CHAPTER 121 - Selected Oncologic Emergencies

Abstract

Oncologic emergencies embody an extensive range of illnesses that can occur at any time during the course of malignant disease. Some oncologic emergencies are insidious and develop during months; others are manifested in hours and can lead to paralysis and death. Prompt, accurate diagnosis and appropriate treatment of oncologic emergencies can improve the quality of life dramatically in patients with cancer. With timely intervention, many of these patients can return to their previous level of function and independence. In addition, a reversible life-threatening emergency can occur in a patient with an underlying malignant neoplasm that is otherwise highly treatable or even curable, making identification and management of the oncologic emergency a potentially lifesaving action. Cancer remains the second leading cause of death in the United States. It is estimated that 1,529,560 men and women (789,620 men and 739,940 women) will be diagnosed with and 569,490 men and women will die of cancer of all sites in 2010. The most commonly diagnosed new cancer is prostate cancer in men and breast cancer in women. The second most commonly diagnosed new cancer in both sexes is lung cancer. The most common cause of cancer death for both sexes is lung and bronchial cancer. Worldwide, the most commonly diagnosed new cancer and most common cause of cancer death is lung and bronchial cancer in men and breast cancer in women. The most common malignant neoplasm of childhood is leukemia, followed by brain tumors and lymphoma. In 2003, it was estimated that the lifetime risk for development of cancer was 1 : 2 for men and 1 : 3 for women. Most cancer patients will experience at least one emergency during the course of their disease, and emergency physicians are increasingly managing complications related to cancer, although definitive therapy for an oncologic emergency is often multidisciplinary, involving surgeons, radiation oncologists, medical oncologists, and other medical and social specialists. Changing trends in cancer have produced an increased number of emergency department (ED) visits secondary to cancer and its complications (Box 123-1). In fact, a study reported that about 40% of cancer patients had visited the ED in the last 2 weeks of life. Therefore, the emergency physician should be well versed in oncologic emergencies. However, many factors can hinder the identification and management of oncologic emergencies in the ED (Box 123-2). This chapter focuses on the most common oncologic emergencies: fever and neutropenia, superior vena cava syndrome, acute tumor lysis syndrome, hyperviscosity syndrome, hyperuricemia, hypercalcemia, neoplastic cardiac tamponade, and spinal cord compression. FEVER