Oncological emergencies (except neutropenic sepsis!) Spinal cord compression

Change in bladder – retention.

Change in bowels – constipation.

Confirmation of diagnosis

Treatment

• Steroids –

• Immediate dexamethasone as ‘holding measure.’
• Cancer Centre recommendation
• 16mg IV stat then 4mg qds PO with PPI cover.
• Aim to reduce vasogenic oedema.

Radiotherapy

• Mainstay of treatment.

• UK usual dose 20Gy/5#, in US 30Gy/10#*.

• Hanover series:

• ~33% improved and 20% deteriorated.
• Those patients whose motor function.
• declined the slowest, had the best outcome.

Radiotherapy

Surgery

• Should be considered in any patient with:

• Single vertebral region of involvement.
• No evidence of widespread metastases.
• Radio-resistant primary e.g. renal, sarcoma.
• Previous RT to site.
• Unknown primary- get tissue.