Two Onc Docs Oncologic Emergencies 2025 Update
Jul 15, 2025
Explore the latest on oncologic emergencies, perfect for new fellows and residents. Learn about crucial management strategies for brain metastases, including the use of dexamethasone and various radiation options. Delve into hypercalcemia treatment methods and urgent protocols for spinal cord compression. Gain insights into SVC syndrome management, emphasizing the importance of tailored therapies and timely interventions. Wrap up with high-yield takeaways that enhance your understanding of these life-threatening situations.
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Start Steroids For Symptomatic Brain Mets
- For symptomatic brain metastases, start high-dose dexamethasone immediately to reduce vasogenic edema and symptoms.
- Consult neurosurgery and radiation oncology early to discuss resection versus SBRT or whole brain radiation depending on number and location of lesions.
Give Prophylaxis When Using High‑Dose Steroids
- When prescribing high-dose steroids, provide prophylaxis: insulin sliding scale, PPI/H2 for ulcer prevention, and PJP prophylaxis if >20 mg prednisone for >30 days.
- Also prescribe calcium and vitamin D for bone health during prolonged steroid use.
Flush, Then Drug: Treat Hypercalcemia Quickly
- For moderate-to-severe hypercalcemia, start isotonic saline aggressively to increase renal calcium excretion and target urine output ~100–150 ml/hr.
- Add IV bisphosphonates (or denosumab if renal failure) and consider calcitonin for rapid short-term reduction; use steroids for myeloma/lymphoma-related hypercalcemia.