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8 - Acute oncology 1: oncological emergencies

Published online by Cambridge University Press:  05 November 2015

Betsan Mai Thomas
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Paul Shaw
Cardiff University, Cardiff, UK
Louise Hanna
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Velindre Cancer Centre, Velindre Hospital, Cardiff
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An oncological emergency is an acute medical problem related to cancer or its treatment which may result in serious morbidity or mortality if not treated quickly. It may be secondary to a structural/obstructive, metabolic or treatment-related complication (Cervantes and Chirivella, 2004). The emergency may be the first manifestation of malignant disease, particularly for superior vena cava obstruction (SVCO) and malignant spinal cord compression (MSCC).

Around 20–30% of all cancer patients suffer from hypercalcaemia. Spinal cord compression is the commonest neurological complication of cancer, occuring in approximately 5–10% of all cancer patients. Thrombotic events are the second leading cause of death in cancer patients after death from cancer itself.

Types of emergency

Metabolic emergencies include:

  1. • hypercalcaemia,

  2. • syndrome of inappropriate antidiuretic hormone (SIADH).

Structural/obstructive emergencies include:

  1. • MSCC and cauda equina compression,

  2. • SVCO,

  3. • raised intracranial pressure,

  4. • acute airway obstruction,

  5. • bleeding,

  6. • urinary obstruction,

  7. • cardiac tamponade,

  8. • pain: this has been named the ‘fifth vital sign’ following pulse, blood pressure, temperature and respiration; when pain is present it should evoke an immediate response. Treatment of pain is considered in Chapter 10 .

  9. • thromboembolic disease.

Treatment-related emergencies include:

  1. • neutropenic fever/sepsis,

  2. • anaphylaxis related to a chemotherapeutic agent,

  3. • tumour lysis syndrome,

  4. • extravasation of a chemotherapeutic agent .

Treatment overview

As with any acute medical emergency, resuscitation measures may be needed to ensure that airway, breathing and circulation are maintained. Adequate hydration, oxygen and monitoring of fluid balance are particularly important in patients with sepsis or tumour lysis syndrome. Steroids are used in patients with SVCO and suspected spinal cord compression, although the evidence base supporting their use is poor. Mannitol infusions may be needed for severe symptomatic raised intracranial pressure that does not respond to steroids. Pain, breathlessness and distress should be treated as priorities, especially in patients presenting with end-stage cancer and an oncological emergency. The WHO pain ladder is a suitable framework to guide appropriate analgesic use. Some seriously ill patients may need to be transferred to a high-dependency unit (HDU) or intensive therapy unit (ITU), especially those with a treatable malignancy and a good prognosis and those who develop complications of curative chemotherapy. Liaison with specialist colleagues at an early stage is recommended.

Publisher: Cambridge University Press
Print publication year: 2015

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Allwood, M. and Stanley, A. (2002). The Cytotoxics Handbook. Oxford: Radcliffe Medical Press.Google Scholar
Bartter, F. and Schwartz, W. B. (1967). The syndrome of inappropriate secretion of antidiuretic hormone.Am. J. Med. 42, 790–806.CrossRefGoogle ScholarPubMed
Bayley, A., Milosevic, M., Blend, R., et al. (2001). A prospective study of factors predicting clinically occult spinal cord compression in patients with metastatic prostate carcinoma. Cancer, 92, 303–310.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Bessmertny, O., Robitaille, L. M. and Cairo, M. S. (2005). Rasburicase: a new approach for preventing and/or treating tumour lysis syndrome. Curr. Pharm. Des., 11, 4177–4185.CrossRefGoogle ScholarPubMed
Cervantes, A. and Chirivella, L. (2004). Oncological emergencies. Ann. Oncol., 15 (Suppl. 4), S299–306.Google ScholarPubMed
Cortes, J., Moore, J. O., Maziarz, R. T., et al. (2010). Control of plasma uric acid in adults at risk for tumor lysis syndrome: efficacy and safety of rasburicase alone and rasburicase followed by allopurinol compared with allopurinol alone – results of a multicenter phase III study. J. Clin. Oncol., 28, 4207–4213.CrossRefGoogle ScholarPubMed
Cullen, M., Steven, N., Billingham, L., et al. (2005). Antibacterial prophylaxis after chemotherapy for solid tumours and lymphomas. N. Engl. J. Med., 353, 988–998.CrossRefGoogle ScholarPubMed
Farge, D., Debourdeau, P., Beckers, M., et al. (2013). International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J. Thromb. Haemost., 11, 56–70.CrossRef
Freitag, L. (2004). Interventional endoscopic treatment. Lung Cancer, 45 (Suppl. 2), S235–238.CrossRefGoogle ScholarPubMed
Gafter-Gvili, A., Fraser, A., Paul, M., et al. (2005). Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann. Intern. Med., 142, 979–995.CrossRefGoogle ScholarPubMed
Goolsby, T. V. and Lombardo, F. A. (2006). Extravasation of chemotherapeutic agents: prevention and treatment. Semin. Oncol., 33, 139–143.CrossRefGoogle ScholarPubMed
Klastersky, J., Paesmans, M., Rubenstein, E. B., et al. (2000). The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J. Clin. Oncol., 18, 3038–3051.CrossRefGoogle ScholarPubMed
Lee, A. Y., Levine, M. N., Baker, R. I., et al. (2003). Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N. Engl. J. Med., 349, 146–153.CrossRef
Maisey, N., Norman, A., Prior, Y., et al. (2004). Chemotherapy for primary gastric lymphoma: does in-patient observation prevent complications?Clin. Oncol. (R. Coll. Radiol.), 16, 48–52.CrossRefGoogle ScholarPubMed
Morris, C. D., Budde, J. M., Godette, K. D., et al. (2002). Palliative management of malignant airway obstruction. Ann. Thorac. Surg., 74, 1928–1932.CrossRefGoogle ScholarPubMed
NICE. (2008). Metastatic Spinal Cord Compression. Diagnosis and Management of Adults At Risk Of and With Metastatic Spinal Cord Compression. NICE Clinical Guideline 75. Manchester: National Institute for Health and Clinical Excellence.
NICE. (2012). Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients. NICE Clinical Guideline 151. Manchester: National Institute for Health and Clinical Excellence.
Ostler, P. J., Clarke, D. P., Watkinson, A. F., et al. (1997). Superior vena cava obstruction; a modern management strategy. Clin. Oncol. (R. Coll. Radiol.), 9, 83–89.CrossRefGoogle ScholarPubMed
Palmer, K. (2004). Management of haematemesis and melaena. Postgrad. Med. J., 80, 399–404.CrossRefGoogle ScholarPubMed
Patchell, R. A., Tibbs, P. A., Regine, W. F., et al. (2005). Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet, 366, 643–648.CrossRefGoogle ScholarPubMed
Poortmans, P., Vulto, A. and Raaijmakers, E. (2001). Always on a Friday? Time pattern of referral for spinal cord compression. Acta Oncol., 40, 88–91.Google ScholarPubMed
Priestman, T. J., Dunn, J., Brada, M., et al. (1996). Final results of the Royal College of Radiologists' trial comparing two different radiotherapy schedules in the treatment of cerebral metastases. Clin. Oncol. (R. Coll. Radiol.), 8, 308–315.CrossRefGoogle ScholarPubMed
Rades, D., Stalpers, L. J., Schulte, R., et al. (2006). Defining the appropriate radiotherapy regimen for metastatic spinal cord compression in non-small cell lung cancer patients. Eur. J. Cancer, 42, 1052–1056.CrossRefGoogle ScholarPubMed
Rampello, E., Fricia, T. and Malaguarnera, M. (2006). The management of tumour lysis syndrome. Nat. Clin. Pract. Oncol., 3, 438–447.CrossRefGoogle Scholar
Rockall, T. A., Logan, R. F., Devlin, H. B., et al. (1996). Risk assessment after acute upper gastrointestinal haemorrhage. Gut, 38, 316–321.CrossRefGoogle ScholarPubMed
Rowell, N. P. and Gleeson, F. V. (2001). Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus. Cochrane Database Syst. Rev., 4, CD001316.CrossRefGoogle Scholar
Smith, T. J., Khatcheressian, J., Lyman, G. H., et al. (2006). 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline. J Clin Oncol., 24, 3187.CrossRefGoogle ScholarPubMed
Stewart, A. F. (2005). Hypercalcemia associated with cancer. N. Eng. J. Med., 352, 373–379.CrossRefGoogle ScholarPubMed
Tokuhashi, Y., Matsuzaki, H., Oda, H., et al. (2005). A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine, 30, 2186–2191.CrossRefGoogle ScholarPubMed

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