Oncologic Emergency Research Articles

Metastatic epidural spinal cord compression: does timing of surgery influence the chance of neurological recovery? An observational case-control study.

Metastatic epidural spinal cord compression (MESCC) is radiologically defined as an epidural metastatic lesion causing the displacement of the spinal cord from its normal position in the vertebral canal. The purpose of this paper is the evaluation of the influence of timing of surgery on the chance of neurological recovery. This is a retrospective observational case-control study performed on patients with MESCC from solid tumors surgically treated at our institute from January 2010 to December 2016. Patients included were divided in two groups depending on surgery that was performed within or after 24h the admission to the hospital. Neurological status was assessed with American Spine Injury Association (ASIA) Impairment Scale. No statistically significant difference was observed in the variation of ASIA if surgery is performed within or after 24h from the admission to the hospital. A statistically significant difference was observed after surgery in each group in the improvement of neurological status. A statistically significant difference was reported in the early post-operative complications in patients surgically treated within 24h. MESCC management is challenge for spine surgeons and may represent an oncologic emergency and if not promptly diagnosed can lead to a permanent neurological damage. According to this study, there is no difference in the chance of neurological recovery if surgery is performed within or after 24h the admission to hospital, but there is a greater rate of early post-operative complications when surgery is performed within 24h from the admission to the hospital.

Extragonadal germ cell tumor of the posterior mediastinum in a child complicated with spinal cord compression: a case report

BackgroundGerm cell tumors (GCTs) in children are rare neoplasms with diverse pathological findings according to the site and age of presentation. The most common symptoms in children with mediastinal GCTs, which are nonspecific, are dyspnea, chest pain, cough, hemoptysis, vena cava occlusion syndrome, and fatigue/weakness. Because of these nonspecific symptoms, it is difficult to suspect a mediastinal mass. A posterior mediastinal tumor causing spinal cord compression is an important example of an oncologic emergency arising from a neurogenic tumor.Case presentationChildren with posterior mediastinum GCTs can be easily mistaken as having a neurogenic tumor because of site of tumor origin. We treated our 7-year-old patient with emergency decompression surgery and high-dose steroid pulse therapy to prevent secondary injury to the spinal cord. Primary injury was a result of spinal cord compression due to the initial manifestation of GCT in the posterior mediastinum. Cisplatin-based chemotherapy was also administered. The patient was followed up regularly for 3 years and is undergoing rehabilitation without any signs of recurrence.ConclusionsWe present an extremely rare case of a child with paraparesis caused by extradural spinal cord compression as the initial manifestation of GCT in the posterior mediastinum. The child was treated with emergency decompression surgery and high-dose pulse steroid therapy to prevent secondary injury to the spinal cord.

Oncologic emergencies in a cancer center emergency department and in general emergency departments countywide and nationwide.

BackgroundAlthough cancer patients (CPs) are increasingly likely to visit emergency department (ED), no population-based study has compared the characteristics of CPs and non-cancer patients (NCPs) who visit the ED and examined factors associated with hospitalization via the ED. In this study, we (1) compared characteristics and diagnoses between CPs and NCPs who visited the ED in a cancer center or general hospital; (2) compared characteristics and diagnoses between CPs and NCPs who were hospitalized via the ED in a cancer center or general hospital; and (3) investigated important factors associated with such hospitalization.Methods and findingsWe analyzed patient characteristic and diagnosis [based on International Classification of Diseases-9 (ICD-9) codes] data from the ED of a comprehensive cancer center (MDACC), 24 general EDs in Harris County, Texas (HCED), and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1/1/2007–12/31/2009. Approximately 3.4 million ED visits were analyzed: 47,245, 3,248,973, and 104,566 visits for MDACC, HCED, and NHAMCS, respectively, of which 44,143 (93.4%), 44,583 (1.4%), and 632 (0.6%) were CP visits. CPs were older than NCPs and stayed longer in EDs. Lung, gastrointestinal (excluding colorectal), and genitourinary (excluding prostate) cancers were the three most common diagnoses related to ED visits at general EDs. CPs visiting MDACC were more likely than CPs visiting HCED to be privately insured. CPs were more likely than NCPs to be hospitalized. Pneumonia and influenza, fluid and electrolyte disorders, and fever were important predictive factors for CP hospitalization; coronary artery disease, cerebrovascular disease, and heart failure were important factors for NCP hospitalization.ConclusionsCPs consumed more ED resources than NCPs and had a higher hospitalization rate. Given the differences in characteristics and diagnoses between CPs and NCPs, ED physicians must pay special attention to CPs and be familiar with their unique set of oncologic emergencies.

Laparoscopic resection followed by decompression with a drainage tube for obstructive colorectal cancer.

844 Background: Obstructive colorectal cancer is an oncological emergency that requires emergency treatment. In Japan, laparoscopic resection after decompression with metallic-stent placement is becoming mainstream as a bridge to surgery (BTS). However, there are reports of worse prognoses due to stent placement, and the European Gastroenterology Society of Endoscopy guidelines do not recommend BTS. In our department, since 2011 the first choice of the treatment has been laparoscopic resection after decompression with a trans-anal or trans-nasal drainage tube. STo investigate the safety and short- and long-term results of laparoscopic resection after decompression with a drainage tube. Methods: Eighty-one cases of obstructive colorectal cancer that underwent surgery at our hospital from 2011 to 2016 were investigated with regards to the short- and long-term outcomes of treatment strategies for obstructive colorectal cancer. Results: The median age was 72 years old (39-94). The ratio of male to female was 46:29. The success rate of decompression was 86.7% (66 cases). Stages II, III and IV were involved in 25, 28 and 28 cases, respectively. The causes of the emergency operations were an inability to insert both the ileus tube and the stent (9.3%, 7 cases), and perforation (2.7%, 2 cases) when the trans-anal ileus tube was inserted. In the cases in which decompression was possible, the laparoscopic operation rate was 89.4% (56 cases) and the primary resection rate was 90.9% (59 cases). The median surgical time was 194 minutes (27-325), the median blood loss was 10 g (0-660 g),The median postoperative hospital stay was 14 days (5-147 days). The rate of anastomotic leak was 4.5%. There were no deaths within 30 and 90 days after surgery. The relapse free survival rate in Stage II and III were 72% and 67.9%, respectively. The median months of overall survival in Stage II, III and IV were 60.4, 56.3 and 18.7, respectively. Conclusions: A treatment strategy with laparoscopic resection followed by decompression with a drainage tube was performed feasibly and safely. At this time, the effects of a stent on oncological prognosis is unclear, and this strategy could be an effective treatment for obstructive colorectal cancer.

Pediatric Hematologic And Oncologic Emergencies

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies. This review contains 6 figures, 6 tables and 57 references

Pediatric Hematologic And Oncologic Emergencies

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies. This review contains 6 figures, 6 tables and 57 references

Neuroendocrine bladder cancer: oncological emergency?

Neuroendocrine bladder cancer is extremely rare, with an estimated incidence of 0.5%- 0.7%. In bladder cancers there is no evident connection between the neuroendocrine phenotypic expression and the clinical history. However, prognosis is usually poor and the survival rate at 5 years does not exceed 8%, if untreated. METHODS. We are here describing three case reports of bladder carcinoma with neuroendocrine differentiation, which is extremely aggressive and leads rapidly to death. At the present time, the local control of these tumors is achieved by radical cystectomy and radiotherapy; they can be both associated to chemotherapy. However, since these lesions are fairly rare, there is no gold standard therapy and there are no prospective studies on the management of these tumors. CONCLUSIONS. Considering the quick evolution and progression of any variant of the neuroendocrine tumors of the bladder, urologists and anesthetists should see them as real oncological emergencies. A prompt intervention through radical surgery with cystectomy and linfadenectomia, and the anathomo-pathologist's systematic investigation of the scraps could make the approach therapeutic and not only palliative. Prospective studies on neo-adjuvant chemotherapy as well as experimental studies about target therapies may yield new guidelines on the tumor management.

Evaluation of pediatric patients with an oncologic emergency: Single center experience.

Çiftçi AÇ, Küpeli S, Sezgin G, Bayram İ. Evaluation of pediatric patients with an oncologic emergency: Single center experience. Turk J Pediatr 2018; 60: 660-668. In this study, we aimed to prospectively analyze the emergency diagnosis and clinical characteristics of the oncologic emergency patients admitted, as well as to evaluate the approach considerations to the cases, their treatment, patient outcomes and the prognostic factors. A total of 88 oncologic emergency patients (90 oncologic emergency hospitalizations), except for febrile neutropenia, were admitted to the pediatric oncology department between July 2014 and December 2015. A total of 30 cases of tumor lysis syndrome, 19 hyperleukocytosis, 11 convulsion, 7 spinal cord compression, 7 hemorrhagic cystitis, 9 pleural effusion, 6 vena cava superior syndrome, 4 typhlitis, 3 anuria, 4 gastrointestinal bleeding, 3 hypercalcemia, 4 acute respiratory distress syndrome, 2 acute massive hepatomegaly and 1 increased intracranial pressure were identified. Sixty-five (72.2%) of the study patients had a primary oncologic disease, whereas 25 (27.8%) had a recurring condition. The most common presenting complaint was fever (23.3%) followed by breathing difficulties (22.2%). Fifty-nine patients (65.6%) recovered and were discharged home, while 31 cases (34.4%) died. Tumor lysis syndrome was the most frequently encountered emergency condition in the pediatric oncology patient group. Oncologic emergencies need to be approached quickly and systematically in the light of current scientific knowledge.

Using Process Improvement Tools to Improve the Care of Patients With Neutropenic Fever in the Emergency Room.

The purpose of this study was to improve the care of patients with neutropenic fever in an academic acute care hospital's emergency room (ER). Using the define, measure, analyze, improve, control method, a two-phase project with three critical to quality metrics (reduction in time to antibiotic administration, increase in percentage of patients with neutropenic fever identified as an oncology emergency, and increase in patients cohorted on oncology units) was completed. Phase I consisted of implementation of best practices (ie, use of neutropenic fever protocol and order set, altering ER workflow, and educating patients and staff). In phase II, the team drew from cardiac and stroke alerts and response teams and implemented an innovative hospital-wide overhead neutropenic fever alert and an ER neutropenic fever response team. After implementing phase I interventions, the time to antibiotic administration decreased from a mean of 100 minutes at baseline to a mean of 67 minutes. After implementing phase II interventions, the mean decreased by 73%, from 100 minutes at baseline to 27 minutes. Furthermore, after phase II interventions, 89% of neutropenic patients were assigned an Emergency Severity Index of 2 and 88% were placed appropriately in a bed on the oncology floor on admission, compared with 11% and 74%, respectively, at baseline. Interventions were effective at improving three critical to quality metrics. Multiple iterations of the define, measure, analyze, improve, control cycle, together with new innovative interventions, were crucial to meeting project goals.

Oncological Emergencies in Chest Medicine

Oncological Emergencies in Chest Medicine

Neonatal Gastric Immature Teratoma Presenting as an Oncologic Emergency: A Report of a Case Requiring Differentiation From Neuroblastoma

Neonatal Gastric Immature Teratoma Presenting as an Oncologic Emergency: A Report of a Case Requiring Differentiation From Neuroblastoma

Spontaneous tumor lysis syndrome in a giant neglected breast cancer.

Tumor lysis syndrome (TLS) is an oncologic emergency that generally triggered by effective cytotoxic chemotherapy in a context of rapidly proliferating and chemo-sensitive tumor or in patients with massive tumor burden. TLS has been rarely described in patients with solid tumors, and it is even more uncommon to have spontaneous tumor lysis syndrome (STLS). To our knowledge, only three cases of STLS in metastatic breast cancer were reported in the literature. Herein, we present a new case of STLS in a 37-year-old female with giant neglected metastatic breast cancer. She subsequently developed acute oliguric renal failure and multiple electrolyte abnormalities requiring hemodialysis. Despite aggressive supportive care, the patient developed multiple organ failure and died eight days after admission. Our case highlights the importance of increased awareness of this rare but life threatening condition. TLS should be included in the differential diagnosis of patients with newly diagnosed breast cancer who present with acute kidney injury even before they receive any active cancer therapy

A Long-Term Surviving Patient With Aggressive Surgical Treatment on Oncologic Emergency for Advanced Adrenal Neuroblastoma

A Long-Term Surviving Patient With Aggressive Surgical Treatment on Oncologic Emergency for Advanced Adrenal Neuroblastoma

Chemotherapy-Induced Tumour Lysis Syndrome in Gastric Adenocarcinoma with Diffuse Liver Metastases: A Case Report

Tumour Lysis Syndrome (TLS) is an important oncological emergency case which is often found together with haematological malignities and, much less often, with solid tumours. While TLS seen in solid tumour cases usually develops following a cytotoxic chemotherapy and its prognosis is poor. We present the case of a 60-year-old man with gastric adenocarcinoma with diffuse liver metastases (image shows diffuse liver metastatic lesions) and high serum LDH levels, who developed TLS after systemic chemotherapy. With urgent and proper supportive treatment (intravenous intensive hydration, sodium bicarbonate, diuretic, calcium gluconate, allopurinol and haemodialysis), an impressive recovery from TLS was achieved in the patient with an advanced stage gastric cancer. The purpose of this report is to emphasize that although the present case was a rare, high physician attention is required because significant morbidity or mortality may occur when the syndrome is not duly considered during the pre-cytotoxic evaluation of the patient, when preventive measures are not taken, or if the appropriate treatment is not applied immediately once the syndrome appears, especially in patients who have high tumour burden solid cancer.

Management of veterinary oncologic emergencies

The emergency situation in oncology can be defined as a pathological condition determined by the clinical evo­lu­tion of cancerous paraneoplastic syndromes or a con­sequence of the chemotherapy disease (metabolic, he­ma­to­lo­gical, neurological, motor). Assessing the diag­no­sis and per­for­­ming specific therapy should be rapid and ad­dress the syn­dromes in the order of their severity. The diag­nosis of the oncology patient’s emergency must be deter­mined in the or­der of priority and type of emer­gen­cy: mor­pho­lo­gi­cal or obstructive paraneoplastic syn­dromes caused by solid tu­mors with organ and/or me­ta­bolic com­pres­sion caused by functional failure of tis­sues or or­gans; chemotherapy di­sease toxicity induced through ia­tro­pa­thy, following the ad­­mi­­nis­tration of che­mo­the­ra­py medication. The objectives in solving oncological emer­gen­cies are the diagnosis of the cause, the clinical and paraclinical evaluation and very rapid therapy. Pa­ra­neo­plas­tic syn­dromes may be due only to primary or associated tumors of lymph node in­va­sion, visceral me­tas­tases, or may be the consequence of established the­­ra­pies: surgical, chemotherapy, hor­mo­nal. Oncology emer­gency may be aggravated by preexisting liver disease, kid­­ney disease, hematologic disease, neurological disease, di­sease evo­lu­tion or therapy-associated. The urgency of on­co­lo­gi­cal the­ra­py is to control pain, restore blood volum, to amend the paraneoplastic symptoms (anemia, cachexia, throm­bo­cy­to­pe­nia, lympho­penia) and eventually restore the mor­pho­struc­tu­ral pal­liative integrity of affected tissues. The choice of the­ra­peu­tic strategy and the combination of techniques and methods are made personalized ac­cor­ding to the cli­ni­cal condition of the oncology patient at the time of diag­nosis by anamnesis, general physical exa­mi­na­tion, TNM clinical staging, monitoring of vital func­tions, histopathological type and the appreciation of the response to the therapies already performed.

A Case of an Oncologic Emergency Caused by Ascending Colon Adenocarcinoma in a Patient With Acute Ischemic Heart Dysfunction

A Case of an Oncologic Emergency Caused by Ascending Colon Adenocarcinoma in a Patient With Acute Ischemic Heart Dysfunction

Tumor lysis syndrome following radiation therapy in metastatic pancreatic cancer: A case report

A 65-year-old female presented to radiation oncology for potential treatment options due to metastatic pancreatic cancer and significant abdominal pain. Imaging demonstrated a large pancreatic mass with lymphadenopathy, vascular encasement, and liver metastases. She initiated palliative radiation treatment and developed persistent nausea and vomiting, as well as significant laboratory derangements. She was subsequently admitted and diagnosed with tumor lysis syndrome, though this diagnosis is usually an oncologic emergency seen with hematologic malignancies following chemotherapy.

Imaging of Oncologic Emergencies

Oncologic emergencies can be either the result of the primary tumor, its metastasis, a paraneoplastic syndrome or reaction to the chemotherapy. Imaging plays a crucial role in ensuring a prompt diagnosis as well as assisting in the therapeutic management. In this article, we discuss the common thoracic and abdominal oncological emergencies that may be encountered in an emergency department.

Leukostasis: Management to Prevent Crisis in Acute Leukemia .

Hyperleukocytosis, a peripheral white blood cell count greater than 100,000/mm3,is most commonly seen in patients with newly diagnosed or relapsed acute lymphoblastic leukemia and acute myeloid leukemia. Leukostasis is a reduction in blood flow related to hyperviscosity. Hyperleukocytosis, causing leukostasis, is an oncologic emergency and requires an exacting assessment and rapid response with appropriate intervention to prevent morbidity and mortality in the first week after diagnosis. The objectives of this article are to equip oncology nurse to identify patients with hyperleukocytosis and to provide nursing interventions that will ensure safe, quality care. A case study is used to demonstrate key concepts that are critical in early assessment, identification, and treatment of patients with leukostasis. . Oncology nurses well versed in the pathophysiology, clinical presentation, and management of leukostasis can make a significant contribution to the safe management of patients with cancer.

Tumour Lysis Syndrome: The Forgotten Oncologic Emergency

Tumour Lysis Syndrome: The Forgotten Oncologic Emergency