cancer complication

Complications

• hypercalcemia
  • laboratory:
    • serum calcium often > 12 mg/dL
    • serum PTH low
    • serum phosphate is normal or low
    • serum calcitriol is low or normal
  • management
    • volume repletion with normal saline followed by furosemide
    • add corticosteroids for acute treatment of
      • multiple myeloma
      • lymphoma
      • hormone sensitive breast cancer
    • bisphosphonate (pamidronate, zoledronate)
• hyponatremia
  • asymptomatic
    • short-term: 500-1000 mL/day
    • long-term: demeclocycline
  • symptomatic
    • 3% NaCl, infuse 0.5-1.0 meq/h + furosemide
    • raise serum Na+ to 120 meq/L
    • see hyponatremia (management)
• deep vein thrombosis (secondary prevention)
  • LMW heparin (do NOT use warfarin)
  • IVC filter (Greenfield filter, umbrella) if LMW heparin contraindicated
• spinal cord compression
  • clinical manifestations:
    • pain (90%), radicular pain,
    • sensory loss, especially perineal
    • muscle weakness
    • autonomic manifestations
      • urinary incontinence
      • fecal incontinence
  • radiology:
    • MRI with gadolinium contrast of entire spine
    • plain radiograph of little value
    • bone scan of little value
  • management:
    • acute spinal cord compression is a medical emergency
    • dexamethasone
    • radiation therapy to involved areas
    • opiates for pain
    • chemotherapy for sensitive tumors
      • lymphoma
      • breast cancer
• superior vena cava syndrome
  • generally NOT regarded as a medical emergency
  • generally MORE IMPORTANT to establish tissue diagnosis
    • biopsy tissue external to obstructing mass
    • if tissue biopsy unsuccessful at establishing diagnosis, bronchoscopy, mediastinoscopy, thoracotomy
  • treatment directed at specific etiology
    • radiation therapy
    • chemotherapy
• pericardial tamponade
  • special Laboratory:
    • electrocardiogram (EKG): low voltage
    • echocardiography
      • right ventricular size generally small
      • right atrial & right ventricular diastolic collapse
    • right heart catheterization
      • elevated, atrial/ventricular equalized diastolic pressure
  • management:
    • pericardiocentesis
    • surgical pericardiotomy
• brain metastases or primary brain tumor with increased intracranial pressure
  • clinical manifestations:
    • headache is the most common symptom, often severe, refractory to therapy, with maximum intensity in the morning
  • radiology: CT or MRI of the brain
  • avoid lumbar puncture: may precipitate brain herniation in patients with space-occupying lesions
  • management:
    • dexamethasone: 6-25 mg every 6 hours
    • avoid glucocorticoids if primary CNS lymphoma suspected until diagnosis established
    • osmotic diuresis with mannitol may be useful
    • hydrocephalus requires immediate neurosurgical drainage
• infertility
  • incidence of congenital anomalies or fetal wastage among cancer survivors who are able to conceive is no higher than the general population
• cognitive impairment:
  • some cancer survivors report cognitive impairment during & after chemotherapy
• increased risk for suicide, especially in the first 6 months after diagnosis

More general terms

• complication

More specific terms

• cancer pain
• paraneoplastic syndrome
• tumor lysis syndrome

Additional terms

• malignant neoplasm (cancer)