Surgical and Oncological Emergencies

Surgical and oncological emergencies can arise during the diagnosis or treatment of cancer, and prompt recognition and intervention are critical for improving outcomes. These emergencies can be caused by cancer itself or as complications from cancer treatment. Below are key examples of both:

Common Oncological Emergencies:

Spinal Cord Compression:

• Cause: Tumor pressing on the spinal cord, commonly seen in cancers like breast, lung, prostate, and multiple myeloma.
• Symptoms: Back pain, weakness, numbness, difficulty walking, loss of bladder or bowel control.
• Treatment: High-dose steroids, emergency radiation therapy, or surgical decompression to relieve pressure on the spinal cord.

Superior Vena Cava (SVC) Syndrome:

• Cause: Tumor (typically lung cancer or lymphoma) obstructs the superior vena cava, reducing blood flow back to the heart.
• Symptoms: Swelling of the face, neck, and upper extremities, shortness of breath, chest pain, and cyanosis.
• Treatment: Radiation therapy, chemotherapy, or stenting of the SVC to restore blood flow.

Tumor Lysis Syndrome (TLS):

• Cause: Rapid breakdown of cancer cells (often after chemotherapy in leukemias or lymphomas) leads to a release of intracellular components like potassium, phosphate, and uric acid, which can overwhelm the kidneys.
• Symptoms: Nausea, vomiting, muscle cramps, arrhythmias, and kidney failure.
• Treatment: Aggressive hydration, medications like allopurinol to lower uric acid levels, and monitoring of electrolytes.

Hypercalcemia of Malignancy:

• Cause: Some cancers, especially breast, lung, and multiple myeloma, cause calcium to be released from bones into the bloodstream.
• Symptoms: Nausea, vomiting, confusion, constipation, lethargy, and in severe cases, coma.
• Treatment: Hydration, bisphosphonates, calcitonin, and treatment of the underlying cancer.

Febrile Neutropenia:

• Cause: Neutropenia (low neutrophil count) caused by chemotherapy increases the risk of severe infections. A fever in this setting is an emergency.
• Symptoms: Fever, chills, sweats, and signs of infection.
• Treatment: Broad-spectrum antibiotics initiated immediately, hospitalization, and sometimes growth factors to stimulate white blood cell production.

Pericardial Tamponade:

• Cause: Accumulation of fluid in the pericardial sac, often due to metastatic cancers (e.g., lung, breast).
• Symptoms: Chest pain, shortness of breath, low blood pressure, and shock.
• Treatment: Pericardiocentesis (draining the fluid), pericardial window surgery, and treatment of the underlying cancer.

Septic Shock:

• Cause: Severe infection leading to systemic inflammation and organ dysfunction, more common in immunocompromised cancer patients.
• Symptoms: High or low body temperature, rapid heart rate, low blood pressure, confusion, and difficulty breathing.
• Treatment: Immediate antibiotics, fluids, vasopressors, and intensive care management.

Chemoport Insertion

A Chemoport is a small medical device implanted under the skin to provide easy access to veins for administering chemotherapy, medications, or drawing blood. It's commonly used in patients who require frequent or long-term intravenous treatment, reducing the need for repeated needle sticks.

What is a Chemoport?

A chemoport, also known as a port-a-cath or implantable venous access device, consists of two parts:

• The port: A small reservoir or chamber implanted under the skin, typically in the chest area.
• The catheter: A thin tube connected to the port, threaded into a large vein (usually the superior vena cava, leading to the heart).

Procedure for Insertion:

• Preparation: The patient may receive local anesthesia or mild sedation. Imaging (such as ultrasound or fluoroscopy) is often used to guide placement.
• Insertion: A small incision is made in the chest or arm, and the catheter is placed into a large vein. The port is then positioned under the skin and connected to the catheter. The skin is closed with sutures, and the device is hidden under the skin.
• Post-Procedure Care: The incision site is bandaged, and the port can be used after the site heals (typically within a week). The device requires maintenance to prevent clots, which may involve flushing the port with saline and an anti-clotting solution (heparin).

Benefits of a Chemoport:

• Ease of Access: Provides a reliable way to deliver chemotherapy without repeatedly accessing peripheral veins, reducing the discomfort of multiple needle sticks.
• Decreased Risk of Vein Damage: Since chemotherapy drugs can be harsh on veins, a port reduces the risk of vein irritation, scarring, and damage.
• Long-term Use: Ports can stay in place for months or even years, depending on the treatment duration, making them ideal for long-term therapy.

Potential Complications:

• Infection: The port can become infected, requiring antibiotics or port removal.
• Clotting: The catheter may develop clots, necessitating anticoagulant treatment or device replacement.
• Device Migration: Rarely, the catheter may move from its original position, which may require adjustment or surgery.