Tumor Lysis Syndrome
Chemotherapy isn't good for you. So when you feel bad, as I am feeling now, you think, 'Well that is a good thing because it's supposed to be poison. If it's making the tumor feel this queasy, then I'm OK with it - Christopher Hitchens
image by: GDJ
Resources
What is Tumor Lysis Syndrome (TLS)?
While we might think that killing cancer cells is a good thing - killing too many at once can be a disaster.
The Tumor Lysis Syndrome
The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers.
Tumor lysis syndrome: current perspective
Tumor lysis syndrome is characterized by a group of metabolic derangements caused by the massive and abrupt release of cellular components into the blood following the rapid lysis of malignant cells. It is observed most frequently in patients with hematologic malignancies such as acute lymphoblastic leukemia (ALL) and Burkitt’s lymphoma after the initiation of chemotherapy, although it may also occur in other malignancies, both hematologic and solid tumors.
Tumor lysis syndrome: Prevention and treatment
The emergence of effective targeted anticancer drugs, used alone or in combination with conventional cytotoxic agents, has led to an increase in the frequency and severity of TLS in hematologic cancers that previously were rarely associated with this complication.
Clinical Advisor
The release of intracellular potassium, phosphorus, and nucleic acids into the extracellular space due to rapid destruction of tumor cells can result in detrimental metabolic derangement in tumor lysis syndrome.
emDocs
Initial management involves recognition of the syndrome, high volume intravenous fluid administration as tolerated, decreasing uric acid production through allopurinol, decreasing uric acid levels through rasburicase if indicated, and determining the need for renal replacement therapy (RRT).
Life in the Fastlane
Usually occurs 12-72 hours after chemotherapy but can occur spontaneously (usually less hyperphosphatemia in this case, presumably due to recycling of phosphate).
NEJM
The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers.
Tangents
There are a few oncologic emergencies that every internist should be able to identify and manage. This is one of them.
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