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  • Oncologic emergencies can result from either the cancer or its treatment. This chapter discusses some selected emergencies.

  • Nervous system emergencies include spinal cord compression, increased intracranial pressure, leptomeningeal disease, seizures, and altered mental status.

  • Superior vena cava (SVC) syndrome, hyperviscosity syndrome, hyperleukocytosis, venous thromboembolism, hemorrhage, and disseminated intravascular coagulopathy are the vascular and hematologic emergencies discussed.

  • Urologic emergencies such as hemorrhagic cystitis and obstructive uropathy are discussed.

  • Pulmonary problems such as airway obstruction, massive hemoptysis, toxic lung injuries, pneumonitis, and pulmonary fibrosis can be caused by cancer or cancer treatments.

  • Several classic metabolic oncologic emergencies include syndrome of inappropriate antidiuretic hormone secretion, tumor lysis syndrome, and hypercalcemia of malignancy.

  • Gastrointestinal bleeding in patients with cancer and typhlitis in patients with neutropenic fever are potentially serious complications.

  • Immune checkpoint inhibitors may cause immune-related adverse effects (irAEs) in practically any organ system. Urgent skin irAEs include grade 3 and 4 inflammatory dermatitis or rash, bullous dermatosis, drug reaction with eosinophilia and systemic symptoms, and Stevens-Johnson syndrome or toxic epidermal necrolysis. Gastrointestinal irAEs are common. The main pulmonary irAE is pneumonitis. Endocrine irAEs affect the thyroid, adrenal, and pituitary glands as well as the pancreatic islets (type 1 diabetes), which may be associated with acute diabetic ketoacidosis. Myocarditis is rare but may be life threatening. Pneumonitis may be associated with poor overall survival.


Oncologic emergencies can result from either the cancer or its treatment. Patients with cancer often have immunologic, metabolic, and hematologic defects, which can lead to complex emergency conditions when they present to an emergency or urgent care center. In addition, emergencies resulting from comorbid conditions also occur in patients with cancer. It is important for practitioners who treat patients with cancer to be aware of the various oncologic emergencies so they can be recognized and treated promptly. This chapter discusses some selected emergencies, including their signs and symptoms, causes, and management.


Spinal Cord Compression

Spinal cord compression is a serious complication of cancer, affecting about 2.5% of patients with cancer overall.1 It is not immediately life threatening unless it involves the first three cervical vertebrae, but compression of the spinal cord at lower levels of the spine leads to significant morbidity. The spinal cord is compressed by the cervical vertebrae in 10%, thoracic vertebrae in 70%, and lumbar vertebrae in 20% of patients. In 10% to 38% of cases, spinal cord compression occurs at multiple levels.2 Compression is predominantly caused by metastatic tumors, with lung, breast, and prostate cancer accounting for 50% of cases. Other tumors that commonly metastasize to the spine are multiple myeloma, renal cell carcinoma, melanoma, lymphoma, sarcoma, and gastrointestinal (GI) cancers. The mechanisms by which tumors can appear in the spine are hematogenous spread of tumor cells to the vertebral bodies, metastasis to the posterior spinal elements, epidural metastasis, and direct extension of paraspinal tumors. ...

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