Onco-Emergency.pptx

Cancer and its treatment may lead to a range of potentially life-threatening conditions that require urgent action to correct them. Most oncological emergencies can be classified as metabolic, haematological, structural, or treatment-relatedFebrile neutropenia is most often seen as an effect of cytotoxic therapy. The neutrophil count usually reaches its lowest level 5 to 10 days after the last dose of chemotherapy. Febrile neutropenia is defined as an oral temperature ≥38.5°C or two consecutive readings of ≥38.0°C for two hours and an absolute neutrophil count ≤0.5 x 109/L.

Up to 80% of patients receiving chemotherapy for haematological malignancies will develop neutropenic fever at least once during the course of therapy. Patients with solid tumors are reported to develop neutropenic fever at a rate of 10-50% during the course of chemotherapy. The likelihood of fever increases with the duration and the severity of neutropenia as well as the rate of decline of the absolute neutrophil count.

1. Introduction Oncological emergencies Dr Mona Quenawy Lecturer of clinical oncology Ain shams university

2. Agenda Definition Types Metabolic Structural Management Prevention

3. Introduction Oncological emergencies are defined as  any acute possible morbid or life-threatening events in patients with cancer either because of the malignancy or because of their treatment . These events may occur at any time during malignancy, from symptoms present to end-stage disease

4. Definitions and classifications

5. Hypercalcemia Metabolic Hy percalcemia is a total serum calcium concentration > 10.4 mg/dL (> 2.60 mmol/L) or ionized serum calcium > 5.2 mg/dL (> 1.30 mmol/L). Principal causes include hyperparathyroidism, vitamin D toxicity, and cancer. 

6. Fatigue lethargy polyuria constipation stupor coma renal failure cardiac arrhythmia Metabolic Clinical presentation Metabolic

7. Signs Metabolic

8. Metabolic cab Metabolic Calcitonin Bisphosphonate Denosumab Prednisone Iv fluids and diuretics Treatment

9. Tumor lysis syndrome Metabolic

10. Pathogenesis

11. Clinical presentation Metabolic

12. Metabolic Management in brief

13. Metabolic Management cont.,

14. Metabolic SIADH

15. Metabolic Metabolic pathogenesis

16. Metabolic Clinical presentation

17. Metabolic Management

18. structural S.V.C compression

19. structural Clinical presentation

20. Signs of S.V.C syndrome :

21. structural Management

22. structural

23. structural

24. structural

25. structural

26. structural

27. structural structural

28. structural structural

29. structural

30. structural

31. Neutropenia is characterized by a reduction in neutrophils below normal counts, usually occurring within 7 to 12 days following cancer chemotherapy It is diagnosed with a blood test that confirms an absolute neutrophil count (ANC) of less than 500 cells per microliter following cytotoxic chemotherapy, or by an ANC expected to decrease to less than 500 cells per microliter within 48 hours.

32. Due to reduced levels of neutrophils in circulation, patients with neutropenia may have an impaired ability to fight infections. Hence, even a minor infection for patients with neutropenia may become very serious.

33. It is crucial to monitor patients for signs and symptoms of infection, which may present as fever, chills, or sweats. Other signs and symptoms of infection for patients with FN are provided Management

34. MASCC Scoring Index Characteristic/Score The burden of illness: no or mild symptoms/5 The burden of illness: none or mild/5 The burden of illness: moderate symptoms/3 The burden of illness: severe symptoms/0 No hypotension (systolic BP greater than 90 mmHg)/5 No chronic obstructive pulmonary disease/4

35. Type of Cancer Solid tumor/4 Lymphoma with previous fungal infection/4 Hematologic with previous fungal infection/4 No dehydration/4 Outpatient status (at the onset of fever)/3 Age less than 60 years/2

36. Management cont In low-risk patients, oral empiric therapy with a fluoroquinolone plus amoxicillin/clavulanate is recommended in the outpatient setting. Clindamycin can be used for those with penicillin allergies. If the patient remains febrile for 48 to 72 hours, the patient will require admission

37. For high-risk patients presenting with neutropenic fever, an intravenous antibiotic therapy should be given within 1 hour after triage and be monitored more than 4 hours before discharge. The Infectious Disease Society of America (IDSA) recommends monotherapy with antipseudomonal beta-lactam agents such as cefepime, carbapenems, or piperacillin and tazobactam. Vancomycin is not recommended for initial therapy but should be considered if suspecting catheter-related infection, skin or soft tissue infections, pneumonia, or hemodynamic instability. If patients do not respond to treatments, coverage should be expanded to include resistant species

38. Methicillin-resistant Staphylococcus aureus (MRSA): vancomycin, linezolid, and daptomycin Vancomycin-resistant enterococci (VRE): linezolid and daptomycin Extended-spectrum beta-lactamase (ESBL)-producing organisms: carbapenems Klebsiella pneumoniae: carbapenems, polymyxin, colistin, or tigecycline

39. Recommendation for prevention of infection in neutropenic patients:

40. Prevention cont.: Yearly influenza vaccination is recommended for all patients receiving chemotherapy. Treatment with a nucleoside reverse transcription inhibitor is recommended for patients at high risk of hepatitis B virus reactivation. Herpes simplex virus- seropositive patients undergoing allogeneic HSCT or leukemia induction therapy should receive prophylaxis. In the National Comprehensive Cancer Network (NCCN) guidelines, it is recommended that patients at a high risk of neutropenic fever can benefit from granulocyte-colony stimulating factors (G-CSFs).

41. Thank you