Patient education: Tumor lysis syndrome (The Basics)

What is tumor lysis syndrome? — Tumor lysis syndrome is a serious medical emergency that can happen to people with cancer. It happens when a lot of cancer cells break down and release certain substances into the bloodstream.

When the cancer cells break down, this causes very high levels of potassium, phosphate, and uric acid in the body. This then leads to very low levels of calcium. All of these substances are normally found in blood, but when there is too much or too little of any of them, it can cause damage to the kidneys as well as other organs.

Tumor lysis syndrome most often affects people with cancers of the blood, such as certain types of lymphoma or leukemia. But it can happen with almost any type of cancer.

What causes tumor lysis syndrome? — Many cancer treatments, like chemotherapy, involve using medicines to kill cancer cells in the body. Tumor lysis syndrome most often happens shortly after chemotherapy or another treatment if a lot of the cancer cells break down at the same time. But it can also happen on its own in a person with cancers of the blood, even if they are not getting treatment at the time.

Your risk of tumor lysis syndrome is higher if you:

●Have a type of cancer in which the cells grow and multiply very quickly

●Have a lot of cancer cells in your body, either because you have a large tumor or because the cancer is spread throughout many areas

●Have problems with your kidneys

What are the symptoms of tumor lysis syndrome? — Symptoms can include:

●Nausea

●Vomiting

●Diarrhea

●Lack of appetite

●Feeling tired

●Blood in the urine

●Muscle cramps or stiffness

●Irregular heartbeat

●Seizures

●Fainting

Tumor lysis syndrome can cause heart failure and kidney injury. In some cases, if it is not treated, it can even lead to death.

Is there a test for tumor lysis syndrome? — If your doctor or nurse suspects that you have tumor lysis syndrome, they will do blood tests. The tests measure your levels of potassium, phosphate, uric acid, and calcium. You might get other blood tests, too.

Your doctor will be able to tell if you have tumor lysis syndrome based on your test results.

Can tumor lysis syndrome be prevented? — There are ways to lower a person's risk of tumor lysis syndrome.

If you have cancer, your doctor or nurse will talk to you about your risk. This depends on the type of cancer you have, the characteristics of your cancer, and your treatment plan.

Based on your risk for tumor lysis syndrome, your doctor might suggest treatments to help prevent it. These treatments are usually started soon before beginning chemotherapy and continued until after the chemotherapy cycle is complete. They can include:

●Fluids given through an IV (a thin tube that goes into a vein) – This can help your kidneys work better, and lower the risk of kidney damage.

●Medicines to lower uric acid levels – There are medicines that can help lower the amount of uric acid in your blood. They include allopurinol (brand names: Aloprim, Zyloprim) and rasburicase (brand name: Elitek). People who cannot take either of these might get a medicine called febuxostat (brand name: Uloric).

During this time, your doctor or nurse will regularly check how much urine your body is making. This helps them see how well your kidneys are working. They will also monitor your heart and do frequent blood tests to check your levels of potassium, phosphate, uric acid, and calcium.

Tumor lysis syndrome can often be prevented. But it can still happen after cancer treatment, even if the above methods are used for prevention. When tumor lysis syndrome does happen, getting treatment right away lowers the risk of serious problems.

How is tumor lysis syndrome treated? — Tumor lysis syndrome is treated in the hospital. Treatment might include:

●IV fluids

●Medicines to correct your electrolyte levels – Potassium, phosphate, and calcium are all "electrolytes." Your body needs certain levels of these electrolytes to work normally. There are medicines that can help return these levels to normal.

●Medicines to lower uric acid levels

●Dialysis – For this treatment, a machine filters your blood, which is normally the job of your kidneys. It is also called "kidney replacement therapy." You might need temporary dialysis if your kidneys are injured, or if your electrolyte levels remain high even with medicines.

With immediate treatment, tumor lysis syndrome does not cause long-term problems for most people.

More on this topic

Patient education: Chemotherapy (The Basics)
Patient education: Hyperkalemia (The Basics)