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INTRODUCTION

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Oncologic emergencies arise from the underlying malignancy or as complications of therapy.

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AIRWAY OBSTRUCTION

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Patients with tumors of the upper and lower respiratory tract may experience acute airway compromise due to edema, bleeding, infection, or loss of protective mechanisms. Presenting symptoms and signs include dyspnea, tachypnea, wheezing, and stridor. Imaging involves plain radiographs, CT scan, and/or endoscopic visualization. Emergency measures include humidified oxygen, optimal patient positioning, and possibly administration of a helium–oxygen mixture. If intubation is required, an “awake look” with a fiber optic bronchoscope with a 5-0 or 6-0 endotracheal tube is preferred. A surgical airway such as cricothyroidotomy, transtracheal jet ventilation, or tracheotomy may be needed.

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BONE METASTASES AND PATHOLOGIC FRACTURES

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Patient with solid tumors, most commonly in breast, lung, and prostate, may present with bony metastases and pathologic fractures, usually in the axial skeleton and proximal limbs. Plain radiographs may only identify half of metastases, so negative films should be followed by CT with contrast or MRI. Control pain with opioid analgesia. Most pathologic fractures require surgical intervention. Painful bone metastases are treated with radiotherapy.

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SPINAL CORD COMPRESSION

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Spinal cord compression from metastases to the vertebral bodies may cause weakness, radicular pain, and bowel or bladder dysfunction. MRI is the imaging study of choice. The presentation, evaluation, and management of malignant spinal cord compromise are described in Table 139-1.

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Table Graphic Jump Location
Table 139-1

Malignant Spinal Cord Compression

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Consider giving corticosteroids if imaging will be delayed. Malignant spinal cord compression is a radiotherapy emergency.

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MALIGNANT PERICARDIAL EFFUSION

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Malignant pericardial effusions are usually asymptomatic but can progress to life-threatening cardiac tamponade. Symptoms depend on the rate of accumulation (see Chapter 24, “The Cardiomyopathies, Myocarditis, and Pericardial Disease”). Patients with symptomatic effusions may present with chest heaviness, dyspnea, cough, and syncope. Physical examination findings include tachycardia, narrowed pulse pressure, hypotension, distended neck veins, muffled heart tones, and pulsus paradoxus.

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