Cancers most commonly causing particular complication | Presenting symptoms and signs | Investigations | Management |
---|---|---|---|
MSCC | |||
Breast cancer Lung cancer Lymphoma Myeloma Prostate cancer | Persistent back pain Limb weakness Sensory loss Bladder dysfunction Altered bowel habit Loss of anal tone | FBC, U/E, clotting, group and save, calcium Whole-spine MRI Post-void bladder scan Rectal examination Consider CT CAP + PSA, hCG, AFP, LDH, CA 125 and serum paraprotein if no known malignancy | Manage patient lying flat with neutral spinal alignment Dexamethasone (16 mg – >8mg BD) + PPI cover Analgesia Antiemetics Discuss spinal stability with neurosurgeons Venous thromboprophylaxis as per local guidelines |
Raised ICP and vasogenic oedema | |||
Breast cancer Cancer of unknown primary Colon cancer Lung cancer Melanoma | Headache Vomiting Changes in vision Seizures Decreased GCS VIth nerve palsy Papilledema Cushing's reflex | FBC, U/E, LFT, blood sugar, bone profile, clotting, group and save Chest X-ray Urgent CT/MRI of head Consider CT CAP + PSA, hCG, AFP, LDH and CA 125 if no known malignancy | Elevate head of bed to 30° Dexamethasone (16 mg – >8 mg BD) + PPI cover Analgesia Antiemetics Discuss with neurosurgeons if any signs of midline shift, cerebral oedema, hydrocephalus and/or acute haemorrhage Discuss with ITU if GCS score <12 and keep nil by mouth Aim for euvolaemia Consider hypertonic saline and mannitol in refractory cases |
SVCO | |||
Breast cancer Germ cell tumours Lung cancer Lymphoma Thymic cancers | Shortness of breath Cough Dysphagia Head, neck and upper limb oedema Cyanosis Stridor Non-pustatile JVP | FBC, U/E, LFT, clotting, group and save Chest X-ray CT scan of chest with contrast Consider CT CAP + PSA, hCG, AFP, LDH and CA 125 if no known malignancy | If patient has known malignancy, consider dexamethasone (16 mg – >8 mg BD) + PPI cover O2 if hypoxic Endovascular stenting Radiotherapy Chemotherapy |
Malignant hypercalcaemia | |||
Breast cancer Lung cancer Myeloma Renal cell carcinoma | Depression Nausea and vomiting Constipation Abdominal pain Polydipsia/polyuria Dehydration Confusion | Serum total calcium, PTH, PTHrP, PO4, vitamin D, U/E, albumin ECG Consider CT CAP + PSA, hCG, AFP, LDH and CA 125 and serum paraprotein if no known malignancy | Intravenous fluids for 24 h Review nephrotoxic medication First line: bisphosphonates as per local trust guidelines In refractory cases, repeat bisphosphonates, calcitonin, glucocorticoids or denosumab (off-label indication) can be trialed Seek endocrinology advice |
AFP = alpha fetoprotein; BD = twice daily; CA l25 = cancer antigen 125; CAP = chest, abdomen, and pelvis; CT = computed tomography; ECG = electrocardiogram; eGFR = estimated glomerular filtration rate; FBC = full blood count; GCS = Glasgow Coma Score; hCG = human chorionic gonadotrophin; ITU = intensive treatment unit; JVP, jugular venous pressure; LDH = lactate dehydrogenase; LFT = liver function test; MRI = magnetic resonance imaging; PPI = protein pump inhibitor; PSA = prostate-specific antigen; PTH = parathyroid hormone; PTHrP = parathyroid hormone-related peptide; U/E = urea/electrolytes.