Oncologic Emergencies - Procedures, Side effects, Recovery time, Costs and alternatives

A patient suffering from cancer or a patient undergoing treatment for cancer using various ‎therapies may encounter several emergency conditions. These emergency conditions are referred ‎to as oncologic emergencies. The treatment of the oncologic emergencies not only poses problems ‎for the oncologists but also to the doctors involved with emergency medicines. There are several ‎conditions for which a patient suffering from cancer may require emergency medical treatment.

Oncologic emergencies are the conditions that require immediate intervention as it can lead to ‎severe permanent damage or death of a patient. A patient suffering from cancer exhibiting acute ‎emergency must be treated in a similar way as done in normal patients. Initial assessment of the ‎patient must be done quickly with a primary focus on the main complaint or symptom being ‎exhibited by the patient. Vital signs must be taken into consideration along with the medical ‎history of the patient. Based on the assessment a doctor may decide whether the condition of ‎emergency is due to cancer or due to the treatment which is being given to cure cancer. ‎Oncologic emergencies can be classified as ‎

Structural or obstructive emergencies: these emergencies include

• Superior vena cava syndrome: this is a condition wherein a patient suffers from either ‎complete or partial blocking of the blood flowing through the superior vena cava thereby ‎causing increased fall in the venous returns from the upper extremities.‎
• Pericardial tamponade: this is a condition wherein pericardial fluid gets accumulated in the ‎patient leading to instability in hemodynamics.‎
• Spinal cord suppression: this condition occurs when the spinal cord is compressed by ‎extradural metastases from the tumors of the spine.‎
• Increased intracranial pressure: this is a condition which arises when the brain of the patient ‎metastases.‎
• Urinary obstruction: this condition is commonly experienced by patients suffering from the ‎cancer of the prostate or cervical.‎
• Massive hemoptysis: this is a condition wherein a patient suffering cancer coughs up blood.‎ Metabolic emergencies
• Hypercalcemia: this condition occurs in the cancer patient when calcium is abnormally ‎released from the bones.‎
• Improper secretion of antidiuretic hormone: this condition must be suspected if a patient is ‎in hyponatremia. However, this condition occurs due to the production of arginine ‎vasopressin by the cells of the tumor.‎

Treatment-related emergencies

• Tumor Lysis syndrome: this condition arises when a large number of active cancer cells are ‎destroyed due to chemotherapy.‎
• Cystitis hemorrhage: when patients are given prolonged treatment with ifosfamide. ‎
• Reactions to chemotherapy agents: in this condition, the patient usually experiences ‎urticarial and angioedema in the majority of the cases.‎

For dealing with oncologic emergencies the treatment given is solely governed by the emergency ‎condition experienced by the patient.‎

Superior vena cava syndrome: the initial treatment for superior vena cava syndrome involves ‎giving diuretic, corticosteroid and supplemental oxygen. After the reports of histology are ‎available a doctor may advise chemotherapy for relieving the all the symptom of SVCS. If this ‎condition has arisen due to the central venous catheter; the catheter should then be removed and ‎anticoagulants must be given to the patient. Stenting of the superior vena cava can be done for ‎providing relief. ‎

Pericardial Tamponade: for treating this condition the doctor may prescribe tetracycline or ‎bleomycin, to begin with. A pericardial window can also be created for the treatment for the ‎drainage of the pericardial fluid.

Spinal cord suppression: the objective of treatment of this condition involves providing relief ‎from the pain along with maintaining the neurological functions. The standard treatment for this ‎condition is dexamethasone along with radiation therapy. In some cases, a doctor may order ‎surgical decompression of the spine. ‎

Increased intracranial pressure: the emergency treatment of this condition includes giving ‎steroids, mannitol, and hyperventilation. Mannitol is given intravenously while dexamethasone is ‎given by intravenous injection. ‎

Urinary obstruction: for treating this condition ureteral stenting is done by the doctor. If this ‎treatment procedure is not possible then a doctor may order percutaneous nephrostomy. Once the ‎patient gets necessary relief then replacement fluids must be started as the treatment may cause ‎dehydration and electrolyte imbalance.‎

Huge hemoptysis: the emergency treatment procedure requires volume supplementation of the ‎blood followed by cough suppressants and oxygen. If the site of the bleeding is identified then it ‎can be treated through a surgical procedure, phototherapy, and radiotherapy. ‎

Hypercalcemia: the treatment for this condition involves rigorous supplementation of intravenous ‎fluids along with bisphosphonates. ‎

Improper secretion of antidiuretic hormone: for the treatment of this condition a doctor ‎prescribes hypertonic saline solution based on the level of hyponatremia. A doctor may prescribe ‎demeclocycline and tolvaptan. ‎

Tumor Lysis syndrome: the treatment of this condition involves adequate hydration. A doctor ‎may prescribe sodium bicarbonate and rasburicase.

Cystitis hemorrhage: in case a patient is suffering from cystitis hemorrhage then intensive ‎hydration for stimulating the flow of urine may be sufficient. However, if it does not stop there ‎then a doctor may advise formalin solution irrigation for ten minutes.‎ Reaction to chemotherapy agents: the emergency treatment in this condition requires ‎subcutaneous injection of epinephrine. Intravenous fluids should be given and a doctor may add ‎antihistamine in the treatment.‎

A patient is eligible for the treatment of oncologic emergency is decided by the doctor. A doctor ‎may decide the eligibility of the patient for the treatment based on the symptoms exhibited by ‎the patient. If the symptoms exhibit any condition that comes under oncologic emergency then a ‎patient becomes eligible for the treatment.‎

In the majority of the cases a patient suffering from cancer may at point suffer from oncologic ‎emergency due to the development of certain disorder; then the medical history of the patient ‎must be taken into consideration to decide whether a patient is eligible for specific emergency ‎treatment or not. However, patients who are not suffering from cancer are not eligible for the ‎treatment of oncologic emergencies.‎

A treatment involving medicines, injections or surgeries have some side effects associated with it. ‎Treatment may have some major and some minor side effects. The occurrence of the side effects ‎whether minor or major varies from patient to patient. In case a minor side effect is experienced ‎then it has the tendency of disappearing after a short duration. However, for a patient ‎experiencing any major side effect emergency medical attention may be required. The side ‎effects associated with the emergency treatment of superior vena cava syndrome include low ‎sodium level, low potassium level, a headache, infection in case of stenting, allergic reaction and ‎bleeding. The side effects involving emergency treatment of pericardial tamponade are nausea, ‎vomiting, loss of appetite, mouth sores, and a headache. The side effects which are experienced ‎by a patient in the emergency treatment of spinal cord compression include upset stomach, ‎depression, allergic reaction, anxiety, and insomnia. ‎

The side effects of the emergency treatment of increased intracranial pressure are a problem in ‎sleeping, anxiety, acidosis, pulmonary congestion, electrolyte imbalance, and dry mouth.‎ When the emergency treatment for urinary obstruction is given the side effects experienced are a ‎slight risk of urine leakage, pain in bladder, kidney, and groin. In the emergency treatment of ‎massive hemoptysis, the side effects experienced are sleepiness, blurred vision, constipation, and ‎confusion. The side effects concerned with the emergency treatment of hypercalcemia include ‎bone, joint or muscle pain, nausea, acidity, and gastric ulcer. Emergency treatment for SIADH ‎has fever, infection, and rashes as the side effects. The side effects of the emergency treatment ‎of tumor lysis syndrome are dizziness, muscle cramping, vomiting, and changing of mood. If ‎rasburicase is given for treatment the side effects are peripheral edema, anxiety, and sepsis.

The ‎side effects associated with the emergency treatment of cystitis hemorrhage are wheezing, rashes ‎on the skin, and watery eyes. The side effects of the emergency treatment of reaction to ‎chemotherapy agents include difficulty breathing, irregular heartbeat, pale skin, nervousness, and ‎sweating. ‎

The post-treatment guidelines contain what a patient a patient must do after the completion of ‎the treatment for complete recovery. The post-treatment guidelines to be followed after ‎oncologic emergency treatment are

• If antibiotics are prescribed for infection then its complete course must be done.‎
• The medicines related to the oncologic emergency must be taken as advised by the doctor.‎
• The therapies related to the cancer treatment must be continued as advised by the doctor.‎

The complete recovery from the oncologic emergency depends on the condition for which the ‎treatment is given. If the oncologic emergency condition is diagnosed early then it may take only ‎‎1 to 2 weeks to recover. However, in some situations, a patient may take a couple of months for ‎complete recovery.‎

The price of the treatment for oncologic emergencies would depend upon the type of condition ‎the patient is suffering from. Also, the location of the hospital and the experience of the doctor ‎handling the emergency condition are included in the emergency treatment it is approx 500 INR ‎to 75000 INR.‎

The results of the treatment given for oncologic emergencies are more immediate than permanent. ‎However, some patients may take time to recover completely. There is also a chance that a patient ‎undergoing cancer treatment may again suffer from an oncologic emergency in the future.‎

Apart from the emergency treatment for the management of oncologic emergencies a doctor may ‎decide on an alternative method for treatment based on the cause of the occurrence of the ‎emergency condition.‎