Tumour lysis syndrome

Question 1

Managing side effects of cancer therapy

Answer 1

• nausea and vomiting - give fluids, ondansetron or metoclopramide
• diarrhoea - give loperamide
• neutropenic sepsis - neutrophils under 0.9 + temperature of >38 or signs of infection
• radiotherapy - tiredness, skin reactions (erythema, dryness, ulcers) - use aqueous cream, mucositis (mouthwash)
• dysphagia after systematic treatment

Question 2

What is tumour lysis syndrome?

Answer 2

• metabolic disturbance - rapid lysis of cancer cells causes release of cellular components into blood
• high urate, phosphate and potassium but low calcium

Question 3

Tumour lysis syndrome presentation

Answer 3

• malaise
• nausea and vomiting
• syncope

Question 4

Tumour lysis syndrome - biological abnormalities

Answer 4

• lab based - 2 of the following either 3 days before or 7 days after treatment:
• uric acid >8
• potassium >6
• phosphate >2
• > 25% change from baseline
• clinical - any lab result + AKI, cardiac arrhythmia or seizure

Question 5

Complications of tumour lysis syndrome

Answer 5

• seizure
• acute kidney injury
• cardiac arrhythmia
• sudden death

Question 6

Tumour lysis syndrome prophylaxis

Answer 6

• low-risk patients - monitor fluid status and electrolytes, ? oral allopurinol
• medium-risk patients - seven days of allopurinol, increased hydration
• high-risk patients - prophylaxis with rasburicase and hydration (not allopurinol)

Question 7

Tumour lysis syndrome management

Answer 7

• symptomatic low calcium - IV calcium gluconate 10%
• high phosphate - consider phosphate binder
• high potassium - insulin/dextrose infusion
• high urate - uricolytic medication, e.g. rasburicase

Question 8

Tumour lysis syndrome medication side effects

Answer 8

allopurinol – can be nephrotoxic, severe skin reactions
- calcium gluconate – renal stones, circulatory collapse, arrythmias, hypotension, vasodilation
- insulin/dextrose – can cause hypoglycaemia