Oncologic Emergencies

Abstract

A new cancer diagnosis is expected to affect approximately 1.9 million people in the United States in 2021. A small percentage of these patients will experience an emergent cancer-related complication. Oncologic emergencies may be encountered in emergency departments or require intensive care management. Patients newly diagnosed with cancer are more likely to present with emergencies related to the underlying malignancies. Oncologic emergencies can have various manifestations, ranging from mechanical obstruction due to tumor growth to metabolic derangements due to abnormal secretions from the tumor. Therefore, early identification and treatment of life-threatening oncologic events is critical. Although there are several different types of oncologic emergencies, this article focuses on metabolic emergencies (tumor lysis syndrome and cytoreductive hyperthermic intraperitoneal chemotherapy) and structural emergencies (increased intracranial pressure and vena cava thrombus). The purpose of this article is to provide acute care clinicians with an overview of selected oncologic emergencies and their evidence-based management.

Oncologic Emergencies: Pathophysiology, Diagnosis, and Initial Management

“…Tumour lysis syndrome (TLS) is foremost associated with hematologic malignancies but can also occur in patients with solid tumours (Higdon et al 2018;Brydges and Brydges 2021). Even though it is a rare condition involving between 3% and 6% of patients with haematological cancers (Punie and Strijbos 2016), TLS has a high mortality rate of between 29% and 79% (Klemencic and Perkins 2019).…”

“…Pathophysiology TLS is foremost caused by cancer treatment like chemotherapy, immunotherapy, and glucocorticoids (Brydges and Brydges 2021) but can also happen spontaneously (Wesemüller and Taverna 2020).…”

“…TLS can occur between 6 h and 72 h after the initiation of the treatment and is caused by tumour cell lysis which in turn releases elements of the cellpotassium, phosphate, uric acid, nucleic acidinto the blood stream causing hyperuricaemia, hyperkalaemia, and hyperphosphatemia (Davidson et al 2004;Punie and Strijbos 2016;Thandra et al 2020;Brydges and Brydges 2021). The hyperuricaemia causes acute renal impairment because of urate crystal formation causing obstructions in the tubules but also by causing vasoconstriction contributing to diminished renal blood flow (Punie and Strijbos 2016;Thandra et al 2020).…”

“…Pathophysiology Tumours metastases to the brain via the blood stream and close to 90% of them reside in the supratentorial part of the brain (Halfdanarson et al 2006). Two routes contribute to the IICP: the tumours themselves as well as the oedema which is caused by damage to the blood-brain barrier (Lewis et al 2011;Brydges and Brydges 2021).…”

“…Clinical Presentation Patients with IICP present with symptoms like headache, nausea and vomiting, focal neurological symptoms, and altered mental status (Lewis et al 2011;Brydges and Brydges 2021). Seizure is another common symptom as close to 70% of all patients with metastases to the brain have experience this condition (Halfdanarson et al 2006; de Mattos-Arruda and Preusser 2016).…”