Overview of the main emergencies in cancer patients: Review

Main Article Content

Mateo Zuluaga Gómez
Mabel Dahiana Roldan Tabares
Felipe Baena Gallego
Santiago Upegui Estrada

Abstract

Oncological emergencies are common complications resulting from the natural evolution of the tumor or its management; however, some of them may be subtle or even overlooked, which contributes to greater morbidity and mortality. Our aim was to gather updated information on the main oncological complications. A narrative literatura review was performed by searching for original articles, systematic reviews and narratives, in databases such as Scopus, SciELO, PubMed, ScienceDirect and in the Google Scholar search engine. 63 references were selected that addressed relevant information about the oncological emergencies raised for the development of the article. According to their origin, complications can be classified into infectious (febrile neutropenia), metabolic (tumor lysis syndrome and malignant hypercalcemia) and obstructive (superior vena cava syndrome, intestinal obstruction, spinal cord compression and cardiac tamponade). Facing these complications requires a high level of suspicion; the physician must be able to resolve each complication and have the necessary knowledge to approach each case, with a rational use of diagnostic resources. It is also necessary to adopt therapeutic measures that positively impact patients. patient prognosis, decreasing morbidity and death.

Keywords:
febrile neutropenia tumor lysis syndrome cardiac tamponade intestinal obstruction spinal cord compression

References

Instituto Nacional del Cáncer. Estadísticas del cáncer [Internet]. 2015 [citado el 5 de febrero de 2021]. Disponible en: https://www.cancer.gov/espanol/cancer/naturaleza/estadisticas

Acosta J, Mejía S. Síndrome de Lisis tumoral. En: Asociación Nacional de Internos y Residentes, ANIR. VIII Simposio Medicina de Urgencias. Medellin, editorial Artes y letras. 2020. P. 303-16.

Halfdanarson TR, Hogan WJ, Madsen BE. Emergencies in hematology and oncology. Mayo Clin Proc. 2017; 92(4):609-41.

Klemencic S, Perkins J. Diagnosis and management of oncologic emergencies. West J Emerg Med. 2019; 20(2):316-22.

Gayol M, Fornt A, Casas I, Estrada O, Domínguez J, Pedro-Botet ML. Utilidad de la escala de MASCC en el tratamiento de la neutropenia febril inducida por quimioterapia en pacientes con neoplasia sólida. Medicina Clinica. 2009; 133(8):296-99.

Klastersky J, de Naurois J, Rolston K, Rapoport B, Maschmeyer G, Aapro M, et al. Management of febrile neutropaenia: ESMO Clinical Practice Guidelines. Ann Oncol. 2016; 27(suppl 5):v111‐v118.

Von Amsberg G. Oncological emergencies in chemotherapy: Febrile neutropenia, tumor lysis syndrome, and extravasation. Urologe A. 2018; 57(5):552‐57.

Klastersky J, Paesmans M, Rubenstein EB, Boyer M, Elting L, Gallagher J et al. The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000; 18(16):3038‐51.

Schmidt-Hieber M, Maschmeyer G, Shalck E. Management of febrile neutropenia in the perspective of antimicrobial de-escalation and discontinuation. Expert Rev Anti Infect Ther. 2019; 17(12):983-95.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prevention and Treatment of Cancer-Related Infections. v2.2017 [Internet]. 2017 [citado el 5 de febrero de 2021]. Disponible en: https://www.nccn.org/professionals/physician_gls/pdf/infections.pdf.

Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2011; 52(4):e56–93.

Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, et al. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013; 31(6):794-810.

Coiffier B, Altman A, Pui CH, Younes A, Cairo MS. Guidelines for the management of pediatric and adult tumor lysis syndrome: An evidence-based review. J Clin Oncol 2010; 28(4):708

Wilson FP, Berns JS. Tumor lysis syndrome: New challenges and recent advances. Adv Chronic Kidney Dis 2014; 21(1):18‐26.

Cairo MS, Bishop M. Tumour lysis syndrome: New therapeutic strategies and classification. Br J Haematol 2004; 127(1):3-11.

Williams SM, Killeen AA. Tumor lysis syndrome. Arch Pathol Lab Med. 2019; 143(3):386‐93.

Adeyinka A, Bashir K. Tumor lysis syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020.

Rahmani B, Patel S, Seyam O, Gandhi J, Reid N. Current understanding of tumor lysis syndrome. Hematol Oncol. 2019; 37(5):537-54.

Eng S, Lee CS, Ahn S, Sharma A. A retrospective analysis of tumor lysis syndrome management in a quaternary care hospital. J Oncol Pharm Pract 2020; 26(2):338-44.

Jones GL, Will A, Jackson GH, Webb NJ, Rule S; British Committee for Standards in Haematology. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol 2015; 169:661-71.

Ñamendys-Silva SA, Arredondo-Armenta JM, Plata-Menchaca EP. Tumor lysis syndrome in the emergency department: Challenges and solutions. Open Access Emerg Med. 2015; 7:39‐44.

Pi J, Kang Y, Smith M, Earl M, Norigian Z, McBride A. A review in the treatment of oncologic emergencies. J Oncol Pharm Pract. 2016; 22(4):625‐638.

Calvo JM. Síndrome de lisis tumoral. Med Clin (Barc). 2019; 152(10):397‐404.

Perry W, Jeffrey S. Tumor lysis syndrome: New challenges and recent advances. Adv Chronic Kidney Dis. 2014; 21(1):18-26.

Asonitis N, Angelousi A, Zafeiris C, Lambrou G, Dontas I, Kassi E. Diagnosis, pathophysiology and management of hypercalcemia in malignancy: A review of the literature. Horm Metab Res 2019; 51(12):770-8.

Pfennig CL, Slovis CM. Electrolyte disorders. In Marx J, Hockberger R, Walls R. (eds): Rosen’s emergency medicine concepts and clinical practice, 8th edition. St Louis (MO): Elsevier, 2013. pp. 1636-1651.

Wagner J, Arora S. Oncologic metabolic emergencies. Hematol Oncol Clin North Am. 2017; 31(6):941‐957.

Dellay B, Groth M. Emergency management of malignancy-associated hypercalcemia. Adv Emerg Nurs J. 2016; 38(1):15‐E1.

Sternlicht H, Glezerman IG. Hypercalcemia of malignancy and new treatment options. Ther Clin Risk Manag. 2015; 11:1779‐88.

Vaughn CB, Vaitkevicius VK. The effects of calcitonin in hypercalcemia in patients with malignancy. Cancer 1974; 34:1268-71.

Wilson LD, Detterbeck FC, Yahalom J. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356:1862-9.

Wei S, Liu J, Li x, Song Z, Dong M. A retrospective stenting study on superior vena cava síndrome caused by lung cancer. Thorac Cancer 2020; 11(7):1835-9.

Hunter W. History of aneurysm of the aorta with some remarks on aneurysms in general. Med Obs Inquir (London). 1757; 1:323.

Wudel L Nesbitt J. Superior vena cava syndrome. Current Treatment Options in Oncology. 2001; 2(1):77-91.

Narang M, Mohindra P, Mishra M, Regine W, Kwok Y. Radiation Oncology Emergencies. Hematol Oncol Clin North Am. 2020; 34(1):279-2.

Tzu-Ting K. Chen P, Shih C, Chen I. Endovascular stenting for end-stage lung cancer patients with superior vena cava syndrome post first-line treatments - A single-center experience and literature review. J Chin Med Assoc. 2017; 80(8):482-6.

Zimmerman S, Davis M. Rapid fire: Superior vena cava syndrome. Emerg Med Clin North Am. 2018; 36(3):577-84.

Cheng S. Superior vena cava syndrome: A contemporary review of a historic disease. Cardiol Rev 2009; 17:16-23.

Straka C, Ying J, Kong FM, Willey C, Kaminski J, Kim DW. Review of evolving etiologies, implications and treatment strategies for the superior vena cava syndrome. Springerplus. 2016; 29;5:229.

Oh IJ, Park CK, Kim YC. Superior vena cava syndrome with extensive collateral vessels Thorac Cancer. 2019; 10(12):2322.

Murphy D, Murray J, Gaine S. Superior vena cava obstruction (SCVO). Ir Med J. 2014; 107(2):51-2.

Sekine I. A prompt diagnosis of superior vena cava obstruction established by physical examination. Intern Med. 2019; 58(22):3211-2.

Thornton MJ, Ryan R, Varghese JC, Farrell MA, Lucey B, Lee MJ. A three-dimensional gadoliniumenhanced MR venography technique for imaging central veins. Am J Roentgenol. 1999; 173(4):999-1003.

Yu JB, Wilson LD, Detterbeck FC. Superior vena cava syndrome-a proposed classification system and algorithm for management. J Thorac Oncol. 2008; 3(8):811-14.

Rowell NP, Gleeson FV. WITHDRAWN: Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus. Cochrane Database Syst Rev. 2015; (3):CD001316.

Batouty N, Sobh D, Gadelhak B, Sobh H, Mahmoud W. Left superior vena cava: Cross-sectional imaging overview. Radiol Med 2020; 125(3):237-46.

Nagata T, Makutani S, Uchida H, Kichikawa K, Maeda M, Yoshioka T, et al. Follow-up results of 71 patients undergoing metallic stent placement for the treatment of a malignant obstruction of the superior vena cava. Cardiovasc Intervent Radiol. 2007; 30(5):959-67.

Wu CY, Fu JY, Wu CF, Hsieh M, Wen CT. Superior vena cava port catheter tip confirmation: Quantified formula for intravascular catheter length versus anatomic landmark reference. Ann Vasc Surg. 2019; 60:193-202.

Thandra K, Salah Z, Chawla S. Oncologic emergencies-the old, the new, and the deadly. J Intensive Care Med. 2020; 35(1):3-13.

Koth J. Diagnosis and treatment of oncologic emergencies. 2019; 91(2):161-72.

Long B, Brém E, Koyfman A. Oncologic emergencies: Immune-based cancer therapies and complications. West J Emerg Med 2020; 21(3):566-80.

Campillo D, Ariztia M, Benítez GF, Martínez JM, Martin CV. Metastatic spinal cord compression: Incidence, epidemiology and prognostic factors. Rev Clin Esp. 2019; 219(7):386-9.

Silva G, Bergmann A, Thuler L. Incidence, associated factors, and survival in metastatic spinal cord compression secondary to lung cancer. Spine J. 2015; 15(6):1263-9. 54. Tuca A, Guell E, Martinez-Losada E, Codorniu N. Malignant bowel obstruction in advanced cáncer patients: Epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res. 2012; 4:159-69.

Ormando V, Palma R, Fugazza A, Repici A. Colonic stents for malignant bowel obstruction: Current status and future prospects. Expert Rev Med Devices. 2019; 16(12):1053-61.

Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017; 15(1):164.

Lee YC, Jivraj N, Wang L, Chawla T, Lau J. Optimizing the care of malignant bowel obstruction in patients with advanced gynecologic cancer. J Oncol Pract 2019; 15(12):e1066-e1075.

Dumont F, Goéré D, Honoré C, Elias D. Abdominal surgical emergencies in patients with advanced cancer. J Visc Surg. 2015; 152(6 Suppl): S91-S96.

Bosscher MR, van Leeuwen BL, Hoekstra HJ. Surgical emergencies in oncology. Cancer Treat Rev. 2014; 40(8):1028-36.

Sánchez-Enrique C, Núñez-Gil IJ, Viana-Tejedor A. Cause and long-term outcome of cardiac tamponade. Am J Cardiol. 2016; 117(4):664-9.

Keramida K, Parissis J, Chioncel O, Farmakis D. Cardiogenic shock in cancer. Heart Fail Rev. 2019; 24(6):997-1004.

Shenoy S, Shetty S, Lankala S, Anwer F, Yeager A, Adigopula S. Cardiovascular oncologic emergencies. Cardiology. 2017; 138(3):147-58.

Newman WC, Laufer I, Bilsky M. Neurologic, oncologic, mechanical, and systemic and other decision frameworks for spinal disease. Neurosurg Clin N Am. 2020; 31(2):151-66.

Article Details

Author Biographies

Mateo Zuluaga Gómez, San Vicente Foundation University Hospital

San Vicente Fundación University Hospital, Rionegro, Colombia. Salud SURA. Medellin, Colombia.

Mabel Dahiana Roldan Tabares , Pontifical Bolivarian University

Faculty of Medicine, Internal Medicine Research Group - Line of Hematology, Universidad Pontificia Bolivariana. Medellin, Colombia.

Felipe Baena Gallego, CES University

CES University. Medellin, Colombia.

Santiago Upegui Estrada, CES University

CES University. Medellin, Colombia.

Most read articles by the same author(s)

1 2 > >>