Tumor lysis syndrome is a complication of chemotherapy and radiotherapy, which cause malignant tumor cells to decompose in a very short time. The cells release substances such as uric acid into the blood, which can result in metabolic derailment and kidney failure. Chemotherapy in particular is typically started slowly to prevent the syndrome.
What is tumor lysis syndrome?
Certain tumors grow particularly quickly and are also considered to be extraordinarily sensitive to chemotherapy. The tumor diseases with such tumors include, for example, acute leukemias such as acute lymphatic leukemia or acute myeloid leukemia. Malignant lymphomas also grow quickly and are sensitive, such as Burkitt’s lymphoma or diffuse large cell lymphoma. For ibm pc explained, please visit psyknowhow.com.
In addition, the two characteristics apply to small cell lung cancer. Because of their sensitivity to chemotherapeutic agents, medicine typically treats tumor diseases with chemotherapy, which causes many of the tumor cells to decompose in a very short time. When too many tumor cells break down in just a short period of time, tumor lysis syndrome occurs.
As the tumors decay, they release certain substances into the bloodstream that can overwhelm the kidneys’ elimination work. For this reason, an acute life-threatening condition can develop during treatment, which can promote kidney failure, for example. The phenomenon is also referred to as tumor decay-related metabolic derailment and, in addition to the negative effects on the kidneys, promotes other metabolic disorders.
Causes
Tumor lysis syndrome is preceded by the rapid decay of malignant tumors. As the tumors decay, they release substances such as uric acid, phosphate, and potassium into the bloodstream. If such substances from the tumor cells accumulate in large quantities, the calcium sinks. The metabolism derails and kidney function can be damaged.
The household of the occurring substances is subject to an essential regulation by the kidneys, so that the elimination organs can be overloaded with the sudden attack of substances. Of particular concern is the accumulation of large amounts of uric acid. If this substance is formed in large quantities and in a very short time, it can no longer be sufficiently filtered out of the organism via the kidneys.
Uric acid then crystallizes in the kidneys and leads to urate nephropathy, which in extreme cases leads to acute kidney failure. As a rule, the rapid decay of tumors and thus tumor lysis syndrome is caused by chemotherapeutic treatment. The syndrome is comparatively less common with radiation therapy. This treatment option usually kills malignant cells less quickly.
Symptoms, Ailments & Signs
Like normal body cells, tumor cells consist of a large number of electrolytes, metabolites and other metabolically active particles. The sudden destruction of the tumor cells by a cytostatic agent results in the release of the ingredients into the blood, so that the organism is flooded with the compounds mentioned and the metabolism derails.
Patients with tumor lysis syndrome primarily suffer from symptoms of the kidneys, which regulate the excretion of metabolites. A complete loss of kidney function can occur. Renal failure may be accompanied by symptoms such as pruritus, foetor uraemicus, and anemia. Renal osteopathy with bone pain can set in. In addition, polyneuropathies with drowsiness, sensory disturbances and paralysis are among the accompanying symptoms.
The same applies to hormonal disorders, edema, headaches, depression, fatigue, dizziness and vomiting. In individual cases, seizures can also occur, which can be associated with metabolic acidosis, cardiac insufficiency, arrhythmias or hypertension. In addition, congestion of the lungs and gastrointestinal disturbances can occur.
Diagnosis & course of disease
The diagnosis of tumor lysis syndrome is largely based on blood values. A derailment of the values during chemotherapy or radiation therapy speaks for the syndrome. The treating physicians are usually aware of the risk of tumor lysis syndrome.
For this reason, the patient’s blood values are usually closely monitored during treatments to break down tumor cells. In most cases, prophylactic measures are initiated. The earlier the syndrome is recognized, the easier it is to counteract acute kidney failure.
Complications
In the worst case, tumor lysis syndrome can lead to death in those affected. Whether this will happen cannot be predicted in general. The further course depends heavily on the exact severity of the disease. Those affected suffer from various paralysis and also from sensory disturbances.
These can significantly restrict everyday life and reduce the patient’s quality of life. Dizziness and vomiting continue to occur. Severe headaches or body aches can also occur in connection with tumor lysis syndrome and also make everyday life more difficult for those affected.
If the disease is not treated, the patients suffer from heart failure and can also die from it. Abdominal or gastrointestinal complaints can also occur. In many cases, those affected suffer from cramps that are associated with severe pain. Treatment of tumor lysis syndrome is carried out with the help of drugs.
There are no complications. However, a completely positive course of the disease is not achieved. In severe cases, patients require a kidney transplant. Until the transplantation, the symptoms are alleviated with the help of dialysis. If the tumor lysis syndrome is treated with the help of chemotherapy, severe side effects occur in many cases.
When should you go to the doctor?
Since tumor lysis syndrome cannot heal on its own, this complication must be treated by a doctor in any case. In the worst case, this can lead to death from kidney failure if this syndrome is not treated properly or not in time. Early diagnosis and subsequent treatment have a very positive effect on the further course of this disease. A doctor should be contacted for tumor lysis syndrome if the patient suffers from symptoms such as headaches or severe depression as part of chemotherapy.
This often leads to permanent tiredness or diarrhea and vomiting. Anemia or severe paralysis and emotional disorders can also point to the disease. They should not be confused with the usual side effects of chemotherapy and should always be checked by a healthcare professional. As a rule, people with tumor lysis syndrome should contact the doctor who is treating the cancer. Further measures depend heavily on the exact symptoms and their severity.
Treatment & Therapy
As soon as tumor lysis syndrome has set in, maintaining kidney function is the focus of all therapeutic efforts. The blood values of the patients are taken regularly, with the aim of compensating for the derailed values. Rasburicase can lower an acutely elevated uric acid level. This is a uric acid-degrading recombinant enzyme.
If acute renal failure occurs, this is a contraindication for the administration of allopurinol. The treatment of an onset of renal insufficiency always depends on the degree of functional failure. In the case of slight or even moderate functional losses, the deterioration of renal function is prevented by eliminating any risk factors.
Advanced renal failure requires renal replacement therapy such as peritoneal dialysis, hemofiltration, or hemodialysis. Additional erythropoietin and phosphate binders can be given. If the kidney tissue has been irreversibly damaged by the metabolic derailment, the dialysis obligation remains for the patient’s entire life.
In this case, a transplant of a donor kidney may become necessary in the long term. Since the treating physicians are aware of the risk of tumor lysis syndrome during chemotherapy, prophylactic measures are usually carried out together with chemotherapy so that metabolic derailment does not occur in the first place.
Prevention
To prevent tumor lysis syndrome, chemotherapy is ideally started slowly and with a low flow rate or with pre-phase therapy. Allopurinol is given prophylactically to control the synthesis of uric acid. Urinary alkalinization makes uric acid more water-soluble, making it easier to excrete. Increased fluid intake by the patient supports kidney function and thus increases diuresis.
Aftercare
In most cases, those affected with tumor lysis syndrome have only very few and only very limited measures or options for direct aftercare available. For this reason, those affected by this disease should see a doctor very early on, in order to prevent possible other complications and symptoms, since self-healing is also not possible.
Since tumor lysis syndrome is a genetic disease, it cannot be completely cured. Therefore, if you wish to have children, a genetic test and counseling should first be carried out in order to prevent the disease from recurring in the offspring. Most of those affected by tumor lysis syndrome are dependent on taking medication.
All doctor’s instructions should be followed. The correct dosage and regular intake must also be observed. Contact with other people affected by the disease can often have a positive effect on the further course. In many cases, the life expectancy of those affected is limited by this disease.
You can do that yourself
To avoid tumor lysis syndrome, close medical supervision is necessary. If typical symptoms such as weakness or urinary retention occur after or during chemotherapy, the doctor must be consulted. If left untreated, the syndrome causes life-threatening complications and can eventually lead to death from kidney failure or cerebral edema. Therefore, the body must be closely monitored during chemotherapy.
The doctor can prescribe suitable medication that lowers the uric acid level and prevents life-threatening urinary poisoning. After being diagnosed with cancer, patients should inform themselves about the risks of chemotherapy in order to be aware of any symptoms and symptoms. Medical textbooks provide the necessary knowledge to be able to take the right measures in the event of tumor lysis syndrome.
Accompanying the causal treatment, the individual symptoms can be alleviated by taking care to rest after the medical treatment. Tumor lysis syndrome places a great deal of stress on the body, which is why further stress must be avoided at all costs. The diet and in particular the food intake should be discussed with the doctor in order to optimally support the drug therapy.
