Tumor Lysis Syndrome
Massive tumor cell lysis → release of intracellular contents. Occurs 12–72h after starting chemotherapy (high-grade lymphomas, leukemia, bulky tumors). Metabolic: hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia. Complications: AKI (uric acid crystals), arrhythmias (hyperkalemia), tetany/seizures (hypocalcemia). Prevention: hydration (3L/m²/day), allopurinol or rasburicase, frequent labs. Treatment: IV fluids, rasburicase, treat electrolytes, hemodialysis if severe.
Spinal Cord Compression
Metastatic tumor compresses spinal cord — ONCOLOGIC EMERGENCY. Cancers: breast, lung, prostate, multiple myeloma. Signs: back pain (first and most common, 95%), weakness, sensory loss, bowel/bladder dysfunction. MRI entire spine. Treatment: IV dexamethasone (immediate), radiation therapy, surgical decompression. Irreversible if not treated within 24–48 hours. Motor function is the most important prognostic factor.
Superior Vena Cava Syndrome
Compression/obstruction of SVC — usually by tumor (lung cancer, lymphoma) or thrombus. Signs: facial/neck/arm swelling, jugular vein distension, dyspnea, cough, hoarseness, headache (worse when bending forward). Treatment: treat underlying cause (radiation/chemo for tumor, anticoagulation for thrombosis), elevate HOB, steroids for edema. Rarely life-threatening unless airway compromise.
Hypercalcemia of Malignancy
Most common metabolic emergency in cancer. Causes: parathyroid hormone-related protein (PTHrP) secretion, bone metastases. Signs: "stones, bones, groans, psychic moans" — kidney stones, bone pain, constipation, lethargy/confusion. Treatment: aggressive IV fluids (normal saline 200–500 mL/hr), bisphosphonates (zoledronic acid), calcitonin (rapid but tachyphylactic), steroids (for hematologic malignancies). Monitor for hypocalcemia after treatment.
Neutropenic Fever
Fever in neutropenic patient (ANC <500 or <1000 and expected to drop) = MEDICAL EMERGENCY. One infection can become sepsis rapidly. Assessment: vital signs, source identification (blood cultures ×2, urine, chest x-ray, line sites). Empiric antibiotics within 1 HOUR (door-to-needle time): antipseudomonal beta-lactam (cefepime, piperacillin-tazobactam, meropenem). Add vancomycin if catheter site infection, MRSA risk, or hemodynamic instability. Admit, reverse isolation.
Important Notes
- Neutropenic fever: obtain cultures then start broad-spectrum antibiotics within 60 minutes — every minute counts.
- Spinal cord compression: any cancer patient with new back pain needs immediate MRI — "time is spine."
Clinical Tips
- Tumor lysis syndrome: "SOAP" — Stone (uric acid), Overall (potassium), Phosphate (high), Calcium (low). Treat high, replace low.
Summary
Oncologic emergencies require rapid recognition and intervention. Tumor lysis, spinal cord compression, SVC syndrome, hypercalcemia, and neutropenic fever are time-sensitive conditions where nursing recognition saves lives.
