Common complications of cancer

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Information about Common complications of cancer

Published on December 16, 2016

Author: DrShadSalimAkhterAkh

Source: slideshare.net

1. CommonCommon Complications ofComplications of CancerCancer Dr. Shad Salim AkhtarDr. Shad Salim Akhtar MB, MD, FRCP(Edin) Fellow UICC . Consultant Medical Oncologist Asst. Director Prince Faisal Oncology Centre KFSH, Buraidah, Al-Qassim

2. Therapy Advanced cancer Common ComplicationsCommon Complications of Cancerof Cancer

3. Common Complications of Cancer • Acute – Nausea, vomiting – Diarrhoea – Extravasations – Hypersensitivity reactions Therapy related

4. • Immediate – Alopecia – Febrile Neutropenia – Pulmonary toxicity – Neurological • Late – Cardiac – Reproductive Common Complications of Cancer Therapy related

5. 0 10 20 30 40 50 60 100 100-500 500-1000 1000-1500 1500 Severe infection All infections Common Complications of Cancer %age of days spent due to infection Neutrophil Count %dayswithinfection

6. • Could be a medical emergency • Fever >380 (2 spikes) or 38.50 • Elderly patients may react differently • ANC <500 or rapidly falling • Assess general condition of the patient • Infection screen • Broad spectrum antibiotics Common Complications of Cancer Febrile neutropenia

7. Common ComplicationsCommon Complications of Cancerof Cancer • Neurological • Skeletal • Haematological • Gastrointestinal • Endocrine • Respiratory • Effusions – Increase with disease progression Advanced cancer

8. • A middle aged man – Lassitude, backache, generalized weakness – Constipation, vomiting, somnolence • Pale, dehydrated, kyphosis with tenderness • Anaemia, raised ESR, BUN, Cr, TP • X-ray Common ComplicationsCommon Complications of Cancerof Cancer • Serum Calcium 3.2 mmol/l

9. Common ComplicationsCommon Complications of Cancerof Cancer • 15-20% patients affected • Epidural cord compression • Raised intracranial pressure • Status epilepticus • Intracerebral haemorrhage • Delirium Neurological

10. Neurological Complications • May be the first sign of malignant disease •Often present as a true emergency •In patients known to have cancer •Diagnosis may be easy •Rapid diagnosis therapy can preserve function

11. • A young lady with a breast mass • Responded to repeated hormonal therapies • Relapse managed with chemotherapy • Responded well • Progressive disease in spite of different modalities of therapy • Admitted with backache Neurological Complications Case History

12. Epidural CordEpidural Cord CompressionCompression • Compression of thecal sac by tumour – Spinal cord – Cauda equina • One of the most common neurological emergencies in oncology • App 5% of all cancer pts affected • Incidence increasing with improved survival

13. Epidural CordEpidural Cord CompressionCompression – Prostate – Lung – Breast – Lymphoreticular malignancies – Sarcoma – Renal cell carcinoma – Gastrointestinal cancers – Melanoma Causes

14. • Cervical (10)% • Thoracic (70%) • Lumbosacral (20%) • 10-38% multiple non-contiguous sites Lung Breast Colon Pelvic Location Epidural CordEpidural Cord CompressionCompression

15. • Direct extension from vertb body (90%) – 71% lytic – 21% mixed – 8% blastic • Paravertebral gutter • Direct to epidural space Hematogenous Batson’s plexus Retroperitoneal Lymphomas Routes of spread Epidural CordEpidural Cord CompressionCompression

16. Clinical features Epidural Cord Compression • Pain – First symptom in 96% pts – Median duration ~7 wks (hrs to months) – Localized initially to back – Midline

17. Pain • May mimic disc disease except: – Exacerbated by recumbence – Improves by upright position • Radicular – Less frequent – Localizing • Referred Epidural Cord Compression

18. Neurological dysfunction – Three quarters-weakness – 50% --sensory loss+autonomic • Weakness – 2nd most common symptom – Typically lower limbs • Irrespective of site – Proximally more marked – Paraplegia may be abrupt Epidural Cord Compression

19. Sensory symptoms • Concurrent with weakness-usually • Begin in the toes and ascend • Cauda equina—dermatomal loss • Bilateral • Perianal area • Posterior thigh • Lateral aspect of leg Epidural Cord Compression

20. Epidural Cord Compression • Late • Impotence • Horner’s • Absence of sweating • Usually not the sole presenting symptom • Ataxia-with pain Autonomic dysfunction

21. Diagnosis • MRI the best diagnostic tool • Myelography under special circumstances • Image the entire spine • High index of suspicion Epidural Cord Compression

22. Epidural cord compression – Tumour – Abscess – Haematoma – Disc herniation – Vertebral haemangioma Differential diagnosis Spinal Cord Dysfunction

23. Intramedullary processes • Metastasis • Abscess • Hematoma • Syrinx Differential diagnosis Spinal Cord Dysfunction

24. Myelopathy – Radiation – Intrathecal chemotherapy – Paraneoplastic Leptomeningeal metastasis Spinal arachnoiditis Spinal Cord Dysfunction

25. • Palliative Corticosteroids • Radiation • Surgery Cytotoxic Hormonal Adjunctive Treatment Epidural Cord Compression

26. • Pain relieving • Oncolytic • Anti-inflammatory • Anti-oedema • Dose, duration, timing? Corticosteroids Epidural Cord Compression

27. Dexamethasone • Dose – 10mg bolus then 16mg/d – 100mg bolus then 96mg/d Randomised trials lacking Epidural Cord Compression

28. • Undefined role • Laminectomy – Destabilises the spine – Poor access to ant. tumors • Anterior resection may be better • Mortality-6-10% (comp 48%) Surgery Epidural Cord Compression

29. Epidural Cord Compression • No history or remote h/o cancer • Spinal instability • Bony compression • Compression in irradiated area • Ideal candidate Good performance status Treatable malignancy Single level disease Surgery- Indications

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