Tumor lysis syndrome (patient information)

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Tumor lysis syndrome
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Tumor lysis syndrome?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

What are the symptoms of Tumor lysis syndrome?

The symptoms of tumor lysis syndrome are:

• Nausea
• Vomiting
• Diarrhea
• Lethargy
• Seizure
• Tetany
• paresthesias
• Arrhythmias
• Hypotension
• Hematuria
• Flank pain
• Hypertension
• Edema
• Oliguria
• Anuria
• Somnolence
• Hallucinations

What causes Tumor lysis syndrome?

Most common causes of tumor lysis syndrome are:

• Burkitt's lymphoma
• Acute lymphoblastic leukemia
• Acute myeloid leukemia
• Chemotherapy including methotrexate

Who is at highest risk?

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.

Diagnosis

he diagnosis of tumor lysis syndrome is based on the Cairo–Bishop criteria:

Category	Diagnostic criteria
Laboratory tumor lysis syndrome	Abnormality in two or more of the following within 3 days before or 7 days after starting chemotherapy: Hyperuricemia ≥ 476 μmol/l Hyperphosphatemia ≥ 2·1 mmol/l (children), x ≥1·45 mmol/l (adults) Hyperkalemia ≥ 6·0 mmol/l Hypocalcemia ≤ 1·75 mmol/l
Clinical tumor lysis syndrome	Laboratory tumor lysis syndrome plus one or more of the following: Increase serum creatinine (1.5 times upper normal limit) Cardiac arrhythmia Sudden death Seizure

Treatment options

• If you are at risk of developing TLS, it can be prevented with different ways before you start cancer treatment.

• This includes taking enough fluids.
• Fluids are usually given 24–48 hours before treatment starts and for several days after treatment is finished.
• During fluid intake, the healthcare team will monitor how much urine you produce. It is important that you output 150–200 ml of urine every hour.
• They may prescribe a diuretic to maintain urine flow.
• Diuretics are drugs that help the body make urine.

If TLS develops, they may suggest the following measures to treat it.

Medicines

• Allopurinol (Zyloprim) is a drug that stops the body from making uric acid.

• Rasburicase (Fasturtec) is a drug that breaks down uric acid so that the body can get rid of it.
• Sodium bicarbonate or acetazolamide (Diamox) with the intravenous fluids.

Dialysis

• You may need to have dialysis,
• If TLS can’t be corrected or if kidney failure worsens
• . Dialysis removes wastes from the blood when the kidneys don’t work properly.