Abstract
The common oncologic emergencies include Superior Vena Cava Syndrome (SVCS) and Superior Mediastinal Syndrome (SMS), Tumor Lysis Syndrome (TLS), Hyperleukocytosis and Febrile Neutropenia. SVCS denotes compression, obstruction or thrombosis of SVC and SMS denotes SVCS and tracheal compression. The diagnosis should be established early with minimum invasive techniques. Steroids should be administered immediately. Sedatives are contraindicated. TLS describes the metabolic derangements in various combinations that include hyperuricemia, hyperphosphatemia, hyperkalemia hypocalcemia and uremia which arise from death of and release of contents from tumor cells. Early recognition of patients at risk and initiation of preventive therapy for TLS is essential. Treatment is directed at adequate hydration, use of allopurinol and alkalinization of urine. Hyperluekocytosis is defined as peripheral leukocyte count exceeding 100,000 per microlitre and therapy is tailored at reduction of blood viscosity with hydration, alkalinization of urine allopurinol; chemotherapy should be started once the child is metabolically stable. Febrile neutropenia is a common oncologic emergency directly related to the immune suppression related to cancer treatment. Successful outcome depends on careful evaluation, identification of cause and prompt treatment with antimicrobials (empirical/directed to a specific focus).
Similar content being viewed by others
References
O’Brien RT, Matlak ME, Condon VR, Johnson DG. Superior vena cava syndrome in children. West J Med. 1981;135:143–7.
Gupta V, Ambati SR, Pant P, Bhatia B. Superior vena cava syndrome in children. Indian J Hematol Blood Transf. 2008;24(1):28–30.
D’Angio GJ, Mitus A. The superior mediastinal syndrome in children with cancer. Am J Roentgenol. 1965;93:537–44.
Arya LS, Narain S, Tomar S, Thavaraj V, Dawar R, Bhargava M. Superior vena cava syndrome. Indian J Pediatr. 2002;69:293–7.
Ingram L, Rivera G, Shapiro DDN. Superior vena cava syndrome associated with childhood malignancy. Analysis of 24 cases. Med Pediatr Oncol. 1990;18:476–81.
Maurer HS, Steinherz PG, Gaynon PS, et al. The effect of initial management of hyperleukocytosis on early complications and outcome of children with acute lymphoblastic leukemia. J Clin Oncol. 1988;9:1425–32.
Nelson SG, Bruggers CS, Kurtzberg J, et al. Management of leukemic hyperleukocytosis with hydration, urinary alkalinization and allopurinol. Are cranial irradiation and invasive cytoreduction necessary. Am J Pediatr Hematol Oncol. 1993;15:351–5.
Rheingold SR, Lange BJ. Oncologic emergencies. In: PA Pizzo, Poplack DG, editors. Principles and practice of pediatric oncology. 5th ed. Philadelphia: 2006. p. 1202–30.
Hande KR, Garrow GC. Acute tumor lysis syndrome in patients with high-grade non-Hodgkin lymphoma. Am J Med. 1993;94:133–9.
Cairo MS, Bishop M. Tumor lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127:3–11.
Rampello E, Fricia T, Malaguarnera M. The management of tumor lysis syndrome. Nat Clin Pract Oncol. 2006;3:438–47.
Hughes WT, Bodey GP, Bow EJ, et al. Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730–51.
Meckler G, Lindemulder S. Fever and neutropenia in pediatric patients with cancer. Emerg Med Clin N Am. 2009;27:525–44.
Walsh TJ, Roilides E, Groll AH, Gonzales C, Pizzo PA. Infectious complications in pediatric cancer patients. In: Pizzo PA, Poplack DG, editors. Principles and practice of pediatric oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkens; 2005. p. 1269–329.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Seth, R., Bhat, A.S. Management of Common Oncologic Emergencies. Indian J Pediatr 78, 709–717 (2011). https://doi.org/10.1007/s12098-011-0381-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-011-0381-5