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Tumor lysis syndrome (TLS) is a potentially life-threatening oncologic emergency that occurs when rapidly dividing cancer cells are destroyed en masse, releasing large amounts of intracellular contents into the bloodstream. This condition most commonly develops after initiation of chemotherapy in patients with high-grade lymphomas, leukemias, or large tumor burdens, though it can occasionally occur spontaneously.
Massive tumor cell destruction releases potassium, phosphorus, nucleic acids, and proteins into the circulation faster than the kidneys can eliminate them. Nucleic acid breakdown produces excessive uric acid, while released phosphorus binds calcium, leading to hypocalcemia. The resulting hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia create a cascade of metabolic derangements that can cause cardiac arrhythmias, seizures, acute kidney injury, and multi-organ failure.
Early recognition requires monitoring high-risk patients with baseline laboratory values and frequent electrolyte checks during treatment initiation. The diagnosis is confirmed by laboratory criteria showing elevated potassium, phosphorus, and uric acid with decreased calcium, often accompanied by rising creatinine. Management focuses on aggressive hydration, electrolyte correction, uric acid reduction with allopurinol or rasburicase, and supportive care including possible dialysis for severe cases.