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Oncologic emergencies

McCurdy, Michael T. MD; Shanholtz, Carl B. MD

doi: 10.1097/CCM.0b013e31824e1865
Concise Definitive Review

Objectives: To provide an up-to-date review of current literature on the pathophysiology, diagnosis, and management of five key malignancy-related complications: superior vena cava syndrome, malignant pericardial effusion, malignant spinal cord compression, hypercalcemia, and acute tumor lysis syndrome.

Data Sources: Database searches and review of relevant medical literature.

Data Synthesis: Malignancy-related complications demand increased attention from intensivists due to their frequency and increasing cancer prevalence. Although such complications portend a poor prognosis, proper acute management can improve short-term outcomes by facilitating either definitive care of the underlying malignancy or the institution of appropriate palliative measures.

Conclusions: Knowledge of malignancy-induced complications in critically ill patients expedites the ability of the intensivist to properly manage them. Five complications commonly requiring emergency management are addressed in this review. Specifically, superior vena cava syndrome may warrant radiation, chemotherapy, vascular stenting, or surgical resection. Malignant pericardial effusion may require emergency pericardiocentesis if cardiac tamponade develops. Malignant spinal cord compression demands immediate spinal imaging, glucocorticoids, and either surgery or radiation. Hypercalcemia requires aggressive intravenous hydration and a bisphosphonate. Acute tumor lysis syndrome necessitates intravenous hydration, rasburicase, and management of associated electrolyte abnormalities.

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine (MTM, CBS) and Department of Emergency Medicine (MTM), The University of Maryland School of Medicine, Baltimore, MD

Dr. Shanholtz consulted for Sanofi-Synthelabo (rasburicase) and received honoraria/speaking fees from Sanofi-Synthelabo (rasburicase). Dr. McCurdy has not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: cshanhol@medicine.umaryland.edu

© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins