Oncologic Emergencies and Complications of Cancer and Treatment
Core concepts
Recognize and act early on febrile neutropenia, tumor lysis syndrome, hypercalcemia, superior vena cava syndrome, spinal cord compression, increased intracranial pressure, sepsis, extravasation, anaphylaxis, and immune-related adverse events. Each has a signature presentation and time course. Febrile neutropenia is a medical emergency requiring prompt cultures and empiric broad-spectrum antibiotics.
Traps in questions
- Fever in neutropenia: do not wait for culture results; antibiotics come first after cultures.
- Tumor lysis: watch potassium, phosphate, uric acid, and creatinine; rising potassium and phosphate with falling calcium signals lysis.
- Spinal cord compression: back pain with new weakness or bowel/bladder change is an emergency - steroids and urgent imaging.
- SVC syndrome: facial swelling, distended neck veins, dyspnea; avoid arm venipuncture on the affected side.
- Extravasation: stop the infusion, aspirate, remove the cannula per protocol, apply antidote and cold or heat as indicated, and document.
Rule of thumb
New neurologic deficit plus cancer equals emergency imaging. Do not attribute new weakness, confusion, or incontinence to fatigue or opioids without ruling out cord compression or hypercalcemia.
Worked example
A patient with lymphoma starting chemotherapy develops oliguria and a potassium of 6.2 mmol/L. This suggests tumor lysis syndrome; the nurse should obtain urgent labs including phosphate, uric acid, calcium, and creatinine, notify the team, and prepare for hydration and rasburicase per protocol.