Management of Common Oncologic Emergencies

The common oncologic emergencies include Superior Vena Cava Syndrome (SVCS) and Superior Mediastinal Syndrome (SMS), Tumor Lysis Syndrome (TLS), Hyperleukocytosis and Febrile Neutropenia. SVCS denotes compression, obstruction or thrombosis of SVC and SMS denotes SVCS and tracheal compression. The diagnosis should be established early with minimum invasive techniques. Steroids should be administered immediately. Sedatives are contraindicated. TLS describes the metabolic derangements in various combinations that include hyperuricemia, hyperphosphatemia, hyperkalemia hypocalcemia and uremia which arise from death of and release of contents from tumor cells. Early recognition of patients at risk and initiation of preventive therapy for TLS is essential. Treatment is directed at adequate hydration, use of allopurinol and alkalinization of urine. Hyperluekocytosis is defined as peripheral leukocyte count exceeding 100,000 per microlitre and therapy is tailored at reduction of blood viscosity with hydration, alkalinization of urine allopurinol; chemotherapy should be started once the child is metabolically stable. Febrile neutropenia is a common oncologic emergency directly related to the immune suppression related to cancer treatment. Successful outcome depends on careful evaluation, identification of cause and prompt treatment with antimicrobials (empirical/directed to a specific focus).