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Oncology emergency, ((VI. Radiation Therapy, I. Overarching Treatment…
Oncology emergency
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Rarely in selected low risk patients vitally can stable with non hematological malignancy be treated as out- patient using oral antibiotics with careful follow up?
- Monotherapy using broad spectrum B-lactamase inhibitors if uncomplicated infection.
- Combination antibiotics using B-lactamase inhibitors plus aminoglycoside for Gram bacilli.
- Indications for using vancomycin include life-threatening septicemia, suspected central line infection, MRSA infection of the skin, and mucosa infection.
- Antifungal therapy is added if persistent fever > 5 days after antibiotic or proven infection.
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- unStable vital sign
- affected liver and kidney function
- Neutropenia expected to elevate within > 7 days
- medical co-morbidities
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- Large Rth field leading to BM suppression.
2-caustive organisms.:• Bacterial is the commonest organism usually Gram –ve (pseudomonas ) and Gram +ve ( staph \ strept ).
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- Careful physical examination of skin, sinuses, mouth, oropharynx, lung, abdomen and vital sings.
- Laboratory tests CBC, CRP, blood culture and urine analysis and culture. 3. CT chest when indicated.
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Active COPD.: Active COPD defined as: Active chronic bronchitis, emphysema, decrease in forced expiratory volumes, and need for oxygen therapy, corticosteroids, and/or bronchodilators.
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- Neutropenia expected to elevate within < 7 days
- No medical co-morbidities
- Stable vital signs
- Adequate liver and kidney functions
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• Hypercalcemia occurs in 10-30% of patients with malignancy and is most commonly associated with breast cancer, lung cancer, non-Hodgkin's lymphoma and multiple myeloma, although it may be seen with any malignancy
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• Hypercalcemia is a poor prognostic indicator in malignant disease and may indicate uncontrolled tumor progression and metastasis.
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• Presenting features of hypercalcemia include nausea and vomiting, anorexia, thirst and polydipsia,
polyuria, lethargy, bone pain, abdominal pain, constipation, confusion and weakness.
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Urgent intervention is required to treat symptomatic hypercalcemia. Management includes intensive hydration and intravenous bisphosphonates.
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Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to chemotherapy e.g. L-Asparaginase
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• Skin reactions, including hives and itching and flushed or pale skin
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• Constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing
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oxygen, IV steroid & antihistaminics, adrenaline
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• It is the compression of the heart due to pericardial effusion resulting in reduced ventricular filling & subsequent hemodynamic compromise. The condition may lead to pulmonary edema, shock & death.
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Spinal cord compression (SCC) is a true oncologic emergency as delays in diagnosis can cause severe, irreversible neurologic compromise, decline in functional status, and impaired quality of life. Most cases result from spine metastases with extension into the epidural space.
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Although all cancers capable of hematogenous spread can cause malignant spinal cord compression, the most common underlying cancer diagnoses associated with this complication are breast, prostate, lung, multiple myeloma, and lymphoma.
Hematogenous seeding of tumor to the vertebral bodies is the most common cause of spinal metastases,
followed by direct extension and cerebrospinal fluid spread.
Nearly 66% of spinal cord compression involves the thoracic spine and
20% involves the lumbar spine
. Colon and prostate malignancies more commonly spread to the lumbosacral spine
while lung and breast cancers frequently affect the
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VI. Radiation Therapy
- Stereotactic radiation therapy:
- Emerging as a preferred modality.
- Offers more frequent radiation dose delivery without exceeding cord tolerance.
- Most common treatment approach.
- Application: Useful for asymptomatic or symptomatic patients with poor surgical candidacy.
- Radio-sensitive tumors (e.g., breast, lymphoma, myeloma, prostate, small cell lung cancer, renal cell carcinoma) show higher chance of preserving or recovering motor function.
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V. Surgical Intervention
- Considered for patients with spinal instability or neurological deficits, unless contraindicated.
- Outcomes: Patients undergoing surgery (e.g., debulking) often experience longer duration of maintained ambulation and improved regaining of ambulation compared to radiation alone (especially for non-ambulatory patients).
- Approximately 16-20% of patients receive surgical decompression.
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V. Biopsy Considerations
- Mandatory if SCC is the initial presentation of a malignancy, prior to starting treatment.
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