Oncologic Emergencies

The answer first

An oncologic emergency is any acute, potentially reversible event in a cancer patient that threatens life or a critical function and for which timely intervention changes the outcome. The unifying rule is door-to-treatment time: the first dose of antibiotic in febrile neutropenia within one hour, the dexamethasone dose the moment cord compression is suspected, the plasmapheresis session for hyperviscosity, the pericardiocentesis for tamponade. These are not conditions to "review on the ward round" — they are conditions to act on now. ^[1]

Ten emergencies dominate the examinable and the clinical landscape. In approximate order of frequency and urgency for a general physician: ^[1]

1. Febrile neutropenia — empiric piperacillin-tazobactam within one hour, risk-stratify with the MASCC score ^[2][1].
2. Tumour lysis syndrome — laboratory versus clinical TLS; hydration plus rasburicase for high risk, allopurinol for intermediate risk; alkalinisation is not recommended ^[3][4].
3. Malignant spinal cord compression — dexamethasone 16 mg, MRI whole spine, surgery or radiotherapy ^[5][6][7].
4. Superior vena cava obstruction — stent for severe, treat the underlying cancer ^[10].
5. Hypercalcaemia of malignancy — fluids, then zoledronic acid, then denosumab if refractory ^[8][9].
6. Hyperviscosity syndrome — urgent plasmapheresis.
7. SIADH from small cell lung cancer — fluid restriction.
8. Neoplastic cardiac tamponade — emergency pericardiocentesis.
9. Leukostasis — leukapheresis and hydroxyurea for urgent cytoreduction.
10. Immune-related adverse events from checkpoint inhibitors — corticosteroids and drug cessation.

The clinical skill is recognition. A febrile patient on chemotherapy is neutropenic until proven otherwise. New back pain with a neurological sign in a cancer patient is cord compression until proven otherwise. A confused cancer patient is hypercalcaemic until proven otherwise. Treat the immediately life-threatening problem first, then treat the underlying cancer as the unifying solution. ^[1]

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References25ShowHide

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