Episode 014: Heme/Onc Emergencies, Pt. 3: Cord compression

What this episode covers

Emergencies happen in hematology and oncology. This is a fact. But how do we manage these emergencies? Look no further. In this episode, we talk all about our third oncologic emergency: new brain mets. Cord compression: - If someone has a pathologic fracture, think about the following differential as underlying etiologies: - Females: rule out breast cancer - Males: Prostate cancer - Others: multiple myeloma, lymphoma, lung cancer, renal cell carcinoma, bladder - If cord compression, administer steroids; may require radiation to help with shrinking; also may need involvement of neurosurgery if there is lack of spine stability. Role of radiation in cord compression: -MRI is beneficial to help with radiation planning -Where is the disease in proximity to the spinal cord? In the bone? In the epidural space? Or pushing against the spinal cord +/- blocking CSF? -Is the spine stable? Use SINS scoring (https://radiopaedia.org/articles/spinal-instability-neoplastic-score-sins-2?lang=us) -If good spine stability (low SINS) or is not surgical candidate or radio-sensitive tumor: radiation up front -If poor spine stability (high SINS) then may need surgery up front Radiosensitive tumors examples: Lymphoma Germ cell tumors Small cell lung cancer Radio-resistant tumor examples (resistant does not mean that radiation cannot be used, however): Melanoma Colorectal Renal cell Continue steroids as they are undergoing radiation to prevent flare up from inflammation and acute worsening from the mass on the spinal cord Role of neurosurgery: - What is a reasonable time that we can wait before operating for a new cord compression? - As noted above, cord compression has various degrees - Questions to ask: What neurologic symptoms? Over what time period? - Asymptomatic: You have time! Perhaps investigate why mass may be there. - Progressive over a couple of weeks: You have a little bit of time (a few days to get them to surgery) - Acutely having symptoms: You should intervene. - Spinal stability: are the weight-bearing components (ligaments) intact? Assessed via upright X-rays - If the tumor is radio-sensitive, may opt for radiation first (if diagnosis is known) A HUGE thank you to our special guests: Ryan Miller, MD, MS: PGY5 in Radiation Oncology at Thomas Jefferson University Hospital, Philadelphia, PA Joshua Lowenstein, MD, MBA: Neurosurgery Attending, REX Neurosurgery and Spine Specialists, Raleigh, NC Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCall Instagram: @TheFellowOnCall Listen in on: Apple Podcast, Spotify, and Google Podcast