Oncological emergencies (except neutropenic sepsis!) Spinal cord compression


Change in bladder – retention. Change in bowels – constipation



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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.



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