Exam 3 - Oncology complications

Question 1

What causes malignant spinal cord compression?

Answer 1

Result of tumor spreading to the spine; directly compressing the spinal cord

Question 2

What are the clinical presentations of malignant spinal cord compression?

Answer 2

• Back pain (worse when supine)
• Motor deficits → lower extremity weakness, leg heaviness, difficulty walking
• Autonomic dysfunctions → urinary frequency, urgency, bladder or bowel incontinence (late stage)

Question 3

What imaging could be ordered to visualize a malignant spinal cord compression?

Answer 3

MRI

Question 4

What is the goal of management for malignant spinal cord compression?

Answer 4

Maintain neurologic function, control growth of tumor, spine stabilization, pain control

Question 5

Malignant spinal cord compression management

Answer 5

• Corticosteroids (dexamethasone) to reduce vasogenic edema
• Radiotherapy for patients with radiosensitive tumors
• Surgery for spinal instability

Question 6

What is superior vena cava syndrome?

Answer 6

Blood flow through the SVC is obstructed (commonly associated with lung cancer and lymphomas)

Question 7

Superior vena cava syndrome clinical manifestations

Answer 7

• Swelling of the neck
• Swelling of the trunk, upper extremities or chest, dyspnea
• Chest pain, cough, dilated chest vein collaterals, new onset paresthesia, dysphagia, confusion, dizziness, hoarseness, night sweats

Question 8

Superior vena cava syndrome physical examination components

Answer 8

• Venous distention in upper body, facial edema, cyanosis, arm and hand edema, telangiectasia of the chest and upper back, hoarse voice, stridor
• Increased cerebral edema → confusion, dizziness, headaches, mental status changes, lethargy, coma

Question 9

Superior vena cava management

Answer 9

• Empiric treatment with airway obstruction or cerebral edema; if neither, treatment directed at underlying cause
• Radiation or chemotherapy
• Intravascular stenting → relief of symptoms within 24-48 hours of placement

Question 10

Malignant spinal cord compression clinical manifestations

Answer 10

• Back pain (worse when supine)
• Motor deficits → lower extremity weakness, leg heaviness, difficulty walking
• Autonomic dysfunctions → urinary frequency, urgency, bladder or bowel incontinence (late stage)

Question 11

Malignant spinal cord compression management

Answer 11

• Goals: maintain neurologic function, control growth of tumor, spine stabilization, pain control
• Corticosteroids (dexamethasone) to reduce vasogenic edema
• Radiotherapy for patients with radiosensitive tumors
• Surgery for spinal instability

Question 12

Clinical manifestations of hypercalcemia

Answer 12

• Lethargy, confusion, constipation, weakness, hypovolemia, polyuria, polydipsia, cardiac dysrhythmias
• Muscle weakness, hyporeflexia, mental status change

Question 13

Hypercalcemia management

Answer 13

• Oral or parenteral rehydration → increase renal clearance of calcium, decrease calcium levels through dilution, restore intravascular volume
• Hospitalization for patients with serum calcium >14 mg/dL or have mild fatigue and constipation
  
  • IV bisphosphonates

Question 14

Lab findings associated with tumor lysis syndrome

Answer 14

Results in hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

• Commonly due to chemotherapy

Question 15

Tumor lysis syndrome clinical manifestations

Answer 15

Due to electrolyte abnormalities

• Nausea, vomiting, constipation, diarrhea
• Low urine output
• Weight gain
• Acute renal failure (hyperphosphatemia)
• Muscle cramps (hypocalcemia)
• Seizures, tetany, arrhythmias (hyperkalemia, hypocalcemia)

Question 16

Tumor lysis syndrome management

Answer 16

• Aggressive hydration to preserve renal function (IV isotonic fluid)
• Monitor electrolytes to prevent cardiac dysrhythmias
• Oral sodium-potassium exchange resin, insulin glucose therapy, loop diuretics for hyperkalemia

Question 17

Malignancy associated with SIADH definition

Answer 17

Impaired water excretion that occurs when ADH is ineffectively suppressed → water retention and hyponatremia

Question 18

SIADH clinical manifestations

Answer 18

• Thirst, anorexia, mild nausea and vomiting, weight gain without edema, muscle cramps, headache, mild lethargy
  
  • Once sodium <115 mg/dL → hyporeflexia, confusion, oliguria, seizures, coma

Question 19

SIADH management

Answer 19

• Mild to moderate (120-135 mEq/L) → limit fluid intake to <1000 mL/24 hours
• Potassium chloride for hypokalemia
• Oral salt supplementation
• Loop diuretics
• Severe SIADH → hypertonic saline

Question 20

What is a Wilms tumor?

Answer 20

• Most common malignancy of the GU tract → firm, smooth mass in abdomen or flank
• Occurs in children between 2-5 years old

Question 21

Wilms tumor clinical manifestations

Answer 21

• Unilateral abdominal mass (usually displaceable)
• Painless
• Fever, dyspnea, diarrhea, vomiting, weight loss, malaise
  
  • NO constitutional symptoms
• Hematuria

Question 22

Wilms tumor physical exam findings

Answer 22

• Firm, smooth abdominal or flank mass that does NOT cross midline → painless, displaceable
• Hypertension
• Left varicocele in males if spermatic vein obstructed
• Lack of iris color (aniridia) → indicates WAGR syndrome (Wilms tumor, GU abnormalities, aniridia, intellectual disability)

Question 23

Wilms tumor diagnostic studies

Answer 23

• Ultrasound (cystic vs solid mass)
• CT scan of chest, abdomen, pelvis to stage
• UA (hematuria)

Question 24

PCP role in the management of Wilms tumor

Answer 24

• Support and educate family/caregivers
• Establish relationship with patient’s oncologist
• Ensure child is reaching developmental milestones
• Keep UTD with WCC/vaccines
• Monitor for cancer recurrence (increased lifetime risk of cancer if patient has had pediatric cancer)