Clin Shonc

Question 1

Tumour Lysis
1) Pathophys including sequalae:
2) Broadly differentiated into? Key blood results?

Answer 1

Large volume tumour cell death eith spontaneouly or in response to treatment -> Release of intracellular ions, nucleic acids, proteins and their metabolites into the systemic circulation.

Leads to: metabolic abnormalities such as hyperuricaemia, hyperK, hyperphosphataemia, secondary hypoCa and uraemia, can in turn lead to renal failure, arrhythmias, seizures, neurological sx.

2) Laboratory TLS, Clinical TLS
The presence of 2 or more of: HyperUric acid, HyperK, HyperP04-, HYPO Ca (adjusted)

For clinical note the Cairo-Bishop grading of clinical tumour lysis syndrome

Question 2

Prophylaxis/Mx of tumour Lysis syndrome?

Answer 2

1) Evaluate risk:
High proliferation rate, rapid response to Tx anticipated (chemo or radio sensitive), large volume, HR Cancer (lymphoma e.g Burkitts, SCLC), pre-existing metabolic disturbance.
2) Aggressive Hydration, ideally begin 24Hrs prior to Tx. Aim UO >100ml/msqr/Hr.
3) Allopurinol TDS
4)Consider Rasburicase (converts uric acid to excretable)
5) Close monitoring