emergencies in malignacy

7/25/2019 Emergencies in Malignacy

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Hery Agung S.A

Emergencies in Malignacy


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1. Superior Vena Cava Syndromme (SVCS)

2. Febrile eu!ropenia


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Superior Vena CavaSyndrommeA group o" symp!oms#irec! obs!ruc!ion o" !$e Superior Vena

Cava

%y malignancies (bronc$ogenic carcinoma&medias!inal lymp$adenopa!$y& rig$! upperlobe lung cancer)

'!$ers (!uberculosis& s!enosis& !$rombosis

rare)


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E!iologies*ung Cancer& H*Me!as!a!ic breas! cancer& H*& !$ymus Ca&+$yroid Ca& Esop$ageal Ca

+$rombosis,n"ec!ion

Sarcoidosis


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Common symp!om and sign#yspneuCoug$ing

S-elling in !$e "ace& nec& upper body& arms

/ember!on0s sign

Horase voice

#isp$agia

S-ollen veins in c$es! or nec

eddis$ sin color


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Eamina!ionC+ scan +$orasVenogra3

C$es! 45ay

M,& /E+& 6S7


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+rea!men!#epends on e!iologieselieve !$e symp!om

Some!imes urgencies (!$erap$y can bedelayed un!il # is clear i" !$e pa!ien! iss!able)


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Modali!iesadio!$erap$yC$emo!$erapy

Endovacular !$erap$y

Cor!icos!eroid


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adio!$erap$yFas! relieve (belo- 82 $ours)895:9; "ree "rom symp!om "or 2 -ees

eccurence< 1951:;

+ailor5made dose (depends on individualand !$e malignancies)


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C$emo!$erap$yAl!erna!ive !$erap$y "or c$emo5sensi!ive

case


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EndovascularComple!e resolu!ion =>5199; in me!alic

s!en!

eccurebce< ?5?@;

Complica!ion< S!en! misplacemen! (19;)&s!en! migra!ion (@;)& s!en! occlu!ion (19;)&ari!mia


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Cor!icos!eroidMaybe $elp"ul in lymp$oma or !$ymoma (or

o!$ers!eroid5responsive malignancies)

o! recommended !o SVCS due !o lungcancer or o!$er cause

#ecrease !$e inmma!ory response !o!umor invasion and edema surrounding !$e!umor


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Febrile eu!ropenia

oral !empera!ure B>.@C or !-oconsecu!ive readings o" B>.9C "or 2 $ and

an absolu!e neu!rop$il coun! 9.@ D 19:l& orepec!ed !o "all belo- 9.@ D 19:l


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Mor!ali!y'verall mor!ali!y ra!es are @; in pa!ien!s

-i!$ solid !umours (1; in lo- ris pa!ien!s)and as $ig$ as 11; in some $aema!ologicalmalignancies

1>; in 7ram5nega!ive and @; in 7ram5posi!ive bac!eraemia

Mor!ali!y varies according !o !$e MASCCprognos!ic inde


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MASCC Scoring ,nde


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e"erencesMic$ael S %eeson& SVCS& in emergency Medicine available

"rom emedicine.medscape.comar!icle8=9B915clinical

McCurdy MG& S$an$ol! C%& Superior Vena Cava Syndrome&available "rom pulmccm.org2912revie-5ar!iclescamcer5rela!ed5medical5emergencies5superior5vena5cava5

syndromeAnonym& Superior Vena Cava Syndrome& available "rom

---.cancer.govcancer!opicspdIsuppor!ivecarecardiopulmonary/a!ien!page@JKeypoin!1@

L. de aurois& ovi!y5%asso& M. L. 7ill& e! al& Managemen!o" "ebrile neu!ropenia< ESM' Clinical /rac!ice 7uidelines&Annals o" 'ncology 21 (Supplemen! @)< v2@2v2@=& 2919
http://www.cancergov/http://www.cancergov/


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CC& /reven!ion and !rea!men! o" cancerrela!ed ,n"ec!ion& 299:& available "rom---.oralcancer"ounda!ion.org!rea!men!pd"in"ec!ions5CC.pd"

ac$ma! S& ,man S&/anNi ,& e! al& Hema!ologidan onologi medi& 299>& Sub %agian H'Mdan /,, bag ,/# FK6/A#& p&B2952
http://www.oralcancerfoundation.org/treatment/pdf/infections-NCCN.pdfhttp://www.oralcancerfoundation.org/treatment/pdf/infections-NCCN.pdfhttp://www.oralcancerfoundation.org/treatment/pdf/infections-NCCN.pdfhttp://www.oralcancerfoundation.org/treatment/pdf/infections-NCCN.pdf

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