Advertisement

Diagnosis and Management of Oncologic Emergencies

  • E. B. Lamont
  • C. M. Rudin
  • P. C. Hoffman
Chapter
  • 110 Downloads

Abstract

This chapter details the epidemiology, pathophysiology, clinical presentation, diagnostic approaches, and treatment modalities of several of the most common oncologic emergencies. Because of the systemic nature of cancer, these emergencies often affect organ systems remote from the original cancer, making diagnosis challenging. Given the long natural history of many advanced cancers, the successful diagnosis and management of these emergencies may be rewarded with prolonged survival. However, when cancer patients become end-stage, the same invasive diagnostic procedures and aggressive treatments may be onerous. Decisions regarding management of these patients may best be made jointly by the patient, the primary oncologist, the family, and the treating physician.

Keywords

Superior Vena Cava Cerebral Spinal Fluid Tumor Lysis Syndrome Leptomeningeal Metastasis Superior Vena Cava Syndrome 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lochridge, SK, Knibbe WP, Doty DB (1979) Obstruction of the superior vena cava. Surgery 85:14–24PubMedGoogle Scholar
  2. 2.
    Armstrong BA, Poerez CA, Simpson JR et al (1987) Role of irradiation in the management of superior vena cava syndrome. Int J Radiat Oncol Biol Phys 13:531–539PubMedCrossRefGoogle Scholar
  3. 3.
    Perez-Soler R, McLaughlin P, Velasquez WS et al (1984) Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. J Clin Oncol 2:260–266PubMedGoogle Scholar
  4. 4.
    Salsali M, Cliffton EE (1969) Superior vena cava obstruction in carcinoma of the lung. N Y State J Med 69:2875–2880PubMedGoogle Scholar
  5. 5.
    Sculier JP, Evans WK, Feld R et al (1986) Superior vena cava syndrome in small-cell lung cancer. Cancer 57:847–851PubMedCrossRefGoogle Scholar
  6. 6.
    Ahmann F (1984) A reassessment of the clinical implications of the superior vena cava syndrome. J Clin Oncol 2:961–969PubMedGoogle Scholar
  7. 7.
    Gradishar WJ, Hoffman PC (1997) The oncologic emergencies. In: Hall J, Schmidt G, Wood LDH (eds) Principles of critical care, 2nd edn. McGraw-Hill, New York, pp 1075–1090Google Scholar
  8. 8.
    Dombernowsky P, Hansen HH (1978) Combination chemotherapy in the management of superior vena cava obstruction in small-cell anaplastic cancer of the lung. Acta Med Scand 204:513–516PubMedCrossRefGoogle Scholar
  9. 9.
    Maddox AM, Valdivieso M, Lukeman J et al (1983) Superior vena cava obstruction in small cell bronchogenic carcinoma. Caner 52:2165–2172CrossRefGoogle Scholar
  10. 10.
    Gaines PA, Belli AM, Anderson PB et al (1994) Superior vena caval obstruction managed by the Gianturco Z stent. Clin Radiol 49:202–206PubMedCrossRefGoogle Scholar
  11. 11.
    Hennequin LM, Fade O, Fays JG et al (1995) Superior vena cava stent placement: results with the Wallstent endoprosthesis. Radiology 196:353–361PubMedGoogle Scholar
  12. 12.
    Kishi K, Sonomura T, Mitsuzan K et al (1993) Self-expandable metallic stent therapy for superior vena cava syndrome: clinical observations. Radiology 189:531–535PubMedGoogle Scholar
  13. 13.
    Oudkerk M, Heystraten FM, Stoter G (1993) Stenting in malignant vena caval obstruction. Cancer 71:142–146PubMedCrossRefGoogle Scholar
  14. 14.
    Shah R, Sabanathan S, Lowe RA et al (1996) Stenting in malignant obstruction of superior vena cava. J Thorac Cardiovasc Surg 112:335–340PubMedCrossRefGoogle Scholar
  15. 15.
    Gray BH, Olin JW, Graor RA et al (1991) Safety and efficacy of thrombolytic therapy for superior vena cava syndrome. Chest 99:54–59PubMedCrossRefGoogle Scholar
  16. 16.
    Skhvatsabaju LV (1986) Secondary tumors of the heart and pericardium in neoplastic disease. Oncology 43:103–106CrossRefGoogle Scholar
  17. 17.
    Thurber DL, Edwards JE, Achor RW (1962) Secondary malignant tumors of the pericardium. Circulation 26:228–241PubMedCrossRefGoogle Scholar
  18. 18.
    Maher EA, Shepherd FA, Todd TJR (1996) Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade. J Thorac Cardiovasc Surg 112:637–643PubMedCrossRefGoogle Scholar
  19. 19.
    Laham RJ, Cohen DJ, Kuntz RE et al (1996) Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart 75:67–71PubMedCrossRefGoogle Scholar
  20. 20.
    Braunwald E (1988) Pericardial disease. In: Braunwald E (ed) Heart disease, 3rd edn. Saunders, Philadelphia, pp 1492–1498Google Scholar
  21. 21.
    Vaitkus PT, Herrmann HC, LeWinter MM (1994) Treatment of malignant pericardial effusion. JAMA 272:59–64PubMedCrossRefGoogle Scholar
  22. 22.
    Galli M, Politi A, Fausto P et al (1995) Percutaneous balloon pericardiotomy for malignant pericardial tamponade. Chest 108:1499–1501PubMedCrossRefGoogle Scholar
  23. 23.
    Palacios IF, Tuzcu EM, Ziskind AA et al (1991) Percutaneous balloon pericardial window for patients with malignant pericardial effusion and tamponade. Cathet Cardiovasc Diagn 22:244–249PubMedCrossRefGoogle Scholar
  24. 24.
    Ziskind AA, Pearce AC, Lemon C et al (1993) Percutaneous pericardotomy for the treatment of cardiac tamponade and large pericardial effusion: description of technique and report of the first 50 cases. J Am Coll Cardiol 21:1–5PubMedCrossRefGoogle Scholar
  25. 25.
    Barron KD, Hirano A, Araki S et al (1959) Experience with metastatic neoplasms involving the spinal cord. Neurology 9:91–106PubMedCrossRefGoogle Scholar
  26. 26.
    Gilbert RW, Kim JH, Posner JB (1978) Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 3:40–51PubMedCrossRefGoogle Scholar
  27. 27.
    Stark RJ, Henson RA, Evans SJW (1982) Spinal metastasis: a retrospective survey from a general hospital. Brain 105:189–213PubMedCrossRefGoogle Scholar
  28. 28.
    Portenoy RK, Galer BS, Salamon O et al (1989) Identification of epidural neoplasm: radiography and bone scintigraphy in the symptomatic and asymptomatic spine. Cancer 64:2207–2210PubMedCrossRefGoogle Scholar
  29. 29.
    Rodichok LD, Ruckdeschel JC, Harper GR et al (1986) Early detection and treatment of spinal epidural metastases: the role of myelography. Ann Neurol 20:696–702PubMedCrossRefGoogle Scholar
  30. 30.
    Haddad P, Thaell JF, Kiely JM et al (1976) Lymphoma of the spinal and extradural space. Cancer 38:1862–1866PubMedCrossRefGoogle Scholar
  31. 31.
    Koch D, Wakhloo AK, van Velthoven V (1995) Magnetic resonance imaging in spinal emergency. Acta Neurochir 134:100–107CrossRefGoogle Scholar
  32. 32.
    Pigott KH, Baddeley H, Maher EJ (1994) Pattern of disease in spinal cord compression on MRI scan and implications for treatment. Clin Oncol R Coll Radiol 6:7–10PubMedCrossRefGoogle Scholar
  33. 33.
    Young RF, Post EM, King GA (1980) Treatment of spinal epidural metastases: randomized prospective comparison of laminectomy and radiotherapy. J Neurosurg 53:741–748PubMedCrossRefGoogle Scholar
  34. 34.
    Posner J, Chernick N (1978) Intracranial metastases from systemic cancer. Adv Neurol 19:575–592Google Scholar
  35. 35.
    Heffner JE, Sahn SA (1983) Controlled hyperventilation in patients with intracranial hypertension. Arch Intern Med 143:765–769PubMedCrossRefGoogle Scholar
  36. 36.
    Wasserstrom WR, Glass JP, Posner JB (1982) Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients. Cancer 49:759–772PubMedCrossRefGoogle Scholar
  37. 37.
    Sze G, Soletsky S, Bronen R et al (1989) MR imaging of the meninges with emphasis on contrast enhancement and meningeal carcinomatosis. AJNR 10:965–975PubMedGoogle Scholar
  38. 38.
    Yousem DM, Patrone PM, Grossman RI (1990) Leptomeningeal metastases: MR elevation. J Comput Assist Tomogr 14:255–261PubMedCrossRefGoogle Scholar
  39. 39.
    Burt ME, Brennan MF (1980) Incidence of hypercalcemia and malignant neoplasm. Arch Surg 115:704–707PubMedCrossRefGoogle Scholar
  40. 40.
    Johnson RA, Boyce BF, Mundy GR et al (1989) Tumors producing human tumor necrosis factor induce hypercalcemia and osteoclastic bone resorption in nude mice. Endocrinology 124:1424–1427PubMedCrossRefGoogle Scholar
  41. 41.
    Black K, Garret IR, Mundy GR (1991) Chinese hamster ovarian cells transfected with murine IL-6 gene causes hypercalcemia as well as cachexia, leukocytosis, thrombosis in tumor-bearing mice. Endocrinology 128:2657–2660PubMedCrossRefGoogle Scholar
  42. 42.
    Gaculp R, Theriault R, Gill I et al (1994) Treatment of cancer-associated hypercalcemia. Arch Intern Med 154: 1935–1944CrossRefGoogle Scholar
  43. 43.
    Schwartz WB, Bennet W, Curalop S et al (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate section of antidiuretic hormone. Am J Med 23:529–542PubMedCrossRefGoogle Scholar
  44. 44.
    Amatruda TT, Mulrow JP, Gallager JC et al (1963) Carcinoma of the lung with inappropriate diuresis. N Engl J Med 260:544–549CrossRefGoogle Scholar
  45. 45.
    Lokich JJ (1982) The frequency and clinical biology of the ectopic hormone syndromes of small cell carcinoma. Cancer 50:2111–2114PubMedCrossRefGoogle Scholar
  46. 46.
    Sterns R (1987) Severe symptomatic hyponatremia: treatment and outcome. Ann Intern Med 107: 656–664PubMedGoogle Scholar
  47. 47.
    Bower M, Brazil L, Coombes RC (1999) Endocrine and metabolic complications of advanced cancer. In: Doyle D, Hanks GWC, MacDonald N (eds) Oxford Textbook of Palliative Medicine, 2nd edn. Oxford University Press, London, pp 715–716Google Scholar
  48. 48.
    Conger JD (1990) Acute uric acid nephropathy. Med Clin North Am 74:859–887PubMedGoogle Scholar
  49. 49.
    Conger JD, Falk SA (1977) Intrarenal dynamics in the pathogenesis and prevention of acute urate nephropathy. J Clin Invest 59:786–793PubMedCrossRefGoogle Scholar
  50. 50.
    Kursch ED, Resnick MI (1984) Dissolution of uric acid calculi with systemic alkalinization. J Urol 132:286–287Google Scholar
  51. 51.
    Steinberg SM, Galen MA, Lazarus JM et al (1975) Hemodialysis for acute anuric uric acid nephropathy. Am J Dis Child 129:956–958PubMedGoogle Scholar
  52. 52.
    Mosekilde L, Eriksen EF, Charles P (1991) Hypercalcemia of malignancy: pathophysiology, diagnosis and treatment. Crit Rev Oncol Hematol 11:1–27PubMedCrossRefGoogle Scholar
  53. 53.
    John WJ, Foon KA, Patchell RA (1997) Paraneoplastic syndromes. In: De Vita VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology, 5th edn. Lippincott-Raven Publishers, PhiladelphiaGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • E. B. Lamont
  • C. M. Rudin
  • P. C. Hoffman

There are no affiliations available

Personalised recommendations