The Fellow on Call: The Heme/Onc Podcast New Fellow Bootcamp Series: Cord compression
Jun 28, 2024
Join neurosurgeon Josh Lowenstein as he dives into the complexities of spinal cord compression in oncology. He discusses the differential diagnosis for various cancers, including breast and prostate cancer. Learn about the acute management strategies, like steroid use, and how crucial it is to involve radiation oncologists in care decisions. Lowenstein also highlights advancements in radiation therapy, including SBRT and SRS, and explores radion sensitivity differences among tumors, emphasizing a collaborative approach in patient management.
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Case: Breast Cancer Cord Compression
- A 55-year-old female with ER-positive breast cancer presented with severe low back pain and new lower extremity weakness.
- MRI showed L4, L5 compression fracture with cord impingement highlighting spinal neurologic symptoms beyond the brain.
Common Cancers Causing Cord Compression
- Breast and prostate cancers are most common causes of spinal cord compression in females and males, respectively.
- Lung cancer, lymphomas, multiple myeloma, renal and bladder cancers are also important considerations.
Steroids for Acute Management
- Start high-dose dexamethasone immediately to reduce spinal cord swelling and preserve neurological function.
- Use 10 mg followed by 4 mg every 6 hours to temporize acute spinal cord compression.