Most oncologic emergencies can be classified as metabolic, hematologic, structural, or side effects from
chemotherapy agents.
Tumor lysis syndrome is a metabolic emergency that presents as severe
electrolyte abnormalities. The condition is treated with
allopurinol or
urate oxidase to lower
uric acid levels.
Hypercalcemia of
malignancy is treated with aggressive
rehydration,
furosemide, and intravenous
bisphosphonates. Syndrome of inappropriate
antidiuretic hormone should be suspected if a patient with
cancer presents with normovolemic
hyponatremia. This metabolic condition usually is treated with fluid restriction and
furosemide.
Febrile neutropenia is a hematologic emergency that usually requires inpatient
therapy with broad-spectrum
antibiotics, although outpatient
therapy may be appropriate for low-risk patients. Hyperviscosity syndrome usually is associated with Waldenström's
macroglobulinemia, which is treated with
plasmapheresis and
chemotherapy. Structural oncologic emergencies are caused by direct compression of nontumor structures or by metastatic disease.
Superior vena cava syndrome presents as neck or facial swelling and development of collateral venous circulation. Treatment options include
chemotherapy, radiation, and intravenous stenting. Epidural
spinal cord compression can be treated with
dexamethasone, radiation, or surgery. Malignant
pericardial effusion, which often is undiagnosed in
cancer patients, can be treated with pericardiocentesis or a pericardial window procedure.