Cancer

Question 1

What is Tumour lysis syndrome

Answer 1

This is a combination of metabolic an d electrolyte abnormalities that occurs in patient with cancer, usually after the initiation of cytotoxic treatment but also spontaneously

It is characterised by:

• Hyperuricaemia
• Hyperphosphataemia
• Hyperkalaemia
• Hypocalcaemia

Question 2

What are risk factors for Tumour lysis syndrome

Answer 2

Occurs most commonly after treatment of lymphomas and leukaemia

RFs:

• Tumour characteristics - High cell turnover rate, rapid growth rate, high tumour bulk
• Patient characteristics - Baseline serum creatinine, renal insufficiency, dehydration
• Chemotherapy characteristics - Chemo-sensitive tumours tend to have a higher risk

Question 3

What are the signs and symptoms of Tumour lysis syndrome

Answer 3

Hyperkalaemia:

• Arrhythmias
• Severe muscle weakness and paralysis

Hyperphosphataemia
- Causes acute kidney failure because of deposition of calcium phosphate crystals in kidney parenchyma

Hypocalcaemia

• Tetany
• Parkinsonism
• Myopathy
• Sudden mental incapacity

Hyperuricaemia
- Gout

Lactic acidosis

Question 4

How is Tumour lysis syndrome diagnosed

Answer 4

Serum:
Uric acid
Phosphate
Potassium
Calcium

FBC - Elevated WCC
LDH - Elevated
Urine pH - <5