Oncologic Emergencies

Oncologic emergencies encompass a variety of clinical entities including tumor lysis syndrome (TLS), superior vena cava syndrome, neutropenic fever, and symptomatic leukostasis (SL). This chapter provides a detailed discussion on the prevention, diagnosis, treatment, and prognosis of oncologic emergencies. TLS is most commonly associated with hematologic malignancies. The best treatment for TLS is prevention, employing continuous cardiac monitoring, serial laboratory evaluations (electrolytes, renal function, uric acid) every 4–6 hours, and rasburicase 0.2 mg/kg with repeated dosing as needed in high risk patients. SL occurs in the setting of hyperleukocytosis, commonly seen in patients with acute myeloid leukemia or chronic myeloid leukemia in blast crisis, in which leukocyte plugs in the microvasculature decrease tissue perfusion.