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
• Hypertensive crises

Respiratory emergencies

• Acute large airway obstruction
• Pulmonary haemorrhage
• Respiratory failure
• Intractable hiccups
• Radiation pneumonitis
• Pleural effusion (malignant)

Metabolic emergencies

• Tumour lysis syndrome
• Hypercalcaemia
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Hypomagnesaemia
• Hypoglycaemia

Endocrine emergencies

• Thyroid dysfunction
• Adrenal insufficiency

Renal & Urological emergencies

• Obstructive uropathy
• Urate nephropathy (from TLS)
• Haemorrhagic cystitis
• Nephritis

Gastrointestinal emergencies

• Bowel obstruction
• Bowel perforation
• Gastrointestinal haemorrhage
• Nausea and vomiting (uncontrolled)
• Mucositis (uncontrolled)
• Diarrhoea (uncontrolled)
• Biliary obstruction
• Oesophageal obstruction
• Abdominal ascites (malignant)
• Neutropaenic enterocolitis
• Transaminitis
• Colitis

Neurological emergencies

• Spinal cord compression
• Cauda equina syndrome
• Raised intracranial pressure
• Seizures (fits)
• Leptomeningeal disease

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

Psychiatric emergencies

• Steroid-induced psychosis