1. Oncological emergencies refer to urgent clinical situations in cancer patients caused by cancer or its treatment. 2. Some examples discussed are hypercalcemia, tumor lysis syndrome, lactic acidosis, hypoglycemia, syndrome of inappropriate antidiuretic hormone secretion, superior vena cava syndrome, spinal cord compression, severe cystitis, bladder hemorrhage, disseminated intravascular coagulation, and cardiac tamponade. 3. The document provides details on symptoms, signs, and treatment approaches for each of these conditions.

1. ONCOLOGICAL EMERGENCIES
SWATILEKHA DAS, RN
B.Sc (H)Nursing, M.Sc
(MSN)
ASST. PROFESSOR

2. ONCOLOGICAL EMERGENCIES
The patients with cancer may develop an
emergent clinical situation due to the Cancer
per se or as a complication of therapy.

3. HYPERCALCAEMIA
• Hypercalcaemia, also spelled hypercalcemia,
is a high calcium (Ca2+) level in the blood
serum. The normal range is 2.1–2.6 mmol/L
(8.8–10.7 mg/dL, 4.3–5.2 mEq/L), with levels
greater than 2.6 mmol/L defined as
hypercalcemia. Those with a mild increase
that has developed slowly typically have no
symptoms

4. SYMPTOMS & SIGNS
• Fatigue
• Lethargy
• Polyuria
• Constipation
• Stupor
• Coma
• Renal failure
• Cardiac arrhythmia

6. TREATMENT
• Calcitonin (Miacalcin).
• Calcimimetics.
• Bisphosphonates. ...
• Denosumab (Prolia, Xgeva). ...
• Prednisone
• IV fluids and diuretics.

7. TUMOR LYSIS SYNDROME
Tumor lysis syndrome is a group of metabolic
abnormalities that can occur as a complication
during the treatment of cancer, where large
amounts of tumor cells are killed off (lysed) at
the same time by the treatment, releasing
their contents into the bloodstream.

9. SYMPTOMS & SIGNS
• Hyperuricaemia & hyperphosphatemia
produce nausea, vomiting & acute renal
failure
• Hypercalcaemia causes muscle cramps,
cardiac arrhythmia & tetany.
• Hyperkalaemia results in cardiac arrhythmia &
flaccid paralysis.

10. TREATMENT
• IV Fluid, normal or half normal saline around
3000ml per day.
• Correction of electrolytes and acid-base
abnormality & IV sodium bicarbonate to
maintain an alkaline urine pH.
• Oral allopurinol is given 300-600mg in divided
doses.

11. • Monitoring serum uric acid, serum creatitine,
serum electrolytes and electrocardiogram
after every few hours.
• IV calcium gluconate is given for
hypocalcaemia.

12. LACTIC ACIDOSIS
Lactic acidosis is a medical condition
characterized by the buildup
of lactate (especially L-lactate) in the body,
with formation of an excessively low pH in the
bloodstream. It is a form of
metabolic acidosis, in which
excessive acid accumulates due to a problem
with the body's oxidative metabolism.

14. SYMPTOMS & SIGNS
• Hyperventilation
• Severe weakness
• Hypotension
• Stupor
• Shock

15. TREATMENT
• The treatment consists of administering
sodium bicarbonate and monitoring of pH.

16. HYPOGLYCAEMIA
Hypoglycaemia, sometimes called a hypo or
low, is a condition that occurs when a person's
blood glucose level (BGL) has dropped too
low, below 4mmol/L. It is important to treat a
hypo quickly to stop the BGL from falling even
lower and the person becoming seriously
unwell.

17. SYMPTOMS & SIGNS
• Weakness
• Excessive swaeting
• Seizures
• Coma

19. TREATMENT
• Administration of IV hypertonic glucose ,
corticosteroids and glucagon.

20. SYNDROME OF INAPPROPRIATE SECRETION OF
ANTIDIURETIC HORMONE(SIADH)
Syndrome of inappropriate antidiuretic
hormone secretion (SIADH) is a condition in
which the body makes too much antidiuretic
hormone (ADH). This hormone helps the
kidneys control the amount of water your
body loses through the urine. SIADH causes
the body to retain too much water.

22. SYMPTOMS & SIGNS
• Lethargy
• Irritability
• Nausea/anorexia
• Confusion
• Muscle weakness
• Cardiac arrhythmia
• Convulsion
• Death

23. TREATMENT
• It is treated by fluid restriction(500-1000ml/day).
• If water restriction is not effective then
demeclocycline is prescribed to interfere with
antidiuetic effect of ADH.
• Lithium can be used as an alternate therapy.
• Patient improves within 7-10 days with
normalisation of sodium.
• An IV infusion of hypertonic saline is given in
severe cases to prevent pulmonary edema
• After the control of SIADH the cancer is treated.

24. SUPERIOR VENA CAVA SYNDROME
Superior vena cava syndrome (SVCS)
is obstruction of blood flow through
the superior vena cava (SVC). It is a medical
emergency and most often manifests in
patients with a malignant disease process
within the thorax.

25. SUPERIOR VENA CAVA SYNDROME

26. SYMPTOMS & SIGNS
• Swelling of face & neck
• Dry cough
• Dyspnea
• Hoarseness of voice
• Nasal congestion
• Headache
• Cyanosis
• Confusion
• Stupor

28. TREATMENT
• Local radiotherapy
• Chemotherapy
• Percutaneous transluminal ballon angioplasty
& insertion of stents

29. SPINAL CORD COMPRESSION
• Spinal cord compression occurs when a mass
places pressure on the cord. A mass can
include a tumor or bone
fragment. Compression can develop
anywhere along the spinal cord from the neck
to the lower spine.

31. SYMPTOMS & SIGNS
• Localised pain & tenderness in back
• Loss of bladder & bowel control
• Painful movements of the spine
• Sensory & motor deficits

32. TREATMENT
• Administration of high dose of
dexamethasone / methylprednisolone
• Local radiation therapy
• Chemotherapy
• Surgical intervention

33. SEVERE CYSTITIS & BLADDER
HAEMORRHAGE
• Cystitis is a sudden inflammation of the urinary
bladder. Most of the time, a bacterial infection causes
it. This infection is commonly referred to as a urinary
tract infection (UTI). Irritating hygiene products, a
complication of certain diseases, or a reaction to
certain drugs can also cause acute cystitis.
• Hemorrhagic cystitis is the sudden onset of hematuria
combined with bladder pain and
irritative bladder symptoms. Hematuria is blood in the
urine. The amount of blood can range from a minute
amount that occurs occasionally to frank bright red
blood that occurs continuously. There are a variety of
causes of hematuria.

34. SYMPTOMS & SIGNS
• Incontinence & hematuria
• Sometimes hematuria can be severe .

35. TREATMENT
• Administration of urinary anagesics, such as
phenazopyridine hydrochloride &
antispasmodics
• In patients with severe hemorrhage packed
red blood cell transfusion is required.
• Irrigation with bladder with Formalin (0.37%)
solution may stop bleeding in many cases.

36. DISSEMINATED INTRAVASCULAR
COAGULATION
Disseminated intravascular coagulation (DIC) is
a condition in which blood clots form
throughout the body, blocking small blood
vessels.

37. SYMPTOMS & SIGNS
• Bleeding, from many sites in the body.
• Blood clots.
• Bruising.
• Drop in blood pressure.
• Shortness of breath.
• Confusion, memory loss or change of
behavior.
• Fever.

38. TREATMENT
• Treatment includes correction of the cause
and replacement of platelets, coagulation
factors (in fresh frozen plasma), and
fibrinogen (in cryoprecipitate) to control
severe bleeding. Heparin is used
as therapy (or prophylaxis) in patients with
slowly evolving DIC who have (or are at risk of)
venous thromboembolism.

39. CARDIAC TEMPONADE
Cardiac tamponade is a clinical syndrome
caused by the accumulation of fluid in
the pericardial space, resulting in reduced
ventricular filling and subsequent
hemodynamic compromise. The condition is a
medical emergency, the complications of
which include pulmonary edema, shock, and
death.

41. SYMPTOMS & SIGNS
• Anxiety and restlessness.
• low blood pressure.
• weakness.
• chest pain radiating to your neck, shoulders, or
back.
• trouble breathing or taking deep breaths.
• rapid breathing.
• discomfort that's relieved by sitting or leaning
forward.
• fainting, dizziness, and loss of consciousness.

42. TREATMENT
• The treatment for cardiac
tamponade involves draining the excess fluid
from the pericardium, stabilizing blood
pressure, and treating the underlying cause.