Oncologic Emergencies

Oncological emergencies are a group of conditions that occur as a direct or indirect result of cancer or its treatment that are potentially life-threatening and require immediate treatment.

The types of Oncological emergencies are as below: 

• Hypercalcemia
• Neutropenic sepsis
• Tumor lysis syndrome
• Leukocytosis
• Raised intracranial pressure
• Spinal cord compression
• Cauda equina syndrome
• Superior vena cava obstruction
• Syndrome of inappropriate ant diuretic hormone secretion (SIADH)
• Disseminated intravascular coagulation

The most common oncology emergencies are febrile neutropenia (FN), TLS, malignant hypercalcemia, spinal cord compression, SVC syndrome, and brain metastases with increased intracranial pressure.

Most oncologic emergencies can be classified as metabolic, hematologic, structural, or treatment related. Tumor lysis syndrome is a metabolic emergency that presents as severe electrolyte abnormalities. Stabilization is focused on vigorous rehydration, maintaining urine output, and lowering uric acid levels.

Acute Oncology ensures that cancer patients who develop an acute cancer-related or cancer treatment related problem receive the care they need quickly and in the most appropriate setting.

Neutropenia is one of the major dose-limiting toxicities of systemic cancer chemotherapy. The depth and duration of neutropenia correlate with the risk of developing infection and death Episodes of febrile neutropenia are considered an oncologic emergency.

The emergencies that are usually encountered in patients with cancer fall under the following categories:

• Pressure or obstruction caused by a space-occupying lesion
• Metabolic or hormonal problems (paraneoplastic syndromes)
• Treatment related complications

Pressure or obstruction caused by a space-occupying lesions caused when the tumor is pressing the normal structures and thus interfering with their normal function which leads to problems. The most frequently occurring problems in this category are:

• Superior Vena Cava syndrome
• Pericardial effusion/tamponade
• Intestinal obstruction
• Urinary obstruction
• Malignant biliary obstruction
• Spinal cord compression
• Increased intracranial pressure
• Neoplastic meningitis
• Seizures
• Pulmonary and intracerebral leukocytosis
• Hemoptysis
• Airway obstruction

The oncologic emergencies can arise out of a number of reasons and proper reason needs to be identified first to treat the emergency. The emergencies that are usually encountered in patients with cancer fall under the following categories:

• Pressure or obstruction caused by a space-occupying lesion
• Metabolic or hormonal problems (paraneoplastic syndromes)
• Treatment related complications

Depending on the type of oncologic emergency, swift action needs to be taken so as to avoid any irreversible damage and in some case even death.

Fever is a common symptom of infection. In a neutropenic fever, the reason is often normal gut bacteria that have made its way into the blood from weakened barriers. Neutropenic fevers are usually treated with antibiotics, even if an infectious source can't be identified. The chemotherapeutic agents attack rapidly dividing cells and hence the blood cells including the cells that provide immunity are affected. This weakens the immune response of the host and opportunistic infections can also cause the fever.

The steps to recognise an oncology emergency are as below: 

• Emergence of signs & symptoms
• Patient recognition of signs & symptoms
• Clinical Team contacted
• Patient assessed and investigated
• Probable diagnosis agreed
•  Intervention(s) instigated

Some of the important points to remember about Oncological emergencies: 

• Oncological emergencies can develop from subtle and seemingly minor symptoms.
• It is very important to assess the exact cause that is responsible for the emergency.
• Exact symptoms described by the patient can be of great help. The clinician should look for specific signs that the patient presents with
• Clear and accessible communication pathways are key to the safe management of Oncological emergencies