Oncologic Emergencies - Differential Diagnosis Framework



HEMATOLOGIC ONCOLOGIC EMERGENCIES:

Hyperviscosity Syndrome:

 • Spontaneous bleeding

 • Shortness of breath

 • Neurologic deficits (peripheral neuropathies)

 • "Sausage-like" hemorrhagic retinal veins, serum viscosity > 4 cP

 • Associated with Waldenström macroglobulinemia.

Leukostasis:

 • WBC > 100,000/mm3

 • Respiratory failure

 • Intracranial hemorrhage

 • Early death

Neutropenic Fever:

 • Absolute neutrophil count < 500 cells/mm3

 • Single oral temperature of ≥38.3°C (101°F)

 • or a ≥38.0°C (100.4°F) sustained over a one-hour period



STRUCTURAL ONCOLOGIC EMERGENCIES::

Malignant Epidural Spinal Cord Compression:

 • New-onset back pain (worse when lying down)

 • Paraplegia (late presentation)

Superior Vena Cava Syndrome:

 • Facial edema

 • Cough

 • Dyspnea at rest

 • Hoarseness

 • Chest and shoulder pain, collateral venous circulation (chest wall)

Malignant Pericardial Effusion:

 • Dyspnea, chest pain, or palpitations

 • Pulsus paradoxus

 • Beck triad (muffled heart sounds, hypotension, increased jugular venous pressure)



METABOLIC ONCOLOGIC EMERGENCIES:

Tumor Lysis Syndrome:

 • Azotemia

 • Hyperphosphatemia

 • Hyperkalemia

 • Hyperuricemia

 • Acute renal failure

 • Hypocalcemia

Hypercalcemia Of Malignancy:

 • Progressive decline in mental function

 • Weakness

 • Anorexia

 • Thirst

 • Constipation

 • Nausea

 • Vomiting, decreased urine output, possible coma

SIADH:

 • Hyponatremia

 • Nausea, vomiting

 • Constipation

 • Muscle weakness



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