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

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: cord compression


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


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Episode 015: Heme/Onc Emergencies, Pt. 4: Immune thrombocytopenic purpura

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Episode 013: Heme/Onc Emergencies, Pt. 2: Brain Mets