Oncologic Emergencies - Procedures, Side effects, Recovery time, Costs and alternatives
Last Updated: Jan 20, 2025
What is Oncologic Emergencies ?
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.
How is the treatment done?
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.
Who is eligible for the treatment?(When is the treatment done ?)
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.
Who is not 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.
Are there any Side Effects?
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.
What are the post-treatment guidelines?
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.
How long doesit take to recover?
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.
What is the price of the treatment in India?
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.
Are the results of the treatment permanent?
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.
What are the alternatives to the treatment?
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.
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