Pain is the presenting symptom of spinal cord compression in 90–95% of patients. The pain is usually constant and close to the site of the lesion. Patients complain of a band or girdle of pain/tightness radiating from back to front, exacerbated by recumbency, movement, coughing and sneezing. Symptoms may include numbness and tingling, which usually precedes weakness. Weakness often presents with “stiffness,” dragging of a limb, or unsteadiness.
Facial edema is the most common symptom of SVC syndrome with patients often describing feeling bloated. Other symptoms include dyspnea, cough, chest and shoulder pain, and hoarseness. Dyspnea may be worse when leaning forward or lying down. Arm swelling and lymphedema are other common symptoms of SVC syndrome.
In both acute and chronic hypercalcemia of malignancy, the major manifestations affect gastrointestinal, renal, and neuromuscular function. Patients with acute hypercalcemia commonly present with anorexia, nausea, vomiting, polyuria, polydipsia, dehydration, weakness, and confusion. Patients with tumor lysis syndrome may have similar symptoms often related to acute renal failure.
Neutropenic patients, usually on chemotherapy, often present to the ED with fever and no clear source of infection. Tachycardia and hypotension may accompany fever and may indicate severe sepsis or septic shock. Weakness and dehydration are usually present.
Patients with cancer who present to the ED require a thorough physical examination to identify potential life threats associated with malignancy. Vital signs and general assessment including mental status will often reveal whether an acute medical emergency such as neutropenic sepsis or arrhythmia exists. A thorough head-to-toe examination should follow. Head, eyes, ears, nose, and throat examination should assess for a patent airway, oropharyngeal infection, facial plethora, and cranial neuropathies. Neck examination should assess for cervical spine tenderness and dilated neck veins. Cardiovascular and respiratory exams should assess breath sounds and cardiac rhythm. Decreased breath sounds or distant heart sounds may indicate pleural or pericardial effusions. Abdominal exam should assess for masses and possible source of occult infection. Back exam should assess for any localized tenderness or masses, and neurologic exam should identify any focal neurologic deficits. Extremities and skin should be assessed for hydration status and edema, possibly related to acute renal failure.