Oncologic emergencies. Treating acute problems resulting from cancer and chemotherapy

Oncologic emergencies can occur in cancer patients who have a good prognosis. In all of them, the challenge to the clinician is to diagnose and treat before irreversible complications occur. In febrile patients with neutropenia, cultures of body fluids should be obtained and therapy should be started immediately with broad-spectrum antibiotics. If spinal cord compression is suspected, either magnetic resonance spectroscopy or complete myelography can be done to confirm the diagnosis. Prompt workup in cancer patients with headaches or seizures may avoid neurologic consequences. For brain metastases, immediate treatment with dexamethasone (Decadron, Dexone, Hexadrol) is indicated. For hypercalcemia, a number of drugs that inhibit bone resorption, resulting in lower serum calcium levels, are now available. Malignant cardiac tamponade is relatively rare but potentially lethal; emergency pericardiocentesis often results in marked improvement.