Oncological emergencies can occur in cancer patients from the malignancy or its treatment. They are classified as metabolic, structural, neurological, cardiovascular, hematological or infectious. Some examples include hypercalcemia, tumor lysis syndrome, spinal cord compression, and disseminated intravascular coagulation. Nursing management focuses on monitoring for signs and symptoms, managing complications, educating patients and families, and treating the underlying causes of the emergency.

1. ONCOLOGICAL EMERGENCIES
Mrs. Ritoo Rana ,
M. Sc. Nursing ,
College of Nursing
K.G.M.U., Lucknow
August 25, 2023

2. Oncological Emergencies
Any acute possible morbid or life threading events in
patients with cancer either because of the malignancy
or because of their treatment. These events may occur
at any time during malignancy, from symptoms present
to end stage of office.

3. Classification
Major Classification
 Metabolic
 Structural
Sub Classification
 Metabolic
 Neurologic
 Cardiovascular
 Hematologic
 Infections

4. CLASSIFICATIONS ONCOLOGICAL EMERGENCIES
Metabolic 1. Hypercalcemia
2. Tumor Lysis Syndrome
3. SIADH (Syndrome of inappropriate antidiuretics syndrome)
Neurological 1. Spinal Cord Compression
2. Brain Metastases / increases ICP
Cardiovascular 1. Malignant Pericardial Effusion
2. Superior Vena Cava Syndrome
Hematologic 1. Hyperviscosity due to Dysproteinemia
2. Hyperleukocytosis
3. DIC ( disseminated intravascular coagulation)
Infections 1. Neutropenic fever
2. Septic Shock

5. HYPERCALCEMIA Clinical Feature Treatment
Hypercalcemia is a
potential life
threating metabolic
activity. Resulting
when calcium release
from the bones is
more than the kidney
can excretes or the
bone can absorb.
Serum calcium level
exceeding - 11mg/dl
Fatigue and weakness,
confusion, decrease
level of responsiveness,
nausea and vomiting,
constipation, polyuria
and polydipsia,
dehydration ,
dysrhythmias
Sodium Chloride -0.9 %
IV
Furosemia (Lasix)
Calcitonin
Corticosteroids

6. Nursing Management of Hyperglycemia
•Identify patient at risk or hyperglycemia an assess for sign and symptoms of
hyperglycemia.
•Educate patient and family, prevention and family detection can prevent fatality.
•Teach at risk patients to recognize and report sign and symptoms of hyperglycemia.
•Encourage patient to consume 2 to 3 liter of fluid daily unless clinical investigation while
existing renal or cardiac disease.
•Colonic investigation such as stool softness and laxatives for constipation.
•Advice patients to maintain nutritional intake without restricting normal calcium intake.
•Discuss anti-emetic therapy if nausea and vomiting occur.
•Promote mobility by emphasizing is important in in preventing mineralization and
breakdown of bones.

7. TUMOR LYSIS SYNDROME Clinical Feature Treatment
Tumor Lysis Syndrome is a
potentially fatal metabolic
emergencies that can develop as a
tumor respond to treatment.
Electrolyte imbalance and acute
renal failure usually began 1 to 2
days after treatment start and
within a week following the
completion the therapy.
*Hyperuricemia &
hyperphosphatemia
produce nausea &
acute renal failure.
*Hypercalcemia causes
muscle cramps, cardiac
arrhythmia & tetany.
*Hyperkalemia results
in cardiac arrhythmia &
flaccid paralysis.
*Hyperphosphatemia
cause arrhythmia and
ARF.
*IV fluid, normal or half
normal saline around
3000ml per day.
*Oral Allopurinol is
given 300-600 mg in
divided doses.
*Correction of
electrolyte and acid
base abnormality & IV
sodium bicarbonate to
maintain an alkaline
urine pH.
*IV calcium gluconate is
given for hypocalcemia.

8. Pathophysiology of Tumor Lysis Syndrome

9. Syndrome of
inappropriate antidiuretic
hormone (SIADH)
Clinical feature Treatment
Excess amount of an ADH
secreted from posterior
pituitary and other entopic
sources
*Related to degree of
hyponatremia, confusion
lethargy, irritability, coma,
seizures.
*Gastrointestinal,
decreased motility with
anorexia, nausea,
vomiting, abrupt weight
gain with edema 5 to 10
percent
*Hypertonic IV fluid to
correct hyponatremia
sodium restriction.
*Diuretics to corrects
low plasma osmolality.
*Demeclocycline to
facilitate free water clear
treat underlying causes.

10. Nursing Management
• Know which client on risk.
• Monitor appropriate urine and serum laboratory test.
• Assess for manifestation of hyponatremia by evaluations
neurological status.
• Observe for changes in concurrent disorder.
• Administer demeclocycline as ordered to interfere with
action monitor possible nephrotoxicity.
• Monitor for hyponatremia with fluid over correction.
• Client and family teaching.

11. SPINAL CORD
COMPRESSION
Clinical feature Treatment
Spinal cord compression is a
form of Myelopathy in which the
spinal cord is compressed.
•Pain and stiffness in the neck,
back or lower back.
• Numbness, cramping or
weakness in the arms, hands, or
legs.
• Loss of the sensation in the
feet.
• Trouble with hand
coordination.
• Loss of sexual ability.
• Urinary and fecal incontinence
or urinary retention
• Lhermitte’s sign (intermittent
shooting electrical sensation) &
hyperreflexia.
 Nonstriodal anti-inflammatory
drugs (NSAIDs) that relieve pain
& swelling.
 Physical therapy may include
exercises to strengthen your
bank, abdomen and leg muscles.
 Surgical treatment include
removing bone spurs & widening
the space between vertebrae.
Other procedures may be done
to relieve pressure on the spine
or repair fractured spine.

12. Nursing Management
On going assessment neurological function to identify existing &
progressing the dysfunction.
Control pain with pharmalogic and non- pharmalogical measures.
Prevent immobility resulting from pain and decrease function.
Prevent immobility resulting from pain & decrease function.
Maintain muscle tone by assisting ROM exercise in collaboration with
physical & occupational therapies.
Intermittent cauterization & bowel training program for patient with
bladder or bowel dysfunction
Provide encouragement & support patient & family coping with pain
& altered functioning, lifestyle, roles & independence.

13. Superior Vena cava
syndrome
Clinical feature Treatment
Compression or invasion of the
SVC syndrome by
tumour/enlarge lymph nodes,
intraluminal thrombus that
obstructs venous circulation or
drainage of head, neck, arms,
thoraces.
• Progressive shortness of
breath, cough and facial
swelling.
• Oedema of neck, arms &
hands, & thoracic & repeated
sensation of skin tightness &
difficult in swelling.
• Dilated thoracic vessels causing
terminal venous pattern on the
chest wall.
• Increase intracranial pressure,
associated visual disturbance ,
headache, altered mental status.
Possibly engorged & distended
jugular, temporal & veins.
• Radiation therapy to shrink
tumour size and relieve
symptoms.
• Chemotherapy for radiation
resistance tumour.
• Anticoagulant or thrombolytic
therapy for intraluminal
thrombosis.
•Surgery to redirect blood flow
around the obstruction.
•Supportive measures such as
Oxygen therapy , corticosteroids
and diuretics

14. Superior Vena Cava Syndrome

15. Nursing Management
Identify patient at risk of SVC.
Monitor and report clinical management of SVC.
Monitor cardiopulmonary and neurological status.
Facilitate breathing by positioning the patient.
Promote energy conservation.
Monitor client fluid volume status and administer fluids cautiously to
minimize oedema.
Assess the thoracic radiation related problem such as dysphasia,
esophagitis.

16. Disseminated Intravascular
Coagulation (DIC)
Clinical Feature Treatment
It is a complex syndrome of activated
coagulation that result in bleeding
and thrombosis, it is basically a loss
of balance between the clotting and
lysing system in the body caused by
the simultaneous pressure of
thrombin and plasma.
 Purpura, petechia & ecchymosed
on the skin , mucus membranes ,
heart lining and lungs.
 Prolonged bleeding from
venipuncture.
 Severe uncontrolled haemorrhage
during surgery as childbirth.
 Excessive bleeding from gums and
nose.
 Intracerebral and age bleeding.
 Renal hematuria.
Tachycardia & hypotension.
 Dyspnea, haemoptysis and
respiratory thrombosis include
oliguria and acute renal failure
pulmonary emboli & respiratory
distress, delirium & ischemia of the
peripheral tissue with risk of the
gangrene.
Treatment underlying therapy
 Replacement therapy (transfusion
of RBC or Plasma)
 Anti-coagulant medication (Heparin
therapy)
 Other treatment.

17. Nursing Management
• Integumentary bleeding or oozing of blood from vein puncture sites
or mucosal surface and wounds pallor, petechia ecchymosed &
hematoma.
• Respiratory tachypanea, haemoptysis, orthopnea & basilar riles.
• Cardiovascular tachycardia and hypotension.
• GI abdominal distension and guaiacum positive stools or gastric
contents.
• Genitourinary Hematuria & oliguria.
• Neurological vision changes, dizziness, headache changes in mental
status & irritability.

18. Thank
You