Tumour lysis syndrome and oncologic emergencies: Viva

This is a branching oral built to probe the reasoning that holds the prevention of the tumour lysis at the centre, and to expose the candidate who has memorised the headline without the corners. The questions escalate from the risk assessment to the prophylaxis, the recognition, the management, and the structural emergencies, with the deliberate probes into the pitfalls. [1]

Opening question: the risk and the prophylaxis

The examiner opens with the Burkitt lymphoma and asks how you assess his tumour lysis risk and what prophylaxis you put in place before the first dose. [3]

A strong answer names the Burkitt lymphoma as the very highest-risk tumour, with its rapid doubling time of around twenty-four hours and its large mass, and the high lactate dehydrogenase confirming the high burden. The prophylaxis is the hyperhydration with an isotonic potassium-free fluid at two to three litres per square metre per day to keep the urine output above two millilitres per kilogram per hour, the rasburicase at zero point one five to zero point two milligrams per kilogram, and the four-to-six-hourly biochemistry for the first twenty-four to forty-eight hours. [1]

Model answer. This boy is at the very top of the tumour lysis risk because the Burkitt lymphoma has the highest cell turnover of any childhood tumour. I would start the hyperhydration with an isotonic potassium-free fluid, give the rasburicase at zero point one five to zero point two milligrams per kilogram after checking the glucose-six-phosphate-dehydrogenase status, and monitor the biochemistry every four to six hours, with the renal replacement therapy on standby. [1][4]