Tumor Lysis Syndrome

What is tumor lysis syndrome?

Tumor lysis syndrome is a group of potentially life-threatening conditions that may happen within hours after cancer treatment. Tumor lysis syndrome occurs quickly and can rapidly become a medical emergency. Healthcare providers treat tumor lysis syndrome with medication and intravenous hydration.

But healthcare providers can prevent tumor lysis syndrome. They do this by knowing who may be at increased risk and using preventive measures to reduce that risk.

How does tumor lysis syndrome affect my body?

Tumor lysis happens when cancer cells, under pressure from chemotherapy and other cancer treatment, fall apart and flood your bloodstream with chemicals and toxins faster than your body can get rid of them. Tumor lysis syndrome is a group of conditions that affect your heart, kidneys and muscles. Those conditions are:

• Hyperuricemia (high uric acid): High uric acid can deposit uric acid crystals into your kidney, causing kidney dysfunction and failure.
• Hyperphosphatemia (high phosphorus): High phosphorus levels affect your kidneys function.
• Hyperkalemia (high potassium): High potassium may cause nausea, vomiting and diarrhea. It may also change your heart rate and heart rhythm and cause heart attacks.
• Uremia: Uremia happens when your kidneys stop filtering toxins from your blood. Uremia causes serious bone, muscle, heart and blood vessel issues.
• Hypocalcemia: Low calcium levels may cause changes to heart rhythm, muscle cramps, confusion, numbness and tingling (paresthesia) and potentially cardiac arrest and death.

Is tumor lysis syndrome an emergency?

Yes, tumor lysis syndrome is a medical emergency that requires immediate treatment.

Who may be affected by tumor lysis syndrome?

Not everyone treated for cancer will develop tumor lysis syndrome. If you’re receiving cancer treatment, ask your healthcare provider about your risk of developing this condition. Tumor lysis syndrome most often affects people receiving chemotherapy for the following kinds of cancer:

• Acute lymphocytic leukemia.
• Aggressive non-Hodgkin’s lymphoma, including Burkitt lymphoma and diffuse large B-cell lymphoma.
• Acute myeloid leukemia (AML).
• B-cell acute lymphoblastic leukemia (ALL).
• Small cell lung cancer.

Tumor lysis syndrome is less commonly associated with

• Anaplastic large cell lymphoma. This is a rare, slow-moving cancer of your immune system.
• Chronic lymphocytic leukemia (CLL).
• Neuroblastoma.
• Breast cancer.
• Soft tissue sarcoma.
• Medulloblastoma.
• Merkel cell carcinoma.

What other factors may cause tumor lysis syndrome?

Healthcare providers know some conditions or medical issues increase people’s chances of developing tumor lysis syndrome. If someone has the following conditions or issues, healthcare providers take additional steps before administering chemotherapy. Factors that may increase someone’s risk for developing tumor lysis syndrome include:

• High white blood cell count.
• High blood uric acid level.
• Kidney problems.
• Dehydration.
• Later-stage cancer.
• Large tumors.

Can you have tumor lysis syndrome without having chemo?

Yes, but such cases are very rare. When that happens, healthcare providers call the condition spontaneous tumor lysis syndrome.

What are the symptoms of tumor lysis syndrome?

Tumor lysis syndrome usually develops within 12 to 72 hours after chemotherapy. Symptoms include:

• Nausea and vomiting.
• Diarrhea.
• Changes in how much pee you produce.
• Weakness and lethargy.
• Blood in your pee (hematuria).
• Seizures.
• Muscle cramps.
• Fainting (syncope}.
• Irregular heartbeat.
• Low blood pressure (hypotension).
• Joint pain.

What causes tumor lysis syndrome?

Tumor lysis syndrome happens when cancer treatment rapidly kills cancer cells. When that happens, dying cancer cells spill their contents into your bloodstream.

Normally, your kidneys filter and eliminate these substances. But if your cancer treatment quickly kills large numbers of cancer cells, your kidneys become overwhelmed by a toxic flood of chemicals and shut down, which allows the toxins to build up.

How do healthcare providers diagnose tumor lysis syndrome?

Healthcare providers focus on preventing tumor lysis syndrome by carefully monitoring your blood and urine for signs your kidneys aren’t eliminating toxins.

What is the treatment for tumor lysis syndrome?

Healthcare providers’ first priority is preventing tumor lysis syndrome. They do this by identifying who might be at increased risk, and then take steps to prevent tumor lysis syndrome — and if needed, treat it quickly.

Prevention

• Intravenous (IV) hydration to keep your pee flowing and removing toxins.
• Medication to keep crystals from forming in your kidneys.

Treatment

• Diuretics to increase how often you pee.
• Medications to remove extra potassium and phosphorus.
• Medications to break up crystals that have formed in your kidney.
• Dialysis to remove toxins.

Can you survive tumor lysis syndrome?

Yes, nearly 90% of people who have tumor lysis syndrome survive.

What happens after I’m treated for tumor lysis syndrome?

Tumor lysis syndrome may damage your kidneys. If you had tumor lysis syndrome, ask your healthcare provider if you’ll need ongoing or additional treatment until your kidneys recover.

A note from Cleveland Clinic

Cancer treatment is evolving and doing more to kill cancer cells quickly. Sometimes, dying cancer cells flood your bloodstream with chemicals and toxins that may cause tumor lysis syndrome, a life-threatening condition that causes serious heart and kidney issues. Healthcare providers manage tumor lysis syndrome with preventive treatment to protect people who are at increased risk, and immediately and aggressively treat symptoms if someone develops tumor lysis syndrome. If you’re receiving cancer treatment, ask your healthcare provider if you’re at risk for tumor lysis syndrome. They’ll explain your potential risk, and do everything they can to prevent or treat tumor lysis syndrome.