Obstructive Emergencies : Cancer

Obstructive Emergencies : Cancer 150 150 Tony Guo
Obstructive Emergencies
Superior Vena Cava Syndrome (SVCS)
  • Results from obstruction of superior vena cava by tumor or thrombosis.
  • Common causes are lung cancer, non-Hodgkin’s lymphoma, and metastatic breast cancer.
  • Presence of central venous catheter and previous mediastinal radiation increase risk of development.
  • Facial edema, periorbital edema.
  • Distention of veins of head, neck, and chest
  • Headache, seizures.
  • Mediastinal mass on chest x-ray.
  • Considered a serious medical problem.
  • Radiation therapy to site of obstruction.
  • Chemotherapy for tumors more sensitive to this therapy.
Spinal Cord Compression
  • Neurologic emergency caused by cancer in epidural space of spinal cord.
  • Common causes are breast, lung, prostate, GI, and renal cancers and melanomas.
  • Lymphomas can also invade epidural space.
  • Intense, localized, and persistent back pain accompanied by vertebral tenderness.
  • Motor weakness, sensory paresthesia and loss.
  • Autonomic dysfunction (e.g., change in bowel or bladder function)
  • Radiation therapy and corticosteroids.
  • Surgical decompressive laminectomy.
  • Activity limitations and pain management.
Third Space Syndrome
  • Shifting of fluid from vascular space to interstitial space.
  • Occurs secondary to extensive surgical procedures, immunotherapy, or septic shock.
  • Signs of hypovolemia: hypotension, tachycardia, low central venous pressure, decreased urine output
  • Fluid, electrolyte, and plasma protein replacement.
  • During recovery hypervolemia can occur, resulting in hypertension, elevated central venous pressure, weight gain, and shortness of breath.

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