Cancer patients, particularly those undergoing chemotherapy or suffering from advanced malignancies, are susceptible to life-threatening complications known as oncologic emergencies. Prompt recognition and management of these conditions are essential to improve patient outcomes. Below, we discuss some of the most critical oncologic emergencies, their causes, symptoms, and treatment approaches.

1. Febrile Neutropenia and Sepsis

Febrile neutropenia (FN) is a serious complication that arises when cancer patients, especially those receiving chemotherapy, develop an abnormally low neutrophil count, making them highly vulnerable to infections.

• Chemotherapy-induced bone marrow suppression
• Bacterial, viral, or fungal infections
• Invasive medical procedures that introduce pathogens

• Fever above 100.4°F (38°C)
• Chills and sweating
• Rapid heart rate and low blood pressure
• Fatigue and malaise

• Immediate hospitalization for intravenous (IV) antibiotics
• Blood cultures and diagnostic tests to identify the infection
• Growth factors (e.g., G-CSF) to accelerate neutrophil recovery
• Strict infection control measures, including isolation in some cases

2. Hypercalcemia of Malignancy

Hypercalcemia occurs when calcium levels in the blood become dangerously high, often due to certain cancers such as lung, breast, and multiple myeloma.

• Tumor secretion of parathyroid hormone-related peptide (PTHrP)
• Bone metastases causing calcium release
• Increased vitamin D production by cancer cells

• Nausea and vomiting
• Constipation and abdominal pain
• Excessive thirst and frequent urination
• Confusion, lethargy, and even coma in severe cases

• Aggressive IV hydration with normal saline
• Bisphosphonates (e.g., zoledronic acid, pamidronate) to inhibit bone resorption
• Calcitonin for rapid but short-term calcium lowering
• Dialysis in extreme cases of refractory hypercalcemia

3. Spinal Cord Compression

Spinal cord compression is a devastating complication of metastatic cancer, particularly from lung, breast, and prostate malignancies, which can lead to permanent neurological damage if not treated promptly.

• Vertebral metastases compressing the spinal cord
• Tumor invasion into the spinal canal

• Severe back pain, often worsening at night
• Weakness or numbness in the limbs
• Loss of bladder or bowel control

• Immediate administration of high-dose corticosteroids (e.g., dexamethasone) to reduce inflammation
• Urgent MRI or CT scan to determine the extent of compression
• Radiation therapy or surgical decompression depending on the severity

4. Tumor Lysis Syndrome (TLS)

TLS is a metabolic emergency caused by the rapid destruction of tumor cells, leading to the release of intracellular contents into the bloodstream, resulting in electrolyte imbalances.

• Aggressive chemotherapy in hematologic malignancies (e.g., leukemia, lymphoma)
• Spontaneous tumor breakdown in highly proliferative cancers

• Hyperkalemia leading to cardiac arrhythmias
• Hyperuricemia causing acute kidney injury
• Hypocalcemia leading to muscle spasms and seizures

• Aggressive IV hydration to promote renal clearance
• Allopurinol or rasburicase to lower uric acid levels
• Continuous cardiac and electrolyte monitoring
• Dialysis in cases of severe kidney failure

5. Superior Vena Cava (SVC) Syndrome

SVC syndrome occurs when a tumor obstructs the superior vena cava, leading to impaired venous return from the upper body to the heart.

• Lung cancer, lymphoma, or mediastinal tumors compressing the SVC
• Thrombosis associated with central venous catheters

• Swelling of the face, neck, and upper limbs
• Shortness of breath and difficulty swallowing
• Distended neck and chest veins

• Elevation of the patient’s head to improve venous drainage
• Oxygen therapy to ease respiratory distress
• Radiation or chemotherapy to shrink the tumor
• Stenting or anticoagulation for cases involving thrombotic obstruction

Conclusion

Oncologic emergencies require immediate recognition and swift intervention to prevent life-threatening complications. Healthcare providers should maintain a high index of suspicion in at-risk cancer patients and implement appropriate treatment strategies promptly. Multidisciplinary collaboration among oncologists, emergency physicians, and palliative care teams plays a vital role in optimizing patient outcomes and improving quality of life.