Oncologic emergencies

The prognosis for the child with cancer has improved dramatically over the past decades. With this success comes the need for recognition and proper treatment of emergencies. Respiratory or circulatory failure may arise from compression of the SVC or airway. Epidural spinal cord compression by tumor may lead to irreversible paraplegia or urinary incontinence if intervention is not rapid. Raised intracranial pressure may be a life-threatening presentation of a brain tumor. Bone marrow failure, with anemia and thrombocytopenia, is associated with malignant infiltration of the marrow. Hyperleukocytosis carries a high risk of thrombotic events if not treated promptly. Coagulation abnormalities are seen in many childhood cancers at the time of diagnosis. Life-threatening metabolic abnormalities are observed at presentation in children with leukemia and lymphoma. Hypercalcemia, although rare, may be a difficult situation to correct. Immediate attention to these emergencies and appropriate treatment may save the life of a child with cancer or make his or her subsequent course just a little smoother.