Patients with active cancer can develop symptoms due to their medication or their underlying cancer. Some of these secondary disease processes are considered emergencies and need urgent treatment.
Febrile Neutropenia
Neutropenia means a low white cell count. This is more common in patients who are receiving chemotherapy as this medication reduces the ability of the body to produce good functioning white cells. These white cells are needed to fight infections so patients with chemotherapy are at higher risk of developing unusual infections and more severe infections.
Cauda Equina Syndrome
The spinal cord ends in a collection of nerves called the cauda equina (’horse’s tail’). The nerves of the cauda equina include nerves that supply the bladder, bowel and lower limbs. Compression of these nerves affect their function and this is called Cauda Equina Syndrome. Causes of nerve compression in this area include cancer growth in the bones or surrounding soft tissue. Treatments such as radiotherapy may help, but need to be started urgently to prevent paralysis and long term incontinence.
Bleeding
Patients with blood cancers or on certain types of chemotherapy have an increased risk of abnormalities with their ability to clot. This means that a more minor injury causing bleeding in a cancer patient needs more urgent attention as the usual mechanisms to stop bleeding are reduced. Bleeding may also be from a cancer mass and it is unlikely this will stop without intervention.
Neurology
We ask questions about weakness, headache, speech changes and photosensitivity in the context of cancer. This is because active cancer increases the risk of having a stroke (hyperviscosity syndrome), a space occupying lesion (metastasis), and a bleed in the brain. The body can also start attacking its own cells via an autoimmune process (paraneoplastic syndrome).
Ascites
Ascites is a term that refers to excess fluid within the abdomen. This can be due to a number of reasons including cancer growths into the lining of the abdomen, causing changes to lymphatic drainage and fluid shifts. This is important as the fluid can build up, causing significant discomfort for the patient. There are treatment options available including physically draining the fluid via a needle/drain and this can be done regularly. It is not uncommon for a patient with cancer like this to need fortnightly drainage of the fluid.