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Vesicant vs Irritant — SCE Medical Oncology MCQ

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EasyOncological EmergenciesVesicant vs IrritantSCE Medical Oncology

A 55-year-old woman on doxorubicin develops extravasation from her peripheral IV line. The site becomes painful and erythematous within hours. What feature distinguishes vesicant from irritant chemotherapy extravasation?

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Correct answer: E — Vesicant agents (doxorubicin, vincristine, mitomycin C) cause tissue NECROSIS that progresses over days-weeks (potentially requiring surgical debridement/skin grafting); irritant agents (oxaliplatin, carboplatin, etoposide) cause local inflammation that resolves without necrosis

Vesicant agents bind DNA in tissues and cause progressive necrosis extending over days-weeks from the extravasation site (the 'iceberg phenomenon' — surface damage underestimates deep tissue destruction). Key vesicants: anthracyclines (doxorubicin — antidote: dexrazoxane), vinca alkaloids (vincristine — antidote: hyaluronidase), and alkylating agents (mechlorethamine). Irritant agents cause local inflammation and pain but NOT progressive necrosis. Classification guides management urgency and antidote selection. Prevention (central venous access for vesicants) is the best strategy.

Reference: BNF; ESMO Supportive Care; UK Oncology Nursing Society Extravasation Guidelines