Oncologic Emergencies (DRAFT)

Oncologic emergencies are potentially life-threatening syndromes that occur in patients with cancer, and are either directly or indirectly related to the patient’s tumor. The clinical progression of these syndromes is rapid and the initial assessment of the patient must be done quickly, as without immediate therapy, high morbidity and mortality results. The oncologic emergency may be due to the tumor, the treatment given to control the tumor, or it may be due to a previously existing condition. This chapter reviews the clinical presentation, treatment, and management of tumor lysis syndrome, hypercalcemia, hyponatremia, disseminated intravascular coagulation, hyperviscosity syndrome, spinal cord compression, and superior vena cava syndrome.

Oncologic Emergencies

AACN Advanced Critical Care ◽

10.4037/nci.0b013e318230112b ◽

2011 ◽

Vol 22 (4) ◽

pp. 337-348 ◽

Cited By ~ 1

Author(s):

Regan Demshar ◽

Rachel Vanek ◽

Polly Mazanec

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Hemodynamic Instability ◽

Cord Compression ◽

Current Evidence ◽

Oncologic Emergencies ◽

Life Threatening

The picture of oncologic emergencies in the intensive care unit has changed over the past decade. The classic emergencies, that is, superior vena cava syndrome, spinal cord compression, tumor lysis syndrome and life-threatening hypercalcemia, are now routinely managed on the general oncology unit or in an outpatient setting. Vigilant monitoring for early signs of complications, proactive interventions to prevent complications, and aggressive management account for this change. Currently, emergent conditions that necessitate intensive care unit admission or transfer in the patient with cancer include respiratory failure, cardiac emergencies, hemorrhagic events and coagulopathies, sepsis, and hemodynamic instability. This article will present the current evidence-based management of these conditions, a brief summary of classic oncologic emergencies, and the role of the critical care nurse in meeting the multidimensional needs of the patient and family during the life-threatening episode, based on Ferrell’s quality of life model.

INTENSIVE CARE OF LIFE-THREATENING CONDITIONS IN PEDIATRIC ONCOHEMATOLOGY

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-5-138-144 ◽

2021 ◽

Vol 100 (5) ◽

pp. 138-144

Author(s):

N.V. Matinyan ◽

◽

T.T. Valiev ◽

K.I. Kirgizov ◽

S.R. Varfolomeeva ◽

...

Keyword(s):

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Cord Compression ◽

Adverse Outcomes ◽

Malignant Neoplasms ◽

Neutropenic Enterocolitis ◽

Compression Syndrome ◽

Life Threatening ◽

Spinal Cord Compression Syndrome

Malignant neoplasms of the blood system in children are represented by highly aggressive variants, which at the stage of diagnosis and program chemotherapy can be complicated by the development of life-threatening conditions. Understanding the risk of possible complications allows you to effectively carry out preventive and therapeutic measures, to minimize adverse outcomes. This article presents modern approaches to the diagnosis and treatment of the most common life-threatening conditions in pediatric oncohematology: acute tumor lysis syndrome, typhlitis and neutropenic enterocolitis, superior vena cava syndrome, malignant airway compression syndrome, acute impairment of consciousness, spinal cord compression syndrome, thrombosis, methemoglobinemia.

Emergencies in Hematology and Oncology

10.2310/im.1020 ◽

2012 ◽

Author(s):

Thorvardur R. Halfdanarson ◽

William J Hogan ◽

Timothy J Moynihan

Keyword(s):

Spinal Cord ◽

Pericardial Effusion ◽

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Cord Compression ◽

Tumor Lysis ◽

Malignant Pericardial Effusion ◽

With the rising incidence of malignancies and expanding treatment options, clinicians must learn to recognize and treat emergencies associated with them. Oncologic emergencies can be broadly classified according to organ systems, which can facilitate recognition and management. Pathophysiology, presentation, diagnosis, and treatment are discussed for complications categorized by metabolic emergencies (hypercalcemia of malignancy, tumor lysis syndrome, lactic acidosis), neurologic emergencies (malignant spinal cord compression, brain metastases, and increased intracranial pressure), cardiovascular emergencies (malignant pericardial effusion and tamponade, superior vena cava syndrome), hematologic emergencies (hyperviscosity due to monoclonal proteins, hyperleukocytosis and leukostasis), infectious emergencies (neutropenic fever, neutropenic enterocolitis, fever associated with splenectomy or functional asplenia), and pulmonary emergencies (acute airway obstruction, acute airway hemorrhage). Figures illustrate spinal cord compression, brain metastases, electrical alternans, malignant pericardial effusion, superior vena cava syndrome, hyperleukocytosis, and an algorithm for initial management of fever and neutropenia. Tables cover management of hypercalcemia of malignancy; the Cairo-Bishop definition of laboratory and clinical tumor lysis; grading, risk stratification, and management of tumor lysis syndrome; management of intracranial hypertension and seizures; infection in patients with neutropenic fever; the Multinational Association for Supportive Care in Cancer Risk Index; and indications for the addition of a gram-positive antibiotic to the initial empirical regimen. This chapter contains 181 references.

Oncologic Emergencies: Superior Vena Cava Syndrome, Tumor Lysis Syndrome, and Spinal Cord Compression

Journal of Emergency Nursing ◽

10.1016/j.jen.2007.09.012 ◽

2008 ◽

Vol 34 (6) ◽

pp. 535-537 ◽

Cited By ~ 7

Author(s):

Faith N. Colen

Keyword(s):

Spinal Cord ◽

Superior Vena Cava ◽

Spinal Cord Compression ◽

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Cord Compression ◽

Tumor Lysis ◽

The Domino Effect-Treatment of Superior Vena Cava Obstruction Triggering Tumor Lysis Syndrome: A Case Report

SciMedicine Journal ◽

10.28991/scimedj-2021-0301-6 ◽

2021 ◽

Vol 3 (1) ◽

pp. 44-50

Author(s):

Suman Ghosh ◽

Tilak TVSVGK ◽

Venkatesan Somasundaram ◽

Mutreja Deepti

Keyword(s):

Superior Vena Cava ◽

Lymphoblastic Leukemia ◽

Superior Vena ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Potassium Phosphate ◽

Successful Outcome ◽

Superior Vena Cava Obstruction ◽

Tumor Lysis ◽

Life Threatening

Oncological emergencies present in a multitude of manners-structural, metabolic, hematologic, etc. affecting multiple systems, often. Urgent institution of therapy is often required for a successful outcome. Occasionally, the treatment of one emergency can initiate a related or unrelated emergency, necessitating management of all the complications simultaneously. Superior vena cava obstruction (SVCO) is a medical emergency and most often manifests in patients with a malignant disease process requiring immediate diagnostic evaluation and therapy due to its’ life threatening presentation. The management of the SVCO is usually with chemotherapy, radiotherapy or intervention. In cases of large tumor burden, management of SVCO can trigger other complications. Tumor lysis syndrome is an oncologic emergency, which is characterized by a massive release of intracellular potassium, phosphate, and nucleic acid metabolites into the systemic circulation, which can be life-threatening. We present the case of a T-cell acute lymphoblastic leukemia with superior vena cava syndrome, developing tumor lysis syndrome on instituting definitive chemotherapy in a young patient. Doi: 10.28991/SciMedJ-2021-0301-6 Full Text: PDF

Recanalization of an Acute Neonatal Life-Threatening Superior Vena Cava Syndrome

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135114553480 ◽

2014 ◽

Vol 6 (1) ◽

pp. 149-150

Author(s):

Alban-Elouen Baruteau

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Neonatal Life ◽

Life Threatening ◽

Emergencies in Hematology and Oncology

10.2310/em.4020 ◽

2015 ◽

Author(s):

David P Curley

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Magnetic Resonance Image ◽

Superior Vena ◽

Risk Index ◽

Tumor Lysis Syndrome ◽

Vena Cava ◽

Severe Infection ◽

Cord Compression ◽

Tumor Lysis

Clinicians must be able to recognize and treat emergencies associated with malignancies and cancer treatment. Such emergencies include metabolic, neurologic, cardiovascular, hematologic, and infectious emergencies. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment and disposition and outcomes for these emergencies in hematology and oncology. Figures show mechanisms of spinal cord compression, a magnetic resonance image showing a metastasis to the thoracic spine compressing the spinal cord, a contrast-enhanced magnetic resonance image of a 54-year-old female with metastatic ovarian cancer, an electrocardiogram and a cardiac echocardiogram of a 50-year-old female with malignant pericardial effusion with cardiac tamponade, a computed tomography scan of a mass compressing the superior vena cava, a blood smear from a patient with acute myeloid leukemia, and an algorithm showing the initial management of fever and neutropenia. Tables list the management of hypercalcemia of malignancy; Cairo-Bishop definition of laboratory and clinical tumor lysis; grading, risk stratification, and management of tumor lysis syndrome; management of intracranial hypertension and seizures in adults; factors favoring low risk of severe infection in patients with neutropenic fever; Multinational Association for Supportive Care in Cancer (MASCC) risk index score; and indications for the addition of a gram-positive antibiotic to the initial empirical regimen. This review contains 8 highly rendered figures, 9 tables, and 136 references.

Cardiovascular Oncologic Emergencies

Cardiology ◽

10.1159/000475491 ◽

2017 ◽

Vol 138 (3) ◽

pp. 147-158 ◽

Cited By ~ 6

Author(s):

Sundeep Shenoy ◽

Safal Shetty ◽

Shilpa Lankala ◽

Faiz Anwer ◽

Andrew Yeager ◽

...

Keyword(s):

Superior Vena ◽

Vena Cava ◽

Cardiovascular Complications ◽

Pericardial Tamponade ◽

Chemotherapeutic Agents ◽

Oncologic Emergencies ◽

Vena Cava Syndrome ◽

High Degree ◽

Very High

Oncologic emergencies can present either as a progression of a known cancer or as the initial presentation of a previously undiagnosed cancer. In most of these situations, a very high degree of suspicion is required to allow prompt assessment, diagnosis, and treatment. In this article, we review the presentation and management of cardiovascular oncologic emergencies from primary and metastatic tumors of the heart and complications such as pericardial tamponade, superior vena cava syndrome, and hyperviscosity syndrome. We have included the cardiovascular complications from radiation therapy, chemotherapeutic agents, and biologic agents used in modern cancer treatment.

Superior vena cava syndrome

VASA ◽

10.1024/0301-1526/a000908 ◽

2020 ◽

Vol 49 (6) ◽

pp. 437-448

Author(s):

Peter Franz Klein-Weigel ◽

Saban Elitok ◽

Andreas Ruttloff ◽

Sabine Reinhold ◽

Jessika Nielitz ◽

...

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Upper Airway ◽

Interventional Therapy ◽

Increased Intracranial Pressure ◽

Life Threatening ◽

Vena Cava Syndrome ◽

Brachiocephalic Veins

Summary: The superior vena cava syndrome (SVCS) is caused by compression, invasion, and/or thrombosis of the superior vena cava and/or the brachiocephalic veins. Benign SVCS is separated from malignant SVCS. SVCS comprises a broad clinical spectrum reaching from asymptomatic cases to rare life-threatening emergencies with upper airway obstruction and increased intracranial pressure. Symptoms are correlated to the acuity and extent of the venous obstruction and inversely correlated to the development of the venous collateral circuits. Imaging is necessary to determine the exact underlying cause and to guide further interventions. Interventional therapy has widely changed the therapeutic approach in symptomatic patients. This article provides an overview over this complex syndrome and focuses on interventional therapeutic methods and results.

Palliative Emergencies

10.1093/med/9780190204709.003.0009 ◽

2017 ◽

Author(s):

Marcia J. Buckley ◽

Ann Syrett

Keyword(s):

Spinal Cord ◽

Palliative Care ◽

Superior Vena ◽

Vena Cava ◽

Cord Compression ◽

Holistic Care ◽

Advanced Practice ◽

Vena Cava Syndrome ◽

Nonpharmacological Treatments

This chapter highlights four emergencies that occur in palliative care: hemorrhage, spinal cord compression, seizures, and superior vena cava syndrome. It is imperative to understand their etiology, pathophysiology, workup, and management in order to rapidly and expertly respond to these emergencies. Palliative advanced practice registered nurses possess a unique skill set combining holistic care of patients with the ability to manage acute, often potentially devastating symptoms that affect the patient’s goals and wishes. Disease state needs to be considered when making treatment and management decisions during these palliative emergencies. The chapter presents an overview of pharmacological and nonpharmacological treatments to prevent and manage these palliative emergencies.