General overview of oncological emergencies management

As with all newly admitted patients, a thorough drug history should be taken. This is especially important for cancer patients presenting with acute toxicity from systemic anticancer therapy (SACT). Any oral anticancer therapy should be identified and discussed with the oncall oncology / haematology registrar - refer to the NHSAAA Acute Oncology Initial Management Guidelines link below for contact details.

Patients with locally advanced or metastatic cancer will often present as an emergency with acute complications of their disease or treatment. Some patients will have a known diagnosis of cancer and others may present with acute complications of undiagnosed malignant disease. Common oncological emergencies may include: 

• Malignant-related ascites
• Malignant spinal cord compression
• Raised intracranial pressure
• Tumour lysis syndrome
• Immune-related adverse events

In all cases, the on-call oncology or haematology registrar should be paged urgently - refer to the NHSAAA Acute Oncology Initial Management Guidelines link below for contact details. For management of oncological emergencies, see below:

• NHSAAA Acute Oncology Initial Management Guidelines (link only active if accessing via NHS network); otherwise, can be accessed via AthenA / Guidelines – Prescribing / Malignant Disease and Immunosuppression.
• West of Scotland Cancer Network guidelines available on the WoSCAN intranet site (NHS network access required) at http://www.intranet.woscan.scot.nhs.uk/, under the Guidelines and Protocols section.