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Oncologic Emergencies

Oncologic Emergencies. 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. Oncologic Emergencies.

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Oncologic Emergencies

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  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

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