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Year 5 Cancer > Y5 - Tumour Lysis Syndrome > Flashcards

Y5 - Tumour Lysis Syndrome Flashcards

1
Q

def

A

combination of metabolic and electrolyte abnormalities (due to cell lysis) which occurs in patients with cancer following chemotherapy

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2
Q

what occurs as a result of excessive cell lysis

A 
in high quantities in the cell:
hyperuricaemia
hyperphosphataemia
hyperkalaemia
in low quantities in the cell:
hypocalcaemia
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3
Q

what condition is TLS most associated with

A

burkitts lymphoma (NHL)

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4
Q

what malignancies is TLS common in

A

malignancies with high proliferating rates such as burkitts lymphoma

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5
Q

what are the three conditions most associated with TLS

A

NHL (burkitts)
ALL
AML

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6
Q

why are elderly people more likely to get TLS

A

reduced GFR so metabolic and electrolyte abnormalities are less easily corrected

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7
Q

aetiology

A

appears in haematological malignancies with high proliferating rates such as NHL (burkitts), ALL, AML

reduced GFR is most likely to increase likelihood of TLS
additionally high LDH and WCC indicate a high tumour load and increased risk of TLS

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8
Q

risk factors

A

haematological malignancy
chemotherapy
renal failure

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9
Q

what indicates a high tumour burden

A

high levels of LDH, WCC, uric acid

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10
Q

what are features of TLS

A

Hx of haematological malignancy and chemotherapy, renal failure

N+V+D
muscle weakness and cramping
paraesthesia

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11
Q

why might cardiac arrythmias occur

A

due to hyperkalaemia or hypocalcaemia

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12
Q

why might seizures occur

A

severe hypocalcaemia or hyperphosphataemia

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13
Q

what is the first line investigation for TLS

A

bloods biochemistry for (uric acid, phosphate, potassium, calcium)

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14
Q

what is the gold standard for diagnosis of TLS

A

bloods biochemistry

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15
Q

what signs may be present with hypocalcaemia

A

chvosteks sign

trousseaus sign

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16
Q

what is chvosteks sign

A

face is tapped and causes twitching of nose or lips

17
Q

what is trousseaus sign

A

when a BP cuff is inflated in occludes the brachial artery and causes the wrist to flex and fingers to extend

18
Q

investigations

A

1 bloods biochemistry

  • high PUP (phosphate, uric acid, potassium)
  • low calcium
  • high WCC
19
Q

why is pH low in TLS

A

uric acid

20
Q

what is the most important feature of management of TLS

A

prevention

21
Q

what should be done if TLS develops despite prevention

A

correction of laboratory and clinical abnormalities

22
Q

how are patients stratified into risk of developing TLS

A

low risk
intermediate risk
high risk

23
Q

which patients are at low risk of developing TLS

A
  • asymptomatic non-hodgkins lymphoma

- low proliferating malignancies

24
Q

how are low risk patients managed

A

regular monitoring of blood biochemistry and fluid balance

25
Q

which patients are at intermediate risk of developing TLS

A
  • diffuse large B cell lymphoma
  • ALL (WBC 50-100)
  • AML (WBC 10-50)
  • CLL (WBC 10-100)
  • CML
  • MM
  • solid tumours with rapid response to therapy
26
Q

how are intermediate risk patients managed

A

2 days prior to cytotoxic therapy patients should receive IV hydration with isotonic NaCl to maintain urinary output of 100mL/hr
-improves intravascalar volume
-enhances renal blood flow
-improves GFR and reduces uric acid, phosphate, and potassium in the blood
give loop diuretics if urine output still unsatisfactory

27
Q

why may allopurinol be given

A

it is a xanthine oxidase inhibitor which prevents the degradation of purine to uric acid

28
Q

which patients are at high risk of developing TLS

A

highly proliferative malignancies

  • burkitts lymphoma
  • lymphoblastic leukaemia
  • ALL (WBC>100)
  • AML (WBC>50)
29
Q

how are high risk patients managed

A

same as intermediate e.g. IV hydration

however give rasburicase instead of allopurinol

30
Q

why is rasburicase used in high risk patients instead of allopurinol

A

rasbicuricase transforms uric acid into allantoin which is far more soluble than uric acid and so is removed by the kidney

31
Q

management for low risk patients

A

regular monitoring and assessment

32
Q

management for intermediate risk patients

A

prechemotherapy IV hydration
regular monitoring and assessment
allopurinol

33
Q

management for high risk patients

A

prechemotherapy IV hydration
regular monitoring and assessment
rasburicase

34
Q

which patients also need an phosphate binder

A

ALL patients

35
Q

complications

A

acute renal failure
cardiac arrythmias
seizures

36
Q

prognosis

A

rasburicase reduces dialysis required in acute renal failure

majority of complications can be managed successfully

Year 5 Cancer (25 decks)

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