Complications of Anti-Cancer Therapy

Question 1

What is tumour lysis syndrome (TLS)?

Answer 1

The rapid breakdown of tumour cells due to chemotherapy. This causes the release of intracellular ions and metabolic by products. THIS CAN BE FATAL.

More commonly associated with haematological malignancies and bulky solid tumours

Question 2

How does tumour lysis syndrome present?

Answer 2

• hyperkalaemia
• hyperphosphatemia
• hyperuricaemia
• resultant hypocalcaemia

-These will culminate in an AKI

Question 3

How do you prevent tumour lysis syndrome?

Answer 3

• adequate pre-hydration 24 hours before starting chemo
• close urine output monitoring
• prophylactic allopurinol to prevent uricemia

Question 4

How do you treat tumour lysis syndrome?

Answer 4

• maintain adequate hydration
• Rasburicase - rapidly clears uric acid
• treat other metabolic disturbances as they arise

Question 5

what defines a grade 4 neutropenia?

Answer 5

WCC less than 0.5 x10(^9)/L

Question 6

What defines febrile neutropenia?

Answer 6

WCC< 0.5/L

temperature >38 degrees

Question 7

What defines neutropenic sepsis?

Answer 7

WCC< 0.5/L
Temperature >38 degrees
evidence of end organ damage (hypotension, decrease urine output, confusion, hypoxia)

Question 8

When is a neutrophil nadir most likely to occur?

Answer 8

7-14 days post chemotherapy Tx

Question 9

What are the symptoms of an acute cholinergic syndrome?

Answer 9

• acute diarhorrea
• sweating
• watering eyes
• abdominal pain
• constricted pupiles
• possibly hyper-salivation

Question 10

How do you teat an acute cholinergic syndrome?

Answer 10

Subcutaneous atropine

with subsequent subcut atropine prior to future chemotherapy