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Chapter 35 - Malaise

Published online by Cambridge University Press:  24 April 2026

By
Patricia Brock
Edited by
Angela Bray Lindsay and
Monica Kathleen Wattana
Angela Bray Lindsay
Affiliation:
Virginia Commonwealth University
Monica Kathleen Wattana
Affiliation:
University of Texas, MD Anderson Cancer Center
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Summary

1. It is important for the provider to maintain a high index of suspicion for those at risk for tumor lysis syndrome (TLS), which includes a large tumor burden, high proliferation rate, pre-existing kidney dysfunction and certain types of cancer such as Burkett lymphoma and acute leukemias.

2. The best form of treatment includes preventive measures with aggressive hydration and urate-lowering agents.

3. In established TLS, in addition to hydration, the use of rasburicase and correction of any electrolyte derangements are key to present complications and preserve renal function.

4. A coordinated approach between the oncologist, nephrologist, and critical care specialists is required to provide effective management.

5. Educating patients and caregivers about the signs and symptoms of TLS is important for early detection and prompt treatment, especially in outpatient settings.

Keywords

HyperkalemiaHyperuricemiaHyperphosphatemiaHypocalcemiaAcute Kidney injury (AKI)Electrolyte imbalanceUric acid nephropathyCytotoxic chemotherapyRapid cell lysisTumor BurdenHigh lactate dehydrogenase (LDH)Renal dysfunctionProphylaxisRasburicaseAllopurinolOncologic Emergency

Information

Type
Chapter
Information
Oncologic Emergency Medicine
Clinical Cases Illustrating Key Concepts
 , pp. 176 - 180
Publisher: Cambridge University Press
Print publication year: 2026

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References

Further Reading

Calvo Villas, JM. Tumour lysis syndrome. Med Clin (Barc). 2019;152(10):397–404.CrossRefGoogle ScholarPubMed
Coiffier, B, Altman, A, Pui, CH, Younes, A, MS, Cairo. Guidelines for the management of pediatric and adult tumor lysis syndrome: an evidence-based review. J Clin Oncol. 2008;26:2767–2778.CrossRefGoogle ScholarPubMed
Durani, U, Hogan, WJ. Emergencies in hematology: tumor lysis syndrome. Br J Haematol. 2020;188(4):494–500.CrossRefGoogle Scholar
Mahfooz, K, Sohail, H, Gvajaia, A, Arif, U, Grewal, D, MR, Muppidi, et al. Rasburicase in treating tumor lysis syndrome: an umbrella review. Cancer Pathog Ther. 2023;1(4):262–271.CrossRefGoogle ScholarPubMed
Marjoncu, D, Holman, K. The efficacy and cost-impact of rasburicase 3 mg versus 6 mg for the management of tumor lysis syndrome: a multicenter analysis. J Oncol Pharm Pract. 2023;29(4):893–898.CrossRefGoogle ScholarPubMed
Mirrakhimov, AE, AM, Ali, Khan, M, Barbaryan, A. Tumor lysis syndrome in solid tumors: an up to date revieZZw of the literature. Rare Tumors. (2014;6(2):68–76.CrossRefGoogle ScholarPubMed
Papapanou, M, AE, Athanasopoulos, Georgiadi, E, SA, Maragkos, Liontos, M, DC, Ziogas, et al. Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature. Med Oncol. 2023;40(8):233.CrossRefGoogle ScholarPubMed
Perissinotti, AJ, MR, Bishop, Bubalo, J, MB, Geyer, Goodrich, A, SC, Howard, et al. Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: results of a modified Delphi panel. Cancer Treat Rev. 2023;120:102603. doi: 10.1016/j.ctrv.2023.102603. Epub 2023 Aug 6. PMID: 37579533.CrossRefGoogle ScholarPubMed
Personett, HA, EF, Barreto, KB, McCullough, Dierkhising, R, Leung, N, TM, Habermann. Impact of early rasburicase on incidence of clinical tumor lysis syndrome in lymphoma. Leuk Lymphoma. 2019;60(9):2271–2277.CrossRefGoogle ScholarPubMed
Tosi, P, Barosi, G, Lazzaro, C, Liso, V, Marchetti, M, Morra, E, et al. Consensus conference on the management of tumor lysis syndrome. Haematologica. 2008;93:1877–1885.CrossRefGoogle ScholarPubMed
Wesemüller, W, Taverna, C. Spontaneous tumor lysis syndrome. Case Rep Oncol. 2020;13(3): 1116–1124.CrossRefGoogle ScholarPubMed

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