Cancer Emergencies: TLS, SVC, Hypercalcemia

• TLS: high-risk patients get fluids plus rasburicase (check G6PD!); manage hyperkalemia; refractory K⁺/PO₄/overload triggers dialysis.
• Febrile neutropenia: antipseudomonal coverage within 1 h; reserve vancomycin for specific indications.
• SVC syndrome: head elevation, steroids, stenting/biopsy; don't biopsy blindly through the compression.
• Other crises include hyperleukocytosis (leukostasis → leukapheresis), hypercalcemia of malignancy, and cord compression (steroids + MRI + XRT).

Hypercalcemia

First tests: Ionized calcium, Sodium, potassium, bicarbonate, urea and creatinine, Phosphate, 12-lead ECG, PTH.

Only if indicated: Etiology-directed tests.

Repeat monitoring: Ionized calcium.

Tumour lysis syndrome

First tests: Potassium, phosphate, calcium, uric acid and creatinine, LDH, 12-lead ECG.

Only if indicated: G6PD activity.

Repeat monitoring: Potassium, phosphate, calcium, uric acid and creatinine, Uric acid sample handling.

Superior vena cava obstruction

First tests: Contrast CT chest / venography, Full blood count.

Only if indicated: Tissue diagnosis, Venous ultrasound.

Hyperleukocytosis / suspected leukostasis

First tests: Full blood count, Peripheral blood film, Sodium, potassium, bicarbonate, urea and creatinine, Uric acid, phosphate, calcium and LDH, PT/INR, aPTT and fibrinogen.

Only if indicated: Flow cytometry and leukemia genetic testing, Noncontrast CT head, Chest X-ray.

Repeat monitoring: Sodium, potassium, bicarbonate, urea and creatinine.

• Evaluating and Managing Suspected Malignant Spinal Cord Compression
• Preventing and Managing Tumor Lysis Syndrome (TLS) in High-Risk Patients
• Evaluating and Managing Suspected or Confirmed Superior Vena Cava (SVC) Syndrome
• Evaluating and Managing Hyperleukocytosis