Tumor lysis syndrome overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In medicine (oncology and hematology), 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.
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
Development of tumor lysis syndrome is the result of initiation of chemotherapy or radiotherapy in cancer patients.
Causes
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.
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.[2]
Epidemiology and Demographics
The exact incidence of tumor lysis syndrome has not been established. There is no racial or sex prediction for tumor lysis syndrome.[3]
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.[4]
Natural History, Complications and Prognosis
If left untreated, patients with tumor lysis syndrome may progress to develop nausea, vomiting, diarrhea, anorexia, hematuria, heart palpitations, muscle cramps. Common complications of tumor lysis syndrome include hyperkalemia, hypocalcemia, and hyperphosphatemia. Prognosis is generally good, if not associated with acute renal failure.[5]
References
- ↑ 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.
- ↑ 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.
- ↑ Locatelli F, Rossi F (2005). "Incidence and pathogenesis of tumor lysis syndrome". Contrib Nephrol. 147: 61–8. doi:10.1159/000082543. PMID 15604606.
- ↑ Nishi HH, Elin RJ (1985). "Three turbidimetric methods for determining total protein compared". Clin Chem. 31 (8): 1377–80. PMID 4017246.
- ↑ 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.