Pulm - Oncologic Emergencies

Compression of the superior vena cava by tumor inhibits the return of blood to the heart. Was most commonly seen with the presence of granulomatous conditions in the mediastinum such as TB or due to syphilitic arotitis. The most commonly etiology now is neoplasia (70-75% lung cancer). It is not an absolute emergency unless there are severe respiratory or neurologic symptoms. Symptoms include venous dilation of arms and chest, facial flushing and swelling, dyspnea, and cerebral edema.

High dose steroids and anti-coagulants. Radiation and chemotherapy are appropriate in case where tumor is sensitive like lymphoma and small cell lung cancer.

The destruction of nervous tissue in the spinal cord by direct growth and pressure of disruption of the blood supply. The most common associated symptom is that of radicular pack pain which can be present for weeks or months. It does not develop over night. The onset of weakness depends on anatomic location and vascular compromise. Weakness is in a distribution below the dermatomal level at which the pain exists. There can be hyperreflexia and urinary and rectal incontinence.

Radiation is the main modality of treatment. Urgent administration of high dose steroids (usually dexamethasone). Surgery in the event of need for diagnosis, rapidly progressive neurologic deficit, and progressive motorsensory changes despite nonsurgical treatment.

Release of calcium from bone due to invading malignant tumor or hormonal mechanisms. It has a constellation of central nervous and peripheral nervous system symptoms, GI symptoms of dyspepsia and constipation, polyuria, shortened Q-T interval, and severe bone pain.

IV fluids and diuretic therapy with furosemide; Glucocorticoids in selected cases, such as lymphoma and myeloma. Bisphosphonate therapy where appropriate. Calcitonin therapy usually only transiently beneficial.

Results from the metabolic product of DNA metabolism, uric acid, from rapidly dividing and necrosing malignant cells. This causes interstitial and tubular renal damage with resultant hyperkalemia, hyperphosphatemia, hypocalcemia, and uremia that can be life-threatening if not recognized early and treated. Usually from acute leukemia, lymphomas, and small cell lung cancer. You want to prevent this, not diagnosis it, because its bad.

Hydration, allopurinol (prevents renal failure), alkalinization with sodium bicarbonate, and rasburicase when needed (a uric oxidase agent which produces harmless allantoin in the urine).

Pericardial tamponade depends on the rapidity of accumulation of pericardial fluid. Slow accumulation rarely leads to emergency, but does need to be treated. Rapid accumulation leads to tamponade. Needs emergent admission, echocardiogram, cardiology consult and pericardiocentesis (window in the pericardium). Symptoms include severe dyspnea, chest pain, tachycardia, Kussmaul's sign, pulsus paradoxicus, electrical alternans of both P wave and QRS complex. and tachypnea.

Surgery (pericardial window), radiation therapy, and chemotherapy if tumor is sensitive. Agressiveness depends on how rapidly the tamponade is progressing.

Tumor-induced destruction and rupture of alveolar arteries. In general, very vascular tumors, particularly those that are metastatic, are the main culprits. This includes lung and renal cancer, and melanoma. Can be a result of the use of angiostatin or endostatin, bevacizmumab, and small molecule tyrosine kinase inhibitors such as sorafenib and sunitinib.

Surgical resection of bleeding pulmonary segment is usually not successful. Radiation only if bleeding is not massive

Presents with severe pain, rapid swelling of injected site with dissemination depending on severity, and possible later neurovascular compromise. Drugs which can cause this include doxorubicin, vincristine, vinblastine, nitrogen mustard, actinomycin-D, mitomycin-C, mithramycin, and daunorubicin.

Immediate cooling of the extremity, debridement, and specific antidotes.