
Contents
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15.1 Oncological emergencies and acute oncology 15.1 Oncological emergencies and acute oncology
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Introduction Introduction
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15.2 Tumour lysis syndrome 15.2 Tumour lysis syndrome
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Prevention Prevention
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Further reading Further reading
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15.3 Hypercalcaemia 15.3 Hypercalcaemia
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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15.4 Hyponatraemia 15.4 Hyponatraemia
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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15.5 Hyperkalaemia 15.5 Hyperkalaemia
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Aetiology Aetiology
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Clinical features Clinical features
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Investigation Investigation
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Treatment Treatment
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15.6 Hypoglycaemia 15.6 Hypoglycaemia
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Introduction Introduction
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Clinical features Clinical features
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Treatment Treatment
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15.7 Hyperuricaemia 15.7 Hyperuricaemia
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Introduction Introduction
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15.8 Febrile neutropenia 15.8 Febrile neutropenia
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Introduction Introduction
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Assessment Assessment
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Treatment Treatment
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Risk stratification Risk stratification
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Empirical antibiotic treatment of high-risk FN Empirical antibiotic treatment of high-risk FN
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Changes in initial treatment in non-responding patients Changes in initial treatment in non-responding patients
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Changes in initial treatment in responding patients Changes in initial treatment in responding patients
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Empirical antibiotic treatment of low-risk FN Empirical antibiotic treatment of low-risk FN
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Prevention Prevention
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Internet resources Internet resources
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15.9 Catheter associated infections 15.9 Catheter associated infections
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Introduction Introduction
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Diagnosis Diagnosis
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Treatment Treatment
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Prevention Prevention
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Further reading Further reading
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15.10 Nausea, vomiting, and diarrhoea 15.10 Nausea, vomiting, and diarrhoea
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15.11 Vascular complications 15.11 Vascular complications
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Extravasation Extravasation
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Aetiology Aetiology
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Clinical features Clinical features
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Treatment and prevention Treatment and prevention
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Venous thromboembolism Venous thromboembolism
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Prevention Prevention
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Further reading Further reading
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Internet resources Internet resources
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15.12 Stridor and airway obstruction 15.12 Stridor and airway obstruction
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.13 Superior vena cava obstruction 15.13 Superior vena cava obstruction
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Prognosis Prognosis
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Treatment Treatment
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Medical management Medical management
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Stent insertion Stent insertion
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Radiotherapy and chemotherapy Radiotherapy and chemotherapy
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Anticoagulation and thrombolysis Anticoagulation and thrombolysis
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15.14 Gastrointestinal obstruction 15.14 Gastrointestinal obstruction
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.15 Urinary tract obstruction 15.15 Urinary tract obstruction
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Aetiology Aetiology
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.16 Thrombocytopenia and disseminated intravascular coagulation 15.16 Thrombocytopenia and disseminated intravascular coagulation
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.17 Gastrointestinal bleeding 15.17 Gastrointestinal bleeding
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Introduction Introduction
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.18 Genitourinary bleeding 15.18 Genitourinary bleeding
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Introduction Introduction
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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15.19 Cardiorespiratory 15.19 Cardiorespiratory
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Introduction Introduction
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Decision not to resuscitate Decision not to resuscitate
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15.20 Cardiac tamponade 15.20 Cardiac tamponade
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Introduction Introduction
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Medical management Medical management
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Surgical management Surgical management
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Further reading Further reading
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15.21 Pleural effusion 15.21 Pleural effusion
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Introduction Introduction
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.22 Brain metastases and raised intracranial pressure 15.22 Brain metastases and raised intracranial pressure
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Introduction Introduction
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Prognosis Prognosis
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15.23 Spinal cord compression 15.23 Spinal cord compression
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Introduction Introduction
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Diagnosis Diagnosis
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Treatment Treatment
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Prognosis Prognosis
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Further reading Further reading
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15.24 Impending and pathological fractures 15.24 Impending and pathological fractures
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Introduction Introduction
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Clinical features Clinical features
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Diagnosis Diagnosis
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Treatment Treatment
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Further reading Further reading
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15.25 Immunotherapy-related emergencies 15.25 Immunotherapy-related emergencies
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Introduction Introduction
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Skin toxicity Skin toxicity
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Treatment Treatment
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Gastrointestinal toxicity Gastrointestinal toxicity
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Hepatotoxicity Hepatotoxicity
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Endocrinopathies Endocrinopathies
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Thyroid Thyroid
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Hypophysitis Hypophysitis
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Pneumonitis Pneumonitis
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Rare toxicities Rare toxicities
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Further reading Further reading
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15 Oncological emergencies and acute oncology
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Published:April 2021
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Abstract
Recently the specialty of acute oncology with a clinical service to support patients and coordinate the care of those presenting with oncological emergencies has been developed. Patients who present with oncological emergencies often have a unique set of clinical problems, many of them iatrogenic, and can benefit from specialist advice from teams who are expert in the management of such conditions. Cancer treatments are developing and diversifying from standard cytotoxic chemotherapeutic drugs to targeted agents and immunological therapies. These introduce new toxicities such as dermatological problems, hypertension, and autoimmune phenomena. The management of the problem will vary depending on the underlying process and specific advice related to the causative agent will be required. This chapter covers oncological emergencies and acute oncology. Topics include tumour lysis syndrome; hypercalcaemia; hyponatraemia; hyperkalaemia; hypoglycaemia; hyperericaemia; febrile neutropenia; catheter associated infections; nausea, vomiting and diarrhoea; vascular complications; stridor and airway obstruction; superior vena cava obstruction; gastrointestinal obstruction; urinary tract obstruction; thrombocytopenia and disseminated intravascular coagulation; gastrointestinal bleeding; genitourinary bleeding; cardiorespiratory; cardiac tamponade; pleural effusion; brain metastases and raised intracranial pressure; spinal cord compression; impending and pathological fractures; and immune-related emergencies.
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