1. Oncologic Emergencies

2. Oncologic Emergencies
Neoplasm = new and abnormal formation of tissue (tumor)
Benign tumor = Does not spread by infilatration of tissue
Malignant tumor (cancer) =
Spreads from primary to distant sites (metastasis)
Destroys host tissues

3. Oncologic Emergencies
Benign Tumors
Structure typical of tissue of origin
Slow rate of growth
Mostly encapsulated
Slightly vascularlized
Does not metastasize
Necrosis, ulceration unusual
Rarely recurs after removal

4. Oncologic Emergencies
Malignant Tumors
Structure atypical of tissue of origin
Rapid rate of growth
Loosely or not encapsulated
Moderately to highly vascularlized
Metastasizes
Necrosis, ulceration common
Frequently recurs after removal

5. Oncologic Emergencies
Types of malignant tumors
Epithelial tissues = Carcinomas
Melanocytes of skin = Melanomas
Connective tissues = Sarcomas
Lymphatic tissues = Lymphomas
Glial tissues of CNS = Neurogliomas
Granular leukocytes = Leukemias
Plasma cells = Multiple myeloma

6. Oncologic Emergencies
Consequences of tumor growth
Destruction of invaded tissue
Obstruction of organs
Compression of adjacent structures
Abnormal hormone production
Nutritional deficiencies, starvation
Hemorrhage
Infection

7. Upper Airway Obstruction
Late result of tumors of
Oropharynx
Neck
Superior mediastinum

8. Upper Airway Obstruction
Suspect in afebrile patients with
Stridor
Palpable neck masses
History of voice change

9. Upper Airway Obstruction
Acute compromise may be caused by:
Infection
Hemorrhage
Trapped secretions
Remove or bypass obstruction

10. Upper Airway Obstruction
Management
Remove or bypass obstruction
Suction
Endotracheal intubation
Surgical airway

11. Laryngectomy Patient Patient breathes through stoma at base of neck
May be complete or partial

12. Laryngectomy Patient
Ventilate through opening in midline at base of neck
Ignore other openings
Seal mouth/nose in partial laryngectomy

13. Acute Spinal Cord Compression
Compression from:
Tumor
Collapse of vertebrae
Hemorrhage
Infection

14. Acute Spinal Cord Compression
Suspect if patient with malignancy develops:
Paraparesis
Paraplegia
Sensory deficits
Urinary incontinence
Acute urinary retention

15. Acute Spinal Cord Compression
Focal or nerve root pain may occur
Pain localized to involved vertebrae may be present

16. Acute Spinal Cord Compression
Management
Immobilize spine
Steroids
Emergency surgical decompression or radiotherapy indicated

17. Pericardial Effusion Causes Effusion from pericardial metastasis
Secondary hemorrhage
Infection
Chemotherapeutic agents
Radiation-induced pericarditis

18. Pericardial Effusion
Effects depend on volume, speed of fluid accumulation

19. Pericardial Effusion Signs Resistant hypotension Narrow pulse pressure
Jugular vein distension
Diminished heart sounds
Pulsus paradoxus

20. Pericardial Effusion
Emergency pericardiocentesis may be needed

21. Superior Vena Cava Syndrome
Cause
Obstruction of superior vena cava
Increased venous pressure in
Arms
Neck
Face
Cerebrum

22. Superior Vena Cava Syndrome
Signs and Symptoms
Headache
Syncope
Feeling of head congestion and fullness in neck/face
Edema of face/arms
Neck/upper chest vein distension
Facial plethora
Telangiectasia

23. Superior Vena Cava Syndrome
May produce
Increased intracranial pressure
Decreased preload and cardiac output

24. Superior Vena Cava Syndrome
Management
Lasix
Steroids

25. Hemorrhage Causes Erosion of vessel walls by neoplasm
Therapy-induced coagulation problems
Thrombocytopenia

26. Hemorrhage Management Control hemorrhage with standard techniques
Treat hypovolemia

27. Chemotherapy Agent Release
Can result from malfunction of ambulatory chemotherapy units
Highly toxic
Wash off skin immediately
Report exposure to physician

28. Vascular Access
Do not start IV’s in implants or shunts used for chemotherapy
Implants may lead to areas other than vascular system
Needles may damage implant or shunt