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
