by Kimberly Allen, RN
Tumor lysis syndrome is an assortment of metabolic disturbances that can develop after receiving treatment for cancer. They are brought on by the destruction of cancer cells. When cancer cells are destroyed the contents of those cells is then release into the bloodstream causing significant increases in the amounts of potassium, phosphates and uric acid circulating through the body. This can lead to numerous problems including acute renal failure and acute uric acid neuropathy as well as hyperkalemia, hyperphosphatemia, and hyperuricosuria, which is excessive uric acid in your urine, you can also develop secondary hypocalcemia or low calcium. When there are high levels of both phosphate and uric acid the injury to the kidneys tends to be severe leading to acute renal failure. While high levels of potassium can cause cardiac arrhythmia’s which can lead to acute cardiac arrest.
The frequency of tumor lysis syndrome is not known because it’s prevalence varies depending on the type of cancer involved. However, with the prevalence of multiple cancers on the rise in the US the incidence of tumor lysis syndrome is also expected to rise. the types of cancer most commonly associated with tumor lysis syndrome are the acute leukemia’s, acute lymphoblastic leukemia, and acute myeloid leukemia, poorly differentiated lymphomas non-Hodgkin’s lymphomas like Burkitt’s lymphoma. Tumor lysis syndrome has also been know to develop with certain cancers affecting the blood like hepatoblastoma and stage IV neuroblastoma though it is much less common. Tumor lysis is usually triggered by a combination of treatments including chemotherapy and radiation therapy, however, it can also be triggered by steroid treatment or even without any treatment, which is referred to as “spontaneous lysis syndrome.” the most common chemotherapeutic agents known to cause tumor lysis syndrome include Etopside, Hydroxyurea, Fludarabine, Paclitaxel, and Thalidomide as well as zolechronic acid.
The symptoms of tumor lysis syndrome are related to the complications it causes. For example, with hyperkalemia the symptoms would include cardiac dysrrythmias and palpitations as well as severe muscle weakness and cramping and a general feeling of malaise. With hypocalcemia you may experience seizures, involuntary muscle contractions as well as parkinsonian type symptoms, some also experience decreased mental capacity issues including emotional liability.
Tumor lysis syndrome is considered an oncologoic emergency requiring immediate intervention. Tumor lysis syndrome should be suspected when any patient with a history of cancer and cancer of treatment present with symptoms of acute renal failure. The main goals of managing tumor lysis syndrome are to identify high risk patients and initiate preventative measures as well as early detection and recognition of both metabolic and renal complications and initiating supportive care including hemodialysis if necessary. This would also include aggressive hydration with intravenous fluids administered at twice the maintenance rate as well as administering medications like Kayexalate to reduce potassium levels.
The best way to prevent tumor lysis syndrome is to administer prophylactic oral or intravenous allopurinol to patients with cancers that have a high cell turn over rate like leukemia’s and lymphomas. It’s also important to maintain adequate hydration in order to promote a high urine output. For patients with a very high risk of developing tumor lysis syndrome some doctors will use Uricase instead of allopurinol because it’s a synthetic urate oxidase enzyme that degrades uric acid.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.