Oncological emergencies and acute oncology

Abstract

Recently the specialty of acute oncology with a clinical service to support patients and coordinate the care of those presenting with oncological emergencies has been developed. Patients who present with oncological emergencies often have a unique set of clinical problems, many of them iatrogenic, and can benefit from specialist advice from teams who are expert in the management of such conditions. Cancer treatments are developing and diversifying from standard cytotoxic chemotherapeutic drugs to targeted agents and immunological therapies. These introduce new toxicities such as dermatological problems, hypertension, and autoimmune phenomena. The management of the problem will vary depending on the underlying process and specific advice related to the causative agent will be required. This chapter covers oncological emergencies and acute oncology. Topics include tumour lysis syndrome; hypercalcaemia; hyponatraemia; hyperkalaemia; hypoglycaemia; hyperericaemia; febrile neutropenia; catheter associated infections; nausea, vomiting and diarrhoea; vascular complications; stridor and airway obstruction; superior vena cava obstruction; gastrointestinal obstruction; urinary tract obstruction; thrombocytopenia and disseminated intravascular coagulation; gastrointestinal bleeding; genitourinary bleeding; cardiorespiratory; cardiac tamponade; pleural effusion; brain metastases and raised intracranial pressure; spinal cord compression; impending and pathological fractures; and immune-related emergencies.