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{{Tumor lysis syndrome}}
{{Tumor lysis syndrome}}
{{CMG}} {{AE}} {{MJK}}
{{CMG}} {{AE}} {{MJK}}
{{SK}} TLS; Laboratory Tumor Lysis Syndrome; LTLS; Clinical Tumor Lysis Syndrome; CTLS
 
{{SK}}  
TLS; Laboratory Tumor Lysis Syndrome; LTLS; Clinical Tumor Lysis Syndrome; CTLS
==Overview==
==Overview==
'''Tumor lysis syndrome''' ('''TLS''') is a group of [[metabolism|metabolic]] complications that can occur after treatment of [[cancer]], usually [[lymphoma]]s and [[leukemia]]s, and sometimes even without treatment. These complications are caused by the break-down products of dying cancer cells and include [[hyperkalemia]], [[hyperphosphatemia]], [[hyperuricemia]], [[hypocalcemia]], and [[acute renal failure]]. If left untreated, patients with tumor lysis syndrome may progress to develop [[nausea]], [[vomiting]], [[diarrhea]], [[anorexia]], [[hematuria]], [[heart palpitations]], and muscle cramps. The diagnosis of tumor lysis syndrome is based on the Cairo–Bishop criteria, which includes [[hyperuricemia]], [[hyperkalemia]], [[hyperphosphatemia]], and [[hypocalcemia]].<ref name="pmid15384972">{{cite journal| author=Cairo MS, Bishop M| title=Tumour lysis syndrome: new therapeutic strategies and classification. | journal=Br J Haematol | year= 2004 | volume= 127 | issue= 1 | pages= 3-11 | pmid=15384972 | doi=10.1111/j.1365-2141.2004.05094.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15384972}}</ref> Screening for tumor lysis syndrome is not recommended. However, patients with malignancies or acute renal failure should be considered for tumor lysis syndrome workup.<ref name="pmid4017246">{{cite journal| author=Nishi HH, Elin RJ| title=Three turbidimetric methods for determining total protein compared. | journal=Clin Chem | year= 1985 | volume= 31 | issue= 8 | pages= 1377-80 | pmid=4017246 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4017246  }} </ref> Tumor lysis syndrome is a medical emergency and requires prompt treatment.<ref name="pmid11694945">{{cite journal| author=Jeha S| title=Tumor lysis syndrome. | journal=Semin Hematol | year= 2001 | volume= 38 | issue= 4 Suppl 10 | pages= 4-8 | pmid=11694945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11694945  }} </ref>
'''Tumor lysis syndrome''' ('''TLS''') is a group of [[metabolism|metabolic]] complications that can occur after treatment of [[cancer]], usually [[lymphoma]]s and [[leukemia]]s, and sometimes even without treatment. These complications are caused by the break-down products of dying cancer cells and include [[hyperkalemia]], [[hyperphosphatemia]], [[hyperuricemia]], [[hypocalcemia]], and [[acute renal failure]]. If left untreated, patients with tumor lysis syndrome may progress to develop [[nausea]], [[vomiting]], [[diarrhea]], [[anorexia]], [[hematuria]], [[heart palpitations]], and muscle cramps. The diagnosis of tumor lysis syndrome is based on the Cairo–Bishop criteria, which includes [[hyperuricemia]], [[hyperkalemia]], [[hyperphosphatemia]], and [[hypocalcemia]].<ref name="pmid15384972">{{cite journal| author=Cairo MS, Bishop M| title=Tumour lysis syndrome: new therapeutic strategies and classification. | journal=Br J Haematol | year= 2004 | volume= 127 | issue= 1 | pages= 3-11 | pmid=15384972 | doi=10.1111/j.1365-2141.2004.05094.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15384972}}</ref> Screening for tumor lysis syndrome is not recommended. However, patients with malignancies or acute renal failure should be considered for tumor lysis syndrome workup.<ref name="pmid4017246">{{cite journal| author=Nishi HH, Elin RJ| title=Three turbidimetric methods for determining total protein compared. | journal=Clin Chem | year= 1985 | volume= 31 | issue= 8 | pages= 1377-80 | pmid=4017246 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4017246  }} </ref> Tumor lysis syndrome is a medical emergency and requires prompt treatment.<ref name="pmid11694945">{{cite journal| author=Jeha S| title=Tumor lysis syndrome. | journal=Semin Hematol | year= 2001 | volume= 38 | issue= 4 Suppl 10 | pages= 4-8 | pmid=11694945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11694945  }} </ref>

Revision as of 18:27, 6 September 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohamad Alkateb, MBBCh [2]

Synonyms and keywords: TLS; Laboratory Tumor Lysis Syndrome; LTLS; Clinical Tumor Lysis Syndrome; CTLS

Overview

Tumor lysis syndrome (TLS) is a group of metabolic complications that can occur after treatment of cancer, usually lymphomas and leukemias, and sometimes even without treatment. These complications are caused by the break-down products of dying cancer cells and include hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia, and acute renal failure. If left untreated, patients with tumor lysis syndrome may progress to develop nausea, vomiting, diarrhea, anorexia, hematuria, heart palpitations, and muscle cramps. The diagnosis of tumor lysis syndrome is based on the Cairo–Bishop criteria, which includes hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.[1] Screening for tumor lysis syndrome is not recommended. However, patients with malignancies or acute renal failure should be considered for tumor lysis syndrome workup.[2] Tumor lysis syndrome is a medical emergency and requires prompt treatment.[3]

Classification

Tumor lysis syndrome (TLS) may be classified according to the 1993 Hande-Garrow classification system into two groups: laboratory tumor lysis syndrome (LTLS) and clinical tumor lysis syndrome (CTLS).[1]

Pathophysiology

Tumor lysis syndrome (TLS) is a group of metabolic abnormalities resulting from rapid lysis of malignant cells and massive release of cell breakdown products into the blood among patients with hematologic malignancies treated with chemotherapy. The most common tumors associated with this syndrome are poorly differentiated lymphomas, such as Burkitt's lymphoma, and leukemias, such as acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Usually, the precipitating medication regimen includes combination chemotherapy, but those patients with lymphoma and ALL can be affected with steroid treatment alone.

Causes

Development of tumor lysis syndrome is the result of initiation of chemotherapy or radiotherapy in cancer patients and sometimes even without treatment.

Tumor Lysis Syndrome Differential Diagnosis

Tumor lysis syndrome must be differentiated from other diseases that cause hyperuricemia, hyperkalemia, and hyperphosphatemia, such as acute kidney injury.[4]

Epidemiology and Demographics

The exact incidence of tumor lysis syndrome has not been established. There is no racial or sex predilection for tumor lysis syndrome.[5]

Risk Factors

The most potent risk factor in the development of tumor lysis syndrome after initiating chemotherapy is kidney disease. Other risk factors include dehydration, hematologic tumors, and solid tumors.

Screening

Screening for tumor lysis syndrome is not recommended. However, patients with malignancies or acute renal failure should be considered for tumor lysis syndrome workup.[2]

Natural History, Complications and Prognosis

If left untreated, patients with tumor lysis syndrome may progress to develop nausea, vomiting, diarrhea, anorexia, hematuria, palpitations, and muscle cramps. Common complications of tumor lysis syndrome include hyperkalemia, hypocalcemia, and hyperphosphatemia. Prognosis is generally good, if not associated with acute renal failure.[6]

Diagnosis

Diagnostic Criteria

The diagnosis of tumor lysis syndrome is based on the Cairo–Bishop criteria, which includes uric acid, potassium, phosphorous, and calcium.[1]

History and Symptoms

Symptoms of tumor lysis syndrome include nausea, vomiting, diarrhea, oliguria, confusion, delirium, and seizure.

Physical Examination

Common physical examination findings of tumor lysis syndrome include edema, cardiac arrhythmia, and tetany.[1]

Laboratory Findings

Laboratory findings consistent with the diagnosis of tumor lysis syndrome include high serum uric acid, potassium, phosphorus, and low calcium.[1]

ECG

Electrocardiogram (ECG) may be helpful in the diagnosis of arrhythmias associated with tumor lysis syndrome.

Chest X Ray

There are no chest x-ray findings associated with tumor lysis syndrome. However, chest x-ray may be useful to detect mediastinal tumors.

Abdominal CT

There are no CT findings associated with tumor lysis syndrome. However, abdominal CT may be useful to detect abdominal tumors or renal masses.

Abdominal MRI

There are no MRI findings associated with tumor lysis syndrome. However, abdominal MRI may be useful to detect abdominal tumors or renal masses.

Abdominal Ultrasound

There are no ultrasound findings associated with tumor lysis syndrome. However, abdominal ultrasound may be useful to detect abdominal tumors or renal masses.

Other Imaging Studies

There are no other imaging studies available for the diagnosis of tumor lysis syndrome.

Other Diagnostic Studies

There are no other diagnostic studies available for the diagnosis of tumor lysis syndrome.

Treatment

Medical Therapy

Tumor lysis syndrome is a medical emergency and requires prompt treatment with intravenous fluids, aluminium hydroxide, calcium gluconate, allopurinol, and dialysis.

Surgery

There is no surgical intervention for the management of tumor lysis syndrome.

Primary Prevention

Effective measures for the primary prevention of tumor lysis syndrome include intravenous hydration and administration of either allopurinol or rasburicase.

Secondary Prevention

There are no secondary preventive measures available for tumor lysis syndrome.

Cost-Effectiveness of Therapy

The cost-effectiveness of administration of a singe low dose (3 mg) of rasburicase for tumor lysis syndrome prevention in cancer patients may be superior to the daily intravenous allopurinol.[7]

References

  1. 1.0 1.1 1.2 1.3 1.4 Cairo MS, Bishop M (2004). "Tumour lysis syndrome: new therapeutic strategies and classification". Br J Haematol. 127 (1): 3–11. doi:10.1111/j.1365-2141.2004.05094.x. PMID 15384972.
  2. 2.0 2.1 Nishi HH, Elin RJ (1985). "Three turbidimetric methods for determining total protein compared". Clin Chem. 31 (8): 1377–80. PMID 4017246.
  3. Jeha S (2001). "Tumor lysis syndrome". Semin Hematol. 38 (4 Suppl 10): 4–8. PMID 11694945.
  4. Wilson FP, Berns JS (2014). "Tumor lysis syndrome: new challenges and recent advances". Adv Chronic Kidney Dis. 21 (1): 18–26. doi:10.1053/j.ackd.2013.07.001. PMC 4017246. PMID 24359983.
  5. Locatelli F, Rossi F (2005). "Incidence and pathogenesis of tumor lysis syndrome". Contrib Nephrol. 147: 61–8. doi:10.1159/000082543. PMID 15604606.
  6. Coiffier B, Altman A, Pui CH, Younes A, Cairo MS (2008). "Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review". J Clin Oncol. 26 (16): 2767–78. doi:10.1200/JCO.2007.15.0177. PMID 18509186.
  7. Patel S, Le A, Gascon S (2012). "Cost-effectiveness of rasburicase over i.v. allopurinol for treatment of tumor lysis syndrome". Am J Health Syst Pharm. 69 (12): 1015–6. doi:10.2146/ajhp110656. PMID 22644973.

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