Emergencies In Cancer Patients Research Articles

Abdominal Emergencies in Cancer Patients.

Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department.

Pictorial Depiction of an Institutional Experience of Acute Abdominal Emergencies in Cancer Patients with COVID-19 Infection

AbstractThe ongoing pandemic of coronavirus disease 2019 (COVID-19) poses a diagnostic and management challenge to the clinician, which further gets heightened when patients present with abdominal complications in a cancer care center. The atypical manifestations of the disease provide a diagnostic conundrum to the radiologist and leave the pathologist in the perils of guiding further management to the clinician. Although previous literature shows gastrointestinal involvement in COVID-19, we present a case series of complicated subjects with clinical imaging as a pictorial essay and relevant pathology. The abdominal manifestations of COVID-19 are complicated in cancer patients where a variety of other differentials such as infiltration by metastatic disease and drug-related chemo toxicity effects must be taken into account, which may be ruled out by clinical workup, adequate imaging, and laboratory tests. This would help achieve better clinical acumen and modify management in these subjects.

Acute Tumor Lysis Syndrome: A Metabolic Emergency in Cancer Patients

Tumor lysis syndrome (TLS) can be a life-threatening complication that occurs following the onset of chemotherapy treatment, most commonly in association with high-grade lymphoproliferative pathologies such as acute lymphoblastic leukemia and Burkitt lymphoma. The massive cell lysis caused by cytotoxic therapy leads to the rapid release in the blood of intracelullary products and the onset of severe metabolic and electrolytic complications (hyperkalemia, hyperphosphatemia, hypocalcemia and hyperuricemia) upto the acute renal failure. This article describes the incidence and pathophysiological basis of TLS, focusing on the new therapeutic strategies implemented over the last few years, especially with regard to the treatment of hyperuricemia. In particular, it highlights the characteristics of a recent drug, Rasburicase, as a safe and effective alternative, compared to traditional allopurinol therapy, for prophylaxis and treatment of children with hyperuricemia induced by chemotherapy.

Evaluation and Management of Genitourinary Emergencies in Patients with Cancer

Background Genitourinary emergencies in cancer patients are common. Most cancer treatments are administered in the outpatient setting, and patients with complications often visit the emergency department. However, there is no recent emergency medicine literature review focusing on genitourinary emergencies in the oncologic population. Objective of the review. To increase awareness of common genitourinary emergencies in patients with cancer and enable the prompt recognition and appropriate management of these conditions. Discussion. Genitourinary emergencies in patients with cancer require a multidisciplinary approach to treatment. The most common genitourinary emergencies in patients with cancer are related to infection, obstructive uropathy, hemorrhagic cystitis, and complications associated with urinary diversions. The treatment approach in patients with infections, including viral infections, is similar to those without cancer. Understanding the changes in the anatomy of patients with urinary diversions or fistulas can help with the management of genitourinary emergencies. Conclusions Familiarization with the uniqueness of genitourinary emergencies in patients with cancer is important for emergency physicians.

Hemostatic radiotherapy

Radiotherapy is one of the widely used modalities of treatment in an oncology setting whether the approach to treat cancer is either curative or palliative. Tumor masses bleeding is not an uncommon emergency in cancer patients and local radiotherapy is very commonly used as a hemostatic therapy. Hemostatic radiotherapy is used in wide variety of cancers such as head-and-neck cancers including oral tongue and base of tongue cancers more commonly, fungating and bleeding neck nodes, bleeding bronchial, and lung tumors presenting as hemoptysis, pelvic malignancies most commonly includes cervical cancers presenting as bleeding per vaginum. teletherapy as well as brachytherapy both can be used for alleviation of symptoms thus avoiding a protracted course and improving the quality of life of patients. The radiotherapy doses of 40 Gray in 15 fractions, 30 Gray in 10 fractions, 20 Gray in 5 fractions, 15 Gray in 5 fractions,8 Gray in single fraction and 4 Gray in single fraction have been used which are equally effective for controlling bleeding but protracted courses should be avoided to prevent treatment dropouts. Long-term side effects are more to be worried of in cases of hypofractionation but such patients have a poor median survival generally so symptom alleviation should be our utmost target. Hypofractionated palliative hemostatic radiotherapy is very effective for the alleviation of symptoms and the purpose of the treatment approach but individualized patient-based decisions should be used for tumor control if to be planned further.

COVID-19: The Impact in Oncology Care.

The COVID-19 pandemic has imposed a critical challenge to the current oncology care and practices including late diagnoses, delayed anti-cancer treatment, and static clinical trials. With the increasing risk of cancer patients acquiring infection during receiving the essential care, the debate ensues on how to balance the risk factors and benefits out of the oncologic emergencies in cancer patients. In this review article, we have focused on the current global re-organization of the integrity and effectiveness of the treatment modalities depending on the patient and cancer-specific urgencies while minimizing exposure to the infection. In this review, we addressed how the worldwide oncology community is united to share therapy schemes and the best possible guidelines to help cancer patients, and to strategize and execute therapy/trial protocols. This review provides collective knowledge on the current re-structuring of the general framework that prioritizes cancer care with the available exploitation of the reduced resources and most importantly the unparalleled levels of companionship as a large health care community towards the need to offer the best possible care to the patients.

Imaging of acute abdomen in cancer patients.

The pattern of disease causing acute abdominal pain has changed over last few decades, some of this has been attributed to intraabdominal cancers. The most common acute abdominal complaints in cancer patients are related to the gastrointestinal system. Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of. This article focuses on imaging illustrations with differential diagnosis for various emergency scenarios related to acute abdomen specifically in oncologic settings.

Gastrointestinal emergencies in critically ill cancer patients

PurposeTo describe gastrointestinal emergencies in cancer patients. MethodsAll cancer patients admitted to the medical ICU of Saint-Louis Hospital for an acute abdominal syndrome during the study period (1997–2011) were included. ResultsA total of 164 patients were included. The most common diagnoses were: neutropenic enterocolitis (NE) (n=54, 33%), infectious colitis and peritonitis (n=51, 31%), bowel infiltration by malignancy (n=14, 9%), and mucosal toxicity of chemotherapy (n=12, 7%). Microbiologically documented infections were reported in 82 patients (50%), including 12 fungal infections. Twenty-seven patients (16%) underwent urgent surgery. The hospital mortality rate was 35%. Five factors were independently associated with hospital mortality: the Simplified Acute Physiology Score II (SAPS II) score on day 1 (OR 1.03/SAPS II point, 95% CI 1.01 to 1.05), microbiological documentation (OR 0.27, 95% CI 0.11 to 0.64), neutropenia (OR 0.42, 95% CI 0.19 to 0.95), allogenic hematopoietic stem-cell transplantation (HSCT) (OR 5.13, 95% CI 1.71 to 15.4), and mechanical ventilation (OR 3.42, 95% CI 1.37 to 8.51). ConclusionsGastrointestinal emergencies in cancer patients are associated with significant mortality. Mortality correlated both with the severity of organ failure upon ICU admission and the underlying diagnosis. Interestingly, patients admitted to the ICU with neutropenia had better survival.

R09 - Emergencies in cancer patients: data on 15,623 cases from a large volume single centre from 2001 to 2013

R09 - Emergencies in cancer patients: data on 15,623 cases from a large volume single centre from 2001 to 2013

1629 Emergencies in cancer patients: Data on 15,623 cases from a large volume single centre

1629 Emergencies in cancer patients: Data on 15,623 cases from a large volume single centre

394. Surgical emergencies in cancer patients; migration of cancer stage and intensity of treatment

394. Surgical emergencies in cancer patients; migration of cancer stage and intensity of treatment

Oncological emergencies: clinical importance and principles of management

Oncological emergencies are common conditions associated with significant morbidity and mortality. Delay in diagnosis and treatment can result in unfavourable outcomes. Cancer itself, cancer-related hormones or cytokines, or treatment effects can cause emergency problems. Febrile neutropaenia, frequently associated with chemotherapy, can lead to life-threatening conditions. Treatment requires systematic evaluation and early empirical antibiotics. Hypercalcaemia of malignancy is the most common metabolic emergency in cancer patients. Non-specific clinical features may cause delay in diagnosis and increase morbidity and mortality. Treatment includes active fluid resuscitation, diuretics and intravenous bisphosphonates. Superior vena cava syndrome is usually caused by external compression. Computerised tomography is useful to confirm diagnosis, evaluate the extent of disease and guide invasive tissue diagnosis. Treatment and prognosis depend on the underlying malignancies. Spinal cord compression is a true emergency due to risk of permanent neurological impairment. Localised back pain is the most common presenting symptom while late presentation of neurological deficit is associated with irreversible outcomes. Magnetic resonance imaging is the investigation of choice. Treatment includes corticosteroids, radiotherapy and/or decompressive surgery.

Oncologic Surgical Emergencies

Surgical oncologic emergencies are relatively common and pose a clinical and therapeutic challenge for the emergency clinician. This article provides a clear clinical reference for assessment and management of some common surgical emergencies in cancer patients.