Tumor Lysis Syndrome

Tumor Lysis Syndrome is an acute condition that can cause life-threatening problems if not treated in time. Read and learn all about the causes, symptoms, diagnosis and treatment of this disorder.

Tumor Lysis Syndrome Definition

Picture 1 - Tumor Lysis Syndrome

Doctors and medical researchers define Tumor lysis syndrome (TLS) as a cluster of metabolic complications that arise after cancer treatment. These metabolic abnormalities, usually leukemias and lymphomas, arise due to tumor necrosis arising spontaneously or after treatment of cancer.

Tumor Lysis Syndrome ICD9 Code

The ICD9 Code for this condition is 277.88.

Tumor Lysis Syndrome Incidence

The actual incidence of this condition is not known. This is due to the fact that medical researchers have not properly studied the disease in most tumors. However, the condition has been evaluated in high-grade non-Hodgkin’s lymphomas (NHL). According to one research, the incidence of TLS is as high as 42% in these tumors although only 6% of these cases were found to be medically significant.

Tumor Lysis Syndrome Symptoms

The condition is clinically marked by fast development of syndromes like:

• Acute renal failure (ARF)
• Hyperkalemia
• Hyperphosphatemia
• Hyperuricemia
• Hypocalcemia

An individual affected with TLS may begin showing discomforting signs and symptoms, such as:

• Cardiac difficulties, such as Arrhythmias
• Congestive heart failure
• Generalized or peripheral edema
• Lethargy
• Nausea
• Shortness of breath
• Seizures
• Tetany or muscular cramps
• Vomiting

If the condition is left uncontrolled, Hypocalcemia can worsen and cause development of Tetany or Uremia (urine in blood). Patients may also experience other problems like irritability, restlessness and difficulties in concentration. The level of uric acid can also increase high enough to cause renal colic and arthritis. In such cases, patients may suffer from life-threatening complications such as metabolic acidosis and heart failure.

Tumor Lysis Syndrome Causes

The disease is supposed to be a result of

• Cancer treatment – Methods used for treatment of malignant conditions, such as chemotherapy and radiotherapy, are supposed to give rise to this condition. In some cases, only steroid treatment can cause this problem. In rare cases, cancerous conditions such as melanoma have also been found to be possible causes.
• Acute leukemia – People affected with acute leukemia and being treated for the condition are also at risk of developing TLS.
• General anesthesia – In rare cases, patients being treated under the effects of general anesthesia are also found to develop TLS.
• Lymphomas – Lymphomas that are poorly differentiated, such as Burkitt’s lymphoma, can give rise to this syndrome.
• Leukemias – Acute myeloid leukemia (AML) and Acute lymphoblastic leukemia (ALL) have also been linked with TLS development.

Individuals being treated with hormonal agents and corticosteroids are also prone to this condition.

Tumor Lysis Syndrome Diagnosis

Laboratory examinations can successfully diagnose TLS. The condition can also be detected with the aid of blood tests that help assess the levels of serum calcium, uric acid, phosphate and potassium in the bloodstream. If tests reveal a rise in potassium levels, there can be cause for worry. Hyperkalemia and other similar effects of raised potassium level can have life-threatening consequences. Even a rise of 5mmol/dL from usual would suggest a presence of Hyperkalemia.

Rise in phosphate levels in blood serum (Hyperphosphatemia) can indicate TLS. It is necessary to check levels of serum phosphate as well as Creatinine and BUN to determine whether TLS is imminent. Doctors should also assess the pH level in the urine of patients to detect a rise in the uric acid level of the body. Highly acidic urine can be a confirmation of TLS. Healthcare providers should also conduct ECG tests to detect changes in the condition of the heart.

Tumor Lysis Syndrome Differential Diagnosis

The differential diagnosis of TLS involves telling its symptoms apart from those caused by other conditions, such as:

• Isolated hyperkalemia
• Isolated hyperphosphatemia
• Isolated hyperuricemia
• Isolated hypocalcemia

Tumor Lysis Syndrome Treatment

The treatment of this condition addresses specific symptoms arising in patients. If patients are found to suffer from electrolyte abnormalities, treatment can involve:

• Daily dose of 15-60 grams of sodium polystyrene sulfonate(Kionex, Kayexalate), to be taken orally (for Hyperkalemia)
• 15 ml aluminum hydroxide, after every 4 – 6 hours (for Hyperphosphotemia)

In individuals suffering from Asymptomatic Hypocalcemia, treatment is not recommended. This is due to an enhanced danger of calcium-phosphate precipitation. If patients are found to exhibit symptoms, they can be administered with Calcium Gluconate. However, doctors should practice caution and monitor the health of sufferers for problems like lowered urine output or deteriorating kidney function. If patients are found to suffer from acute renal failure or other acute abnormalities, Hemodialysis should be used as an emergency treatment. If treated on a prompt basis, the condition is likely to take a turn for the better.

Supportive care is one of the main goals of TLS treatment. Supportive care helps avoid potential complications of this disorder and involves:

Frequent blood tests

Blood tests conducted on a frequent basis helps determine the serum levels of a patient and assess the condition properly.

Frequent ECG tests

These are useful in monitoring abnormalities in the potassium levels of TLS patients and avoid Hyperkalemia, which can be extremely damaging to health.

Hydration

Frequent hydration helps prevent bad effects arising from excess elimination of water from the body of people suffering from TLS. It can be effective in increasing the amount of body fluids as also the intravascular volume.

Dialysis

In some cases, the blood of patients needs to be cleansed. This is possible through Hemodialysis, a process that removes metabolic wastes or toxic substances from the bloodstream of sufferers. It is used in cases where the kidneys of suffering individuals become non-operational (kidney failure). Hemodialysis helps carry out those functions that are usually performed by the kidneys.

Medications

Individuals at risk of developing TLS are prescribed various medications, which include:

• Allopurinol – The drug reduces the risk of rise in uric acid levels and prevents development of TLS.
• Rasburicase – It is a type of medicine that lowers the level of uric acid in the bloodstream and helps cure Hyperuricemia. These are Uricosurics, curative agents that are popular for their ability to control uric acid levels in serum.
• Calcium supplements – These help increase calcium level in blood and prevent problems like cramps, seizures and tetany. The supplements can be provided through diet or medications.
• Kayexalate – This is administered in order to reduce the increased potassium levels. Along with that, foods rich in potassium are restricted.
• Sodium bicarbonate – It helps attain alkalinity in serum and maintain stability in pH levels in the bloodstream of patients.
• Diuretics – Mannitol and Furosemide are often administered to patients to lower the level of uric acid in renal tubules or the system.
• Electrolytes – These help cure patients and restore the balance of electrolytes in their body.

If patients are treated for cancerous symptoms, their health should be carefully monitored. Proper assessment and frequent laboratory exams are necessary to cure impending TLS.

Tumor Lysis Syndrome Risk Factors

Cancerous cells are frequently many in number and undergo rapid proliferation. Chemotherapy helps destroy these quickly and in large numbers. Large-scale destruction at the same time leads to rapid release of the cellular contents into the bloodstream. This leads to TLS, generally within 1-5 days after using chemotherapy. In rare cases, the condition is found to arise spontaneously and without any exposure to agents of chemotherapy.

Tumor Lysis Syndrome Prognosis

The outcome of condition can be often predicted. Generally, effective prevention and treatment are possible by closely monitoring the health of patients who are at risk. Morbidity and mortality are usually associated to problems like:

• Acute renal failure
• Cardiac arrhythmia (occurring due to Hyperkalaemia)
• Metabolic acidosis

Tumor Lysis Syndrome Complications

Some of the primary complications of this disease include:

• Acute renal failure
• Cardiac arrhythmia
• Lactic acidosis
• Seizures

In some cases, anticancer treatment can lead to the rapid destruction of many neoplastic cells thereby releasing into the systemic circulation many intracellular ions as well as metabolic byproducts. This can lead to possible life-threatening complications.

Tumor Lysis Syndrome Management

The management and prevention of this condition necessitates recognizing patients who are at risk of developing this disorder. Individuals suffering with renal impairment from before are also at an increased risk. The kidney function and electrolyte level of high-risk patients should be monitored before chemotherapy and even 2-3 days after it. This can help in early detection of the disease and timely prevention of problems like renal failure.

With timely and effective treatment, Tumor Lysis Syndrome shows an excellent prognosis. If you suspect anyone in your family to be a patient of this disorder, you should seek professional medical attention on an immediate basis. Early diagnosis and treatment can ensure a faster recovery for patients and prevent any risk of possible life-threatening complications.

References:

http://emedicine.medscape.com/article/282171-overview

http://www.emedicinehealth.com/script/main/art.asp?articlekey=130281&page=4

http://www.virtualmedicalcentre.com/diseases.asp?did=737&title=tumour-lysis-syndrome

http://bestpractice.bmj.com/best-practice/monograph/936/diagnosis/differential.html

http://syndrome.org/tumor-lysis-syndrome/