Introduction

An oncological emergency is an acute medical problem related to cancer or its treatment, which may result in serious morbidity or mortality if not treated quickly. It may be secondary to a structural/obstructive, metabolic or treatment-related complication (Cervantes and Chirivella, 2004). The emergency may be the first manifestation of malignant disease, particularly for superior vena cava obstruction (SVCO) and malignant spinal cord compression (MSCC).

Spinal cord compression is the commonest neurological complication of cancer, occurring in approximately 5% of all cancer patients. Around 10% of advanced solid tumours give rise to malignant hypercalcaemia.

Types of emergency

Metabolic emergencies include the following:

• Hypercalcaemia.

• Syndrome of inappropriate antidiuretic hormone (SIADH).

Structural/obstructive emergencies include

• MSCC and cauda equina compression.

• SVCO.

• Raised intracranial pressure.

• Acute airway obstruction.

• Bleeding.

• Urinary obstruction.

• Cardiac tamponade.

• Pain: this has been named the ‘fifth vital sign’ following pulse, blood pressure, temperature and respiration; when pain is present it should evoke an immediate response. Treatment of pain is considered in Chapter 7.

Treatment-related emergencies include

• Neutropenic fever/sepsis.

• Anaphylaxis related to a chemotherapeutic agent.

• Tumour lysis syndrome.

• Extravasation of a chemotherapeutic agent.

Treatment overview

As with any acute medical emergency, resuscitation measures may be needed to ensure that airway, breathing, and circulation are maintained. Adequate hydration, oxygen, and monitoring of fluid balance are important in patients with sepsis or tumour lysis syndrome. Steroids are used in patients with SVCO and suspected spinal cord compression, although the evidence base supporting their use is poor. Mannitol infusions may be needed for severe symptomatic raised intracranial pressure that does not respond to steroids.