Therapeutic Handbook - GGC Prescribing

Management of acute oncologicalcomplicationsIntroductionPatients with locally advanced or metastatic cancer will often present as an emergency with acutecomplications of their disease or treatment. Some patients will have a known diagnosis of cancer andothers may present with acute complications of undiagnosed malignant disease. Listed below arecommon oncological emergencies with guidance on signs and symptoms and initial management. Inall cases, the on-call oncology or haematology registrar should be paged urgently.As with all newly admitted patients, a thorough drug history should be taken. This is especiallyimportant for cancer patients presenting with acute toxicity from chemotherapy or other systemicanticancer therapy. Any oral anticancer therapy should be identified and discontinued until advice issought from the on-call oncology / haematology registrar.This section includes advice on management of:• Malignant spinal cord compression (see next page)• Raised intracranial pressure in cancer patients (page 331)• Tumour lysis syndrome (page 334)• Malignant ascites (page 336)Other oncological complications are covered elsewhere in the Handbook:• Neutropenic sepsis: see infection section page 214.• Superior vena cava obstruction (SVCO page 155), stridor (page 153) and malignant pleuraleffusion (page 145) in respiratory section.Hypercalcaemia of malignancy: see page 304 and West of Scotland guideline on the use ofbisphosphonates in cancer patients www.intranet.woscan.scot.nhs.uk / Systemic Anti CancerTherapy Protocols / Supportive Care).Oncological EmergenciesPage 328