Oncologic Emergencies: Diagnosis and Treatment

Any acute, potentially fatal, or morbid incident connected directly or indirectly to a patient's tumor or the therapy used to treat it is considered an oncologic emergency. Some oncologic emergencies might appear gradually and remain undiagnosed resulting in increased morbidity and mortality. Oncologic emergencies are generally characterized by common conditions encountered by cancer patients, such as nausea, discomfort, headache, and fever. Physicians must maintain a high level of suspicion to avoid and identify oncologic emergencies, and they must appropriately educate patients about preventative measures.

Common oncologic emergencies

– The common oncologic emergencies include

• Superior vena cava syndrome

• Spinal cord compression

• Increased intracranial pressure

Superior vena cava syndrome

Superior vena cava syndrome (SVCS) occurs when the superior vena cava is slightly or completely constricted. Cancer is the most common cause of SVCS. Some common symptoms are upper body swelling, coughing, shortness of breath, and chest pain. People suffering from lung Cancer, Non-Hodgkin lymphoma, or cancer that has progressed to the chest are at high risk of developing SVCS in several ways – • Superior vena cava contraction by a tumor • Superior vena cava obstruction due to tumor enlargement • Lymph node enlargement due to cancer spread • Blood clots in the vein due to cancer spread

Diagnosis

– X-ray of the chest or the vein, computed tomography, MRI, and Ultrasound.

Treatment –

• Chemotherapy.

• Corticosteroids – lower swelling and inflammation.

• Diuretics – Frequent urination resulting in loss of extra body fluids.

• Stent administration in blocked veins to increase blood flow.

• Surgery

Spinal cord compression -

Spinal cord compression is a serious condition that develops when anything exerts pressure on the spinal cord such as a tumor resulting in vertebrae being damaged which leads to decreased blood flow to the spinal cord and nerves. The most common cancers that can spread to the spinal cord are breast cancer, lung cancer, prostate cancer, kidney cancer, lymphoma, and multiple myeloma.

Diagnosis –

MRI, CT scan, Myelography, and X-ray.

Treatment –

• Corticosteroids – Reduce swelling and pressure around the spinal cord, relieve pain, and lower the body’s immune response.

• External beam radiation therapy – Shrink the tumor surrounding the tissue with the help of radiation.

• Surgery – Remove the tumor, stabilize the spine, and lower pressure on the spine. • Chemotherapy – In cases of non-Hodgkin lymphoma (NHL).

• Bisphosphonates – Protect the bones from breaking down due to the effects of cancer.

Increased intracranial pressure (ICP) -

Tumors that develop in the brain or cancer that has spread, or metastasized, to the brain result in elevated ICP. Increased ICP can develop because of the following reasons – CSF pathway blockage, infection of the brain or membrane, bleeding in the brain, and swelling in the brain.

Diagnosis –

MRI, CT scan, X-ray, lumbar puncture.

Treatment –

• Corticosteroids (Dexamethasone) – Prevents swelling of the brain.

• Radiation therapy or intrathecal chemotherapy – Use of a device called Ommaya reservoir implanted beneath the scalp to deliver chemotherapy drugs directly into the CSF.

• Surgery – Debulking surgery is done to remove the tumor.