Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency characterized by metabolic abnormalities that can occur during rapid tumor breakdown in response to anti-cancer treatment.
It has, however, been studied in high-grade non-Hodgkin's lymphomas (NHL). Let's review these abnormalities and why they happen.Hyperuricemia (elevated uric acid) is the most common complication of TLS, and is caused by the release and breakdown of nucleic acids into uric acid. Of note, malignant cells contain about four times as much phosphorus as a normal cell. PMC1838823. Intravenous fluids can help the kidneys to flush out toxins in the urine. "bulky disease". Uric acid is cleared by the kidneys, but large amounts can lead to crystal precipitation in the distal tubules, resulting in decreased renal function. TLS is most frequently seen in acute lymphocytic leukemia and high-grade NHLs, but many other hematologic and solid tumors have been associated with this complication (see Table 1)Characteristics that put a patient at risk for TLS are: tumor with a high proliferative rate (rapid division and growth); tumor with a high sensitivity to chemotherapy; and tumor of large size, i.e. This drug can cause anaphylactic reaction and nurses should have appropriate medications (diphenhydramine and epinephrine) at the bedside. Precipitation of uric acid crystals results in declining glomerular filtration, and ultimately, acute renal failure. Patients must also be observed for fluid overload, which is accomplished by monitoring weight, output, vital signs and respiratory status. sign up for alerts, and moreto access your subscriptions, sign up for alerts, and moreto access your subscriptions, sign up for alerts, and moreto download free article PDFs, sign up for alerts, customize your interests, and moreto make a comment, download free article PDFs, sign up for alerts and more Nurses should monitor laboratory values and avoid using nephrotoxic medications (aminoglycoside antibiotics, NSAIDs). McCurdy MT, Shanholtz CB. How Does TLS Affect the Body? Most often, TLS is associated with the administration of induction chemotherapy, but it has been reported to occur with radiation therapy, corticosteroids, hormonal agents, biologics, monoclonal antibodies, intrathecal chemotherapy and chemo-embolization. The patient should be encouraged to maintain adequate fluid intake and be aware of the need for accurate input and output monitoring. All Rights Reserved.to download free article PDFs,
Decreased kidney function and elevated lactate dehydrogenase (LDH) at baseline also increases risk. Symptoms of hyperuricemia include: nausea, vomiting, diarrhea, and anorexia. This is a potentially reversible situation when treated promptly.Nursing interventions should include monitoring of urine output and alkalinization, when sodium bicarbonate is used. TLS is not limited to patients receiving traditional chemotherapy; it can also occur in patients receiving steroids, hormonal therapy, targeted therapy, or radiation therapy. Tumor lysis syndrome (TLS) is a condition that occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood. This includes patients whose tumors have a high proliferative rate, a high sensitivity to therapy, large or bulky tumor mass, preexisting renal insufficiency, dehydration, or elevated LDH or uric acid levels at baseline.
Clinical trials found that uric acid levels decreased 85% with rasburicase, as compared with 12% with allopurinol, within 4 hours of starting the medications. When he received low-dose vincristine therapy daily with high-dose prednisone therapy given on alternate days, a fatal tumor lysis syndrome occurred. Phosphorous is also cleared by the kidneys, which quickly become overwhelmed and unable to maintain normal levels. It can occur spontaneously or after chemotherapy or radiotherapy. Discover information about different types of cancerLearn about cancer, diagnosis, treatment, coping & survivorshipFind resources & tools for oncology healthcare professionalsTumor lysis syndrome (TLS) is a life-threatening oncologic emergency characterized by metabolic abnormalities that can occur during rapid tumor breakdown in response to anti-cancer treatment. Patients who are dehydrated and those with existing kidney dysfunction are at higher risk of developing TLS.What Are the Symptoms of TLS, and How Is It Diagnosed?Symptoms are generally nonspecific and can include:Kidney failure and death can occur, especially if TLS is left untreated.TLS is diagnosed based on blood tests, along with signs and symptoms.
There is a very high risk of tumour lysis syndrome and so close monitoring of electrolytes and prophylaxis with allopurinol or … Patients may demonstrate one, several, or all of these metabolic abnormalities. TLS may even occur spontaneously, before the initiation of therapy.TLS is caused by the rapid destruction of tumor cells and the release of the contents of these cells into circulation. Hyperkalemia should be treated quickly with sodium polystyrene sulfonate ( For patients with severe abnormalities or acute renal failure, hemodialysis should be initiated emergently. Bloodwork is repeated frequently to assess electrolyte levels and kidney damage, and the heart rhythm and urine output are closely monitored.