Oncologic Emergencies
A client with lung cancer suddenly can't lie flat and their face is swollen and dusky — this isn't a chemo side effect. It's a life-threatening oncologic emergency requiring immediate intervention.
Core Concept
Oncologic emergencies are acute, potentially fatal complications caused by the cancer itself or its treatment. Three high-yield emergencies dominate NCLEX testing. Superior vena cava (SVC) syndrome occurs when a tumor (usually lung cancer or lymphoma) compresses the SVC, obstructing venous return from the head and upper body. Signs include facial and periorbital edema, neck vein distension, dyspnea worse when lying flat, and a dusky or plethoric appearance of the face and upper chest. This is a medical emergency requiring upright positioning, oxygen, and emergent notification. Tumor lysis syndrome (TLS) results from rapid cancer cell destruction — often 12–72 hours after initiating chemotherapy for high-tumor-burden cancers like leukemia or lymphoma. Dying cells release potassium, phosphate, and uric acid into the blood. The hallmark lab pattern is hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Cardiac dysrhythmias and acute kidney injury are the lethal risks. Aggressive IV hydration and allopurinol are given prophylactically. Spinal cord compression presents with new back pain, motor weakness, and bowel or bladder changes in a client with known bone metastases. This is a neurological emergency — delays beyond 24–48 hours risk permanent paralysis. The nurse's priority is recognizing the triad and reporting immediately.
Watch Out For
Don't confuse TLS (caused by cancer cell death releasing intracellular contents) with sepsis from neutropenia — TLS has a specific lab fingerprint (high K+, high phosphate, high uric acid, low calcium) while neutropenic sepsis presents with fever and infection signs. Students mix up SVC syndrome (upper body edema, facial plethora) with cardiac tamponade (Beck's triad: hypotension, muffled heart sounds, JVD) — both cause JVD, but SVC syndrome has prominent facial swelling that tamponade does not.
Clinical Pearl
TLS labs go UP-UP-UP-down: Uric acid UP, Potassium UP, Phosphate UP, Calcium DOWN. If those four hit together after chemo, think tumor lysis.
Test Your Knowledge
3 quick questions — see how well you understood Oncologic Emergencies