approach to the cancer patient

cancer

Cancer can be a multi-system disease and cancer patient’s are at risk of multiple complications from the tumour itself, the treatment and their immunocompromised state. Using a systems-based approach you can consider complications:

A: ABCDEFGHIJKLMNOP

  • Growth: worsening of throat/esophageal ca
  • Hemorrhage of tumour or post-cric

B: CHEST

  • Effusion: malignant, can be massive and requiring urgent draining or cathetic for continual drainage
  • Sick pneumonia, from immunocompromised
  • Tumour: increase growth

C: CARDIOVASCULAR

  • Around heart: malignant pericardial effusion
  • RV strain: higher risk of PE on chemo
  • Lactate: sepsis, including febrile neutropenia
  • Adrenal crisis: patients on steroids can develop adrenal insufficiency when they become ill
  • Rx: chemo drugs can be cardiotoxic

D: NEUROLOGIC

  • Neuron seize: from brain mets
  • Unregulated pressure from blocked VP shunt
  • RBC bleed from anticoagulation
  • Onco mass expansion
  • myeLopathy: spinal cord compression

E: ENDO

  • Electrolyte: hyponatremia from SIADH, hypercalcemia, hyperkalemia from tumour lysis

F: CREATININE

  • renal failure from Extracellular volume decrease, nephrotoxic drugs, compression from tumour, or bladder obstruction

G: ABDOMINAL

  • Ascites
  • No motion from narcotics or bowel obstruction

H: HEME

  • anemic, thrombocytopenia, neutropenia

I: INTOX

  • treatment toxicities

J

  • pathological fracture

 

Putting this together into an approach to the cancer patient

  • A: consider airway compromise and difficult intubation
  • B: consider multiple lung pathology with POCUS, CXR +/- CT
  • C: consider pericardial effusion and PE if SOB, in addition to sepsis and adrenal insufficiency if in shock
  • D: consider CT head for headache/vomiting, MRI spine for back pain/retention/incontinent/weak
  • E: measure and correct electrolytes
  • F: consider multiple threats to renal function
  • G: assess bowel function and ascites
  • H: measure CBC
  • I: consider treatment toxicities
  • J: consider pathological fracture with focal pain

cancer

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