Tumor Lysis Syndrome

What is Tumor Lysis Syndrome?

Tumor Lysis Syndrome is a life-threatening complication of anticancer treatment that occur after rapid break down of tumor. It is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, acute renal failure and hypocalcemia. This is a result of metabolic byproducts and intracellular ion release that occur during rapid killing of neoplastic cells.

Tumor lysis syndrome is a rare case that may happen rapidly or spontaneously. Cancer cells killed by therapy treatment may spill intracellular contents which may then accumulate faster than eliminated causing electrolyte and metabolic disturbances resulting to tumor lysis syndrome.

Patients at high risk for tumor lysis are those suffering from leukemia and lymphoma due to aggressive chemotherapy treatment. Patients with pre-existing kidney dysfunction are also potential to develop tumor lysis.

Tumor Lysis Syndrome Symptoms

Tumor lysis syndrome on early stage has no manifestations of symptoms. The manifestation is only determined when laboratory diagnostic test is done giving abnormal results. Increased level of certain body substance will denote the presence of tumor lysis and these are:

• Hypocalemia – calcium level in blood is decreased due to severe cardiovascular effects and neurologic dysfunction such as seizure.
• Hyperuricemia – a condition where uric level in the blood is elevated. The excess uric acid will be converted to crystals which may block tubes of the kidney and may result to kidney damage.
• Hyperkalemia – an elevated level of potassium in the blood causing cardiac irregularity and neuromuscular dysfunction.
• Hyperphosphatemia – an excess level of phosphate in the blood causing decrease level of calcium in the blood. It is also a contributing factor in kidney failure.
• Acute Renal Failure – is rapid renal filtration dysfunction as a result of hyperuricemia.

Initial symptoms a patient may experience include:

• Nausea and vomiting
• Lethargy
• Weakness
• Joint pains
• Hiccups
• Fatigue
• Edema
• Hypertension

Tumor lysis syndrome if left untreated and symptoms progress, the patient may experience:

• Irregular heartbeat
• Mental ability damage
• Seizure
• Tetany
• Anxiety
• Paralysis

Tumor Lysis Syndrome Causes

Rapid breakdown of cancer or killing of neoplastic cell is the cause of tumor lysis syndrome. It is a complication of anticancer treatment. People prone to it or who are potentially at risk are those suffering from leukemia and lymphomas. Treatments that may contribute include:

Radiation Therapy Treatment

This treatment aimed at controlling or killing malignant cells by damaging DNA of exposed tissue with the use of ionizing radiation. The therapy can be done either as external radiotherapy which is facilitated outside the body with the use of high energy x-rays or internal radiotherapy facilitated within the body with the use of radioactive material.

Hormonal Agents

A major method of controlling cancer cells by manipulating endocrine system through the use of hormone administration specifically of steroid hormone. Treatment may be facilitated with the use of corticosteroid hormone and sex hormone which is demonstrates by cutting off food supply of the cancer cells.

Chemotherapy

Treatment that uses antineoplastic drug or a combination in a standardized treatment regimen.

Monoclonal Antibodies

A synthetic drug designed to destroy lymphocytes although the treatment can lower body resistance to infection.

Tumor Lysis Syndrome Guidelines

Guidelines for managing tumor lysis syndrome are geared in preventive measures and supportive care of the patient candidate to acquire the syndrome.

The first line of defense is identifying patient at risk for tumor lysis syndrome and who are receiving treatments that put them at risk for the syndrome.

Guidelines in preventing and providing supportive care for patient potentially at risk for tumor lysis syndrome include:

1. Frequent monitoring of blood test to monitor patient of serum level and others significant to patient’s health.
2. Laboratory monitoring to assess level of uric acid, BUN, creatinine, calcium, potassium, phosphate and LDH. Monitoring must be done within 48-72 hours upon initiation of chemotherapy treatment or other treatment significant to patient’s condition.
3. Cardiac monitoring is important to evaluate cardiac activity that may indicate complication of treatment.
4. Proper hydration to patient must be done accordingly to prevent depletion in volume of fluid and electrolytes in the body in which case may worsen the complication.
5. Diuretics may also be recommended to patient experiencing water retention. It is advised to patients who are not dehydrated to facilitate renal excretion.
6. The best team to handle the patient is those who have experience in caring and managing patient afflicted with tumor lysis syndrome.

Tumor Lysis Syndrome Treatment

Treating tumor lysis syndrome afflicted patient aimed in preventing complications brought by treatment a patient is presently undergoing. The treatment is geared in the symptoms the patient is manifesting and treatments include:

• Allopurinol – a medication use to avoid onset of tumor lysis syndrome by reducing the occurrence of elevated uric acid.
• Kayexalate – is administered to reduce the level of increasing potassium content in the blood.
• Rasburicase – is for the treatment of hyperuricemia and is administered intravenously. It acts by reducing uric acid level and also controls serum potassium, creatinine, phosphate and calcium level and the drug takes effect as quickly as 4 hours.
• Calcium Supplements – either by medication or diet form, this help by preventing tetany, muscle cramps and seizure as a result of decrease level in calcium.
• Diuretics – to facilitate proper renal excretion and to decrease uric acid level in renal tubules to prevent crystal formation.
• Electrolyte Replacement – to control and balance electrolyte and avoid its depletion.