Oncological Emergencies Dr. Gary Harding md, frcpc

Vertebral metastases are more common than ESCC

• Vertebral metastases are more common than ESCC

• Prostate cancer: 90%

• Breast Cancer: 74%

• Lung Cancer: 45%

• Lymphoma: 29%

• Renal cell: 29%

• GI: 25%

• ESCC can be initial presentation of a malignancy

• Around 20% of cases
• In many cases diagnosis is made by biopsy of the spinal lesion

Spinal Location10

• Thoracic spine: 60%

• Lumbosacral spine: 30%

• Cervical spine: 10%

• Specific tumor predilection is difficult to define

Clinical Features

Important to recognize

• Important to recognize

• Early recognition leads to better outcomes

• Efficacy of treatment depends most on patient’s neurological function at presentation

• Median time from symptoms to diagnosis is around 2 months11

• More than half of patients who present to hospital are non-ambulatory

RED FLAGS…..

First Red Flag: Pain

• Usually first symptom12

• 80-90% of the time

• Usually precedes other neurologic symptoms by seven weeks

• Increases in intensity

• Severe local back pain

• Aggravated by recumbency

• Distension of venous plexus

• May become radicular

Second Red Flag: Motor

• Weakness: 60-85%13

• At or above conus medularis

• Extensors of the upper extremities

• Above the thoracic spine

• Weakness from corticospinal dysfunction
• Affects flexors in the lower extremities

• Patients may be hyperreflexic below the lesion and have extensor plantars

Weakness tends to be symmetrical

• Weakness tends to be symmetrical

• Progressive weakness is followed by lost of gait function then paralysis

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