Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment

Abstract

Oncologic emergencies can occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient's cancer history and its possible complications forms an important part of any clinician's knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. This article reviews hypercalcemia, hyponatremia, hypoglycemia, tumor lysis syndrome, cardiac tamponade, superior vena cava syndrome, neutropenic fever, spinal cord compression, increased intracranial pressure, seizures, hyperviscosity syndrome, leukostasis, and airway obstruction in patients with malignancies. Chemotherapeutic emergencies are also addressed.

Tumors Metastatic to the Heart

“…9,10 Although echocardiography can identify the pericardial effusion, cardiac tamponade is a clinical diagnosis that relies on the presence of hypotension (often with a narrow pulse pressure), elevated jugular venous pressure, and distant heart sounds. 9,10 Although less common than pericardial effusions, deposits of pericardial metastases may also compromise cardiac output via constrictive pericarditis ( Figure 1C). However, this condition may also result from pericardial adhesions caused by radiation therapy or any prior surgery requiring sternotomy.…”

“…However, rapid accumulation of even small volumes from 100 to 200 mL can quickly result in cardiac tamponade, necessitating immediate pericardiocentesis to avert hemodynamic collapse. 9,10 Although echocardiography can identify the pericardial effusion, cardiac tamponade is a clinical diagnosis that relies on the presence of hypotension (often with a narrow pulse pressure), elevated jugular venous pressure, and distant heart sounds. 9,10 Although less common than pericardial effusions, deposits of pericardial metastases may also compromise cardiac output via constrictive pericarditis ( Figure 1C).…”

Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies

“…Very important for the treatment of malignant hypercalcemia is adequate hydration -diuretics, like furosemide 40 mg intravenous every 12 to 24 hours, also glucocorticoids, such as 60 mg of prednisone orally daily or 100 mg of hydrocortisone intravenously (IV) every 6 hours, can be used. Administration of IV bisphosphonate, coupled with adequate hydration, effectively normalizes serum calcium in the majority of cancer patients [Lewis et al 2011]. Nonsystemic therapies, although important, are not discussed in this review.…”

Onco-Nephrology

“…TLS is characterized by the release of potassium, phosphorous, and nucleic acids from cancer cells into the blood stream, with the potential to cause hyperkalemia; hyperphosphatemia and secondary hypocalcemia; hyperuricemia; AKI; and, should usual homeostatic mechanisms fail, death. TLS most commonly follows treatment of hematologic malignancies, such as acute lymphocytic or lymphoblastic leukemia, acute myeloid leukemia, and Burkitt lymphoma, but also occurs after treatment of other bulky or rapidly growing tumors, particularly if highly sensitive to the effects of cytotoxic chemotherapy (2)(3)(4). TLS has been reported after treatment with conventional chemotherapy, dexamethasone (5), and newer agents such as bortezomib (6,7), thalidomide (8,9), and rituximab (10); radiation therapy of radio-sensitive solid tumors (11); and total-body irradiation (12).…”