Question 1

A patient is in the induction phase of chemotherapy just after diagnosis of cancer. Which prophylactic measures will help prevent tumor lysis syndrome? (Select all that apply.)&#10;A) Acidifying the urine&#10;B) Initiation of allopurinol&#10;C) Intravenous fluids of 2000 to 3000 mL/day&#10;D) Rasburicase administration&#10;E) Sodium polystyrene sulfonate

Accepted Answer

Tumor lysis syndrome (TLS) is a medical emergency that can occur after initiation of chemotherapy in patients with hematologic malignancies. It results from the rapid lysis of tumor cells which leads to the release of intracellular contents into the bloodstream, such as uric acid, potassium, and phosphate, which can lead to metabolic derangements such as hyperuricemia, hyperkalemia, and hyperphosphatemia. 
Prophylactic measures that can help prevent TLS include the initiation of allopurinol, which decreases serum uric acid levels, intravenous fluids of 2000-3000 mL/day to promote urine output and dilute the concentration of electrolytes, and rasburicase administration, which is a recombinant urate oxidase enzyme that converts uric acid to allantoin, a more soluble compound that can be easily excreted by the kidneys. Acidifying the urine can worsen TLS by increasing the concentration of uric acid and exacerbating renal dysfunction, so it is not a prophylactic measure for TLS. Sodium polystyrene sulfonate is used for the treatment of hyperkalemia and is not a prophylactic measure for TLS.

Question 2

A patient diagnosed with non-Hodgkin's lymphoma reports experiencing a dull, aching pain in the anterior thoracic region for several weeks along with difficulty walking. The provider notes an ataxic gait. What is the immediate treatment for this condition?

A) Chemotherapy
B) Radiation therapy
C) Steroid therapy
D) Surgical decompression

C

Accepted Answer

The patient's symptoms suggest spinal cord compression, which is a medical emergency. Steroid therapy is the immediate treatment to reduce inflammation and swelling around the spinal cord, providing relief to the patient. Chemotherapy, radiation therapy, and surgical decompression may be considered later as definitive treatments depending on the underlying cause of the spinal cord compression.

Question 3

Which situations are considered oncologic emergencies in a patient diagnosed with cancer and requires urgent referral to an oncologist? (Select all that apply.)&#10;A) Bone marrow suppression&#10;B) Metastasis of cancer cells&#10;C) Superior vena cava syndrome&#10;D) Syndrome of inappropriate antidiuretic hormone&#10;E) Tumor lysis syndrome

Accepted Answer

C, D, E

Deck 223: Oncology Complications, Paraneoplastic Syndromes, and Cancer Survivorship