolone
  • Surgery
spinal cord compression signs and symptoms
Spinal Cord CompressionSigns and Symptoms
  • Back pain in 80%
  • Progressive Weakness
  • Sensory Abnormalities
  • Paresis
  • Paraplegia and Quadriplegia
  • Sphincter dysfunction
spinal cord compression evaluation
Spinal Cord Compression Evaluation
  • MRI scans T1, T2 weighted
  • CT Myelography
  • CSF examination
spinal cord compression treatment
Spinal Cord CompressionTreatment
  • Dexamethasone IV 1.0-2.0mg/kg bolus
  • Local Radiotherapy
  • Surgical decompression
  • Chemotherapy if diagnosis is known
oncological emergencies hyperleukocytosis
Oncological EmergenciesHyperleukocytosis
  • WBC count >100,000
    • ALL 9-13%
    • AML 5-22%
hyperleukocytosis complications
HyperleukocytosisComplications

Bunin NJ, Piu CH, J. Clin Oncol 1985;3:1590

hyperleukocytosis signs and symptoms
HyperleukocytosisSigns and Symptoms
  • Mental Status Changes, Headache, Blurred Visions, Seizures, Coma
  • Pulmonary Leukostasis, dyspnea, hypoxia, cyanosis, acidosis
  • Priapisim, dactylitis
  • Renal failure
hyperleukocytosis treatment
HyperleukocytosisTreatment
  • IV hydration
  • Maintain hemoglobin below 10g/dL
  • Exchange transfusion 52-66% reduction
  • Leukapharesis 48-62% reduction
  • Systemic chemotherapy
  • Cranial irradiation upto 400 cGy prevents CNS hemorrhage
oncological emergencies
Oncological Emergencies
  • Anticipate
  • Prevent
ad