Category: Emergencies
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Abdominal Emergencies
Abdominal pain stands as a prevalent concern among oncology patients, manifesting either as an indicator of a newly developed intra-abdominal malignancy or as an adverse effect of ongoing therapeutic interventions. The complexity of diagnosing abdominal pain in patients undergoing cancer treatment is underscored by a wide differential diagnosis, necessitating a comprehensive approach that includes a…
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Disseminated Intravascular Coagulation
Disseminated intravascular coagulation (DIC) is characterized by systemic activation of blood coagulation, which results in generation and deposition of fibrin, leading to microvascular thrombi in various organs and contributing to multiple organ dysfunction syndrome. Consumption of clotting factors and platelets in DIC can result in life-threatening haemorrhage. It is a thrombo-haemorrhagic disorder. Explained by two different…
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Bleeding Child
Bleeding complications in cancer patients can be potentially life-threatening if not adequately and promptly recognized and treated. The most frequent haemostatic defect causing bleeding in this setting is thrombocytopenia. Other disorders are represented by liver insufficiency with or without vitamin K deficiency, disseminated intravascular coagulation (DIC), inappropriate or excessive use of anticoagulants, as well as…
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Haemorrhagic Cystitis
Both alkylating agents, cyclophosphamide and ifosfamide, have the potential to induce severe cases of haemorrhagic cystitis. The pathogenesis of haemorrhagic cystitis associated with cyclophosphamide is attributed to acrolein, a metabolite of cyclophosphamide that infiltrates the uroepithelium, instigating DNA damage and ensuing tissue necrosis. Approximately 1-6% of patients administered cyclophosphamide will manifest gross haematuria, with mortality…
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Pericardial Effusion and Tamponade
Pericardial involvement in patients with malignancy is common. Widespread use of non-invasive diagnostic techniques, such as echocardiography and computed tomography (CT) scanning, has increased awareness of this diagnosis. The mere presence of pericardial effusion does not necessarily imply pericardial infiltration by malignant cells. Pericardial malignancy is often asymptomatic. It is observed on chest radiography performed…
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Spinal Cord Compression
Spinal cord compression, though relatively rare, demands immediate attention to prevent permanent consequences. It complicates 4-7% of childhood malignancies from diagnosis to the end of treatment. Most cases of spinal cord compression occur in the terminal stages of relapsed or progressive cancer, but 25% present in children who have not yet been diagnosed. Other causes…
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Superior Mediastinum Syndrome
Children presenting with an anterior mediastinal mass pose a significant haemato-oncological emergency. This subset of patients is at risk of encountering severe and potentially life-threatening complications either upon presentation or during sedation/general anaesthesia. These complications typically arise due to extrinsic compression of the airway, obstruction of venous return, or impediment to cardiac output. Fortunately, with…
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Extravasation
Extravasation refers to the leakage of medication, administered intravenously, from a vein into the surrounding tissue. Certain medications can cause severe tissue damage if extravasation occurs. The best prevention is the correct administration technique to avoid such incidents. Nonetheless, should extravasation happen, the provided guidelines outline the immediate steps to manage and minimize potential tissue…
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Perirectal Abscess/Cholecystitis/Veno-Occlusive Disease
In pediatric oncology, certain emergencies require immediate attention due to their complex nature and potential for rapid deterioration. Perirectal abscess, a painful and potentially serious infection near the rectum, poses a significant risk of sepsis. Cholecystitis, or inflammation of the gallbladder, can occur due to various factors, including complications from cancer therapy. Veno-occlusive disease (VOD),…