Tumor Lysis Syndrome

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Tumor Lysis Syndrome
Introduction:
- Tumor lysis syndrome is a life-threatening metabolic emergency caused by the rapid destruction of cancer cells.
- It can occur spontaneously or as a result of chemotherapy, radiation therapy, or surgery.
- Tumor lysis syndrome is characterized by a constellation of metabolic abnormalities, including hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, azotemia, and oliguria.
Causes:
- Common cancers that can cause Tumor lysis syndrome: Leukemia, Lymphoma, Burkitt's lymphoma, Acute myeloid leukemia, Small cell lung cancer, Breast cancer, Ovarian cancer, and Testicular cancer.
- Risk factors associated with Tumor lysis syndrome: High tumor burden, Rapidly growing tumors, Tumors sensitive to chemotherapy or radiation therapy, Pre-existing renal dysfunction.
Pathophysiology:
- The release of cellular contents from lysed cancer cells triggers a cascade of events.
- Hyperkalemia: can cause cardiac arrhythmias and sudden death.
- Hyperphosphatemia: can cause acute kidney injury, renal failure, and hypocalcemia.
- Hypocalcemia: can cause neuromuscular irritability and seizures.
- Hyperuricemia: can cause uric acid crystallization in the kidneys and renal failure.
- Azotemia and oliguria: can occur as a result of renal failure.
Clinical Manifestations:
- Nausea, vomiting, diarrhea, and abdominal pain.
- Muscle weakness, seizures, coma, and cardiac arrhythmias.
- Renal failure.
Diagnosis:
- Based on clinical symptoms and laboratory findings.
- Laboratory tests: Serum potassium, phosphate, calcium, uric acid, blood urea nitrogen, and serum creatinine.
- Cairo-Bishop criteria: At least two metabolic disturbances within 3 days before or 7 days after initiation of therapy.
Treatment:
- Intravenous fluids to correct dehydration and electrolyte imbalances.
- Allopurinol or rasburicase to lower serum uric acid level.
- Sodium bicarbonate to alkalinize the urine and prevent uric acid crystallization.
- Dialysis to remove waste products from the blood.
- Generally not recommended to supply calcium, as it can increase the calcium phosphate product and lead to further renal deposition and damage.
Prevention:
- Identify patients at risk and start treatment before the condition develops.
- Prophylactic treatment with allopurinol or rasburicase before chemotherapy or radiation therapy.
- Avoid substances that can cause vasoconstriction of the renal vasculature, such as NSAIDs and iodinated contrast.
Conclusion:
- Tumor lysis syndrome is a common oncologic emergency with potentially life-threatening complications.
- Early identification and prompt treatment are crucial to prevent severe complications and improve patient outcomes.

[@user-tb9ms2px5c]

Very well explained. Thank you sir. 👍👍👍

[@mouradrouis5011]

Informative and clear