Articles:Oncological emergencies

Acute emergencies in oncology are a group of conditions caused by complications of cancer or its treatment, that are life-threatening or irreversibly disabling if clinical management is delayed. As a consequence of our ability to treat increasingly larger numbers of patients effectively, the knowledge to recognise and respond swiftly to such presentations has never been more important.

These emergencies may be encountered at any stage in the pathway of a patient's journey through cancer. This may be at presentation, during the course of treatment, or later in the disease process. Below reviews the most frequently encountered oncological emergencies. It may sound obvious, but it is worth bearing in mind that unrelated acute medical or surgical conditions may occur in patients with malignant disease. Generally, the management will be the same as that of a patient without known cancer.

The emergencies are grouped according to the causative system of origin.

Cardiovascular emergencies

Superior vena cava obstruction

Cardiac tamponade (malignant pericardial effusion)

Venous thromboembolism

Extravasation injury

Complications of central venous devices

Respiratory emergencies

Acute large airway obstruction

Pulmonary haemorrhage

Respiratory failure

Intractable hiccups

Radiation pneumonitis

Pleural effusion (malignant)

Renal and metabolic emergencies

Tumour lysis syndrome

Hypercalcaemia

Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Hypomagnesaemia

Renal and genitourinary emergencies

Obstructive uropathy

Urate nephropathy (from TLS)

Haemorrhagic cystitis

Gastrointestinal emergencies

Obstruction

Perforation

Gastrointestinal haemorrhage

Nausea and vomiting (uncontrolled)

Mucositis (uncontrolled)

Diarrhoea (uncontrolled)

Abdominal ascites (malignant)

Neutropaenic enterocolitis

Neurological emergencies

Spinal cord compression

Cauda equina syndrome

Raised intracranial pressure

Seizures (fits)

Haematological emergencies

Leukostasis

Hyperviscosity

Disseminated intravascular coagulation

Thrombocytopaenia

Febrile neutropaenia (neutropaenic sepsis)

Ophthalmological emergencies

Ocular and orbital metastases

Musculoskeletal emergencies

Metastatic bone pain

Pathological fractures

Gynaecological emergencies

Gynaecological haemorrhage

Dermatological emergencies

Acute skin reactions