Cancer Complication

From Anvita Health Wiki

Adverse-effects

• hypercalcemia

• laboratory:

• serum calcium often > 12 mg/dL
• serum PTH low
• serum phosphate is normal or low
• serum calcitriol is low or normal

• 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)

• hyponatremia

• asymptomatic

• short-term: 500-1000 mL/day
• long-term: demeclocycline

• symptomatic

• 3% NaCl, infuse 0.5-1.0 meq/h + furosemide
• raise serum Na+ to 120 meq/L
• see hyponatremia (management)

• deep vein thrombosis (secondary prevention)

• LMW heparin (do NOT use warfarin)
• IVC filter ( Greenfield filter, umbrella) if LMW heparin contraindicated

• spinal cord compression

• clinical manifestations:

• pain (90%), radicular pain,
• sensory loss, especially perineal
• muscle weakness
• autonomic manifestations

• urinary incontinence
• fecal incontinence

• radiology:

• MRI with gadolinium contrast of entire spine
• plain radiograph of little value
• bone scan of little value

• 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

• superior vena cava syndrome

• generally NOT regarded as a medical emergency
• generally MORE IMPORTANT to establish tissue diagnosis

• biopsy tissue external to obstructing mass
• if tissue biopsy unsuccessful at establishing diagnosis, bronchoscopy, mediastinoscopy, thoracotomy

• treatment directed at specific etiology

• radiation therapy
• chemotherapy

• pericardial tamponade

• 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

• management:

• pericardiocentesis
• surgical pericardiotomy

• brain metastases or primary brain tumor with increased intracranial pressure

• clinical manifestations:

• headache is the most common symptom, often severe, refractory to therapy, with maximum intensity in the morning

• radiology: CT or MRI of the brain
• avoid lumbar puncture: may precipitate brain herniation in patients with space-occupying lesions
• 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

• infertility

• incidence of congenital anomalies or fetal wastage among cancer survivors who are able to conceive is no higher than the general population

• cognitive impairment:

• some cancer survivors report cognitive impairment during & after chemotherapy

References

1. Medical Knowledge Self Assessment Program (MKSAP) 14, 15, American College of Physicians, Philadelphia 2006, 2009

cancer complication