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cancer complication
Complications:
1) hypercalcemia
a) laboratory:
- serum calcium often > 12 mg/dL
- serum PTH low
- serum phosphate is normal or low
- serum calcitriol is low or normal
b) management
- volume repletion with normal saline followed by furosemide
- add corticosteroids for acute treatment of
- multiple myeloma
- lymphoma
- hormone sensitive breast cancer
- bisphosphonate (pamidronate, zoledronate)
2) hyponatremia
a) asymptomatic
- short-term: 500-1000 mL/day
- long-term: demeclocycline
b) symptomatic
- 3% NaCl, infuse 0.5-1.0 meq/h + furosemide
- raise serum Na+ to 120 meq/L
- see hyponatremia (management)
3) deep vein thrombosis (secondary prevention)
- LMW heparin (do NOT use warfarin)
- IVC filter (Greenfield filter, umbrella) if LMW heparin contraindicated
4) spinal cord compression
a) clinical manifestations:
- pain (90%), radicular pain,
- sensory loss, especially perineal
- muscle weakness
- autonomic manifestations
- urinary incontinence
- fecal incontinence
b) radiology:
- MRI with gadolinium contrast of entire spine
- plain radiograph of little value
- bone scan of little value
c) management:
- acute spinal cord compression is a medical emergency
- dexamethasone
- radiation therapy to involved areas
- opiates for pain
- chemotherapy for sensitive tumors
- lymphoma
- breast cancer
5) superior vena cava syndrome
a) generally NOT regarded as a medical emergency
b) generally MORE IMPORTANT to establish tissue diagnosis
- biopsy tissue external to obstructing mass
- if tissue biopsy unsuccessful at establishing diagnosis, bronchoscopy, mediastinoscopy, thoracotomy
c) treatment directed at specific etiology
- radiation therapy
- chemotherapy
6) pericardial tamponade
a) special Laboratory:
- electrocardiogram (EKG): low voltage
- echocardiography
- right ventricular size generally small
- right atrial & right ventricular diastolic collapse
- right heart catheterization
- elevated, atrial/ventricular equalized diastolic pressure
b) management:
- pericardiocentesis
- surgical pericardiotomy
7) brain metastases or primary brain tumor with increased intracranial pressure
a) clinical manifestations:
- headache is the most common symptom, often severe, refractory to therapy, with maximum intensity in the morning
b) radiology: CT or MRI of the brain
c) avoid lumbar puncture: may precipitate brain herniation in patients with space-occupying lesions
d) management:
- dexamethasone: 6-25 mg every 6 hours
- avoid glucocorticoids if primary CNS lymphoma suspected until diagnosis established
- osmotic diuresis with mannitol may be useful
- hydrocephalus requires immediate neurosurgical drainage
8) infertility
- incidence of congenital anomalies or fetal wastage among cancer survivors who are able to conceive is no higher than the general population
9) cognitive impairment:
- some cancer survivors report cognitive impairment during & after chemotherapy
10) increased risk for suicide, especially in the first 6 months after diagnosis [2]
Related
malignant neoplasm (cancer)
Specific
cancer pain
paraneoplastic syndrome
tumor lysis syndrome
General
complication
References
- Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 18
American College of Physicians, Philadelphia 2006, 2009, 2018
- Henson KE, Brock R, Charnock J et al
Risk of Suicide After Cancer Diagnosis in England.
JAMA Psychiatry. Published online November 21, 2018.
PMID: 30476945
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2714596
- Nock MK, Ramirez F, Rankin O.
Advancing Our Understanding of the Who, When, and Why of Suicide Risk.
JAMA Psychiatry. Published online November 21, 2018.
PMID: 30477023
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2714593