Oncologic Emergencies

Oncologic
Emergency

Causes

Clinical
Manifestations

Diagnostics and
Treatments

Nursing
Responsibilities

Superior Vena Cava

Syndrome

Compression or invasion
of SVC by tumor, enlarged
lymph nodes, or
thrombus.

Impaired venous
drainage.
Shortness of breath.
Cough; hoarseness.
Chest pain.
Facial swelling and
edema.
Difficulty swallowing.
Distended neck veins.
Increased ICP with
associated visual
disturbances; headache.
Fever
Signs of infection.

Chest x-ray
CT scan
MRI

Monitor for signs and

symptoms of SVCS.
Monitor cardiac,
respiratory, and
neurological status.
Monitor fluid volume
status.
Avoid upper extremity
venipuncture and blood
pressure.

Risk of occurrence with

lung and breast cancer.

Infection, Sepsis, Septic

Shock

Spinal Cord Compression

Nadir = Period after

chemotherapy
administration when the
WBC and platelet count
are at the lowest point;
occurs 7-14 days after
administration.
The nadir period affects
the immune system and
causes the patient to be
vulnerable to infection.
Compression or swelling
around spinal cord and its
nerve roots from tumor,
lymphomas, intervertebral
collapse, or interruption of
blood supply to the nerve
tissue.
60% occur at the thoracic
level.

Treatment:
Radiation or
chemotherapy to shrink
tumor.

Complete Blood Count

(CBC)
Vital signs.

Mild elevation of
temperature can quickly
progress to sepsis, septic
shock, and death.

Local inflammation and

edema in area of
compression.
Loss of movement and
sensation according to
dermatome chart.
Pain increased with
movement.
Bladder and/or bowel
dysfunction depending on
level of compression.

Monitor CBC values.

Identify cancer patients at
risk for infection.
Place patients in
Neutropenic Precautions
at the slightest indication
of infection. Dont wait to
see if things change!

Spinal cord x-rays.

CT scan
MRI
Myelogram
Percussion tenderness at
level of compression.
Abnormal reflexes.
Tx: palliative care with
high dose corticosteroids
to reduce the swelling

No exposure to infection!
Monitor neurological
function.
Control pain.
Prevent complications
from immobility.
Look at a dermatome
chart.

Oncologic Emergencies
around the spinal cord;
high dose radiation to
reduce the size of the
tumor; surgery to remove
the tumor

Hypercalcemia

Bone destruction by
tumor cells causes
calcium to be released
from the bones.
Calcium released from the
bones is more than
kidneys can excrete or
bones can reabsorb.
Most common oncologic
emergency.

Pericardial Effusion and

Pericardial Tamponade

Accumulation of fluid in
the pericardial space.
Increased accumulation
compresses the heart and
impedes cardiac output.

Fatigue, weakness and

confusion.
Decreased level of
responsiveness.
Nausea, vomiting,
constipation.
Excessive thirst; polyuria;
dry mucous membranes.
Renal calculi; renal failure;
cardiac arrest.

Serum calcium levels

exceeding 11 mg/dl.

Neck vein distention

during inspiration.
Pulsus paradoxus.
Distant heart sounds.
Tachycardia.

Chest x-ray.
CT scan
ECG

Assist with
pericardiocentesis.
Monitor vital signs and
oxygen saturation.
ECG tracings.
Heart and lung sounds.
Intake and output.
Monitor ABGs and
electrolyte levels.

Hyponatremia
Weight gain
Nausea, vomiting.
Pain
Fatigue
Irritability
Confusion

The following levels are

decreased:
Sodium
BUN
Creatinine
Serum albumin

Patient will be on fluid

intake restrictions.
Monitor for increased
signs and symptoms.
Minimize patient
activities.
Maintain safety
precautions.

Tx: hydration, NS , oral

glucocorticoids, calcitonin,
diphosphonate, dialysis if
life threatening or kidney
disease

Risk occurs with lung,

esophagus, and breast
cancer.

Syndrome of
Inappropriate ADH
(SIADH)

Continuous, uncontrolled
release of antidiuretic
hormone.
Leads to increased
extracellular fluid volume.
Most common cause of
SIADH is cancer.

(Decreased values are

Identify and monitor

patients at risk.
Encourage patients to
drink 2-3 liters of fluid
daily.
Promote and encourage
mobility.
Remember: Patients need
increased hydration with
treatment.

Oncologic Emergencies
due to dilution.)

Disseminated
Intravascular Coagulation
(DIC)

Complex disorder of
coagulation which results
in bleeding.

Prolonged bleeding from

injection sites and
venipunctures.
GI bleeds.

Most commonly
associated with
hematologic cancers.

Tumor Lysis Syndrome

When a large tumor is

destroyed by treatment,
the rapid destruction of
tumor cells releases
intracellular K+,
phosphorus, and uric acid
into the circulation. This
leads to electrolyte
imbalances and acute
renal failure.

Increased:
PT
PTT
Fibrin split products.
D-dimer
Decreased:
Fibrinogen
Platelets
Clotting Factors

Weakness
Nausea
Diarrhea
ECG changes
Muscle cramps, twitching.
Hypotension
Altered mental status.
Symptoms start 1-2 days
after cancer treatment
starts.

Electrolyte imbalances.
Renal failure

Patients at highest risk are

those whose tumors
respond well to treatment.

Monitor lab values closely

as excess fluid is
eliminated.
Monitor vital signs.
Continuous assessment
for signs and symptoms of
bleeding.
Administer blood products
as ordered.
Prevent bleeding; apply
pressure to all
venipuncture sites.

Aggressive hydration
before and after
treatment.
Allopurinol and sodium
bicarbonate may be
administered.