{"slug":"acute-oncology","tag":"acute-oncology","variants":["acute-oncology"],"description":"No description yet","count":22,"kinds":{"protocol":22},"related":[{"slug":"protocol","tag":"protocol","shared":22},{"slug":"oncological-emergency","tag":"oncological-emergency","shared":11},{"slug":"irae","tag":"irae","shared":7},{"slug":"car-t","tag":"car-t","shared":3},{"slug":"cell-therapy","tag":"cell-therapy","shared":3},{"slug":"endocrine","tag":"endocrine","shared":2},{"slug":"metabolic","tag":"metabolic","shared":2},{"slug":"neutropenic-sepsis","tag":"neutropenic-sepsis","shared":2},{"slug":"cardio-oncology","tag":"cardio-oncology","shared":1},{"slug":"electrolytes","tag":"electrolytes","shared":1},{"slug":"haematology","tag":"haematology","shared":1},{"slug":"neurology","tag":"neurology","shared":1}],"records":[{"id":"acute-oncology-telephone-triage","kind":"protocol","name":"Acute oncology telephone triage: the 24-hour helpline and the UKONS red, amber and green grading","route":"/protocols/acute-oncology-telephone-triage/","tldr":"During cancer treatment you should have a phone number answered day and night. A trained nurse asks set questions about each symptom and grades it green, amber or red. Green means advice for home, one amber a review within 24 hours, and red (or two ambers) being seen in person as soon as possible. A temperature of 37.5 °C or more, or below 36 °C, always means urgent assessment."},{"id":"crs-grading-and-management","kind":"protocol","name":"Cytokine release syndrome after CAR T-cell therapy: ASTCT grading, tocilizumab and steroids","route":"/protocols/crs-grading-and-management/","tldr":"After CAR T-cell therapy, the immune cells can release a flood of chemical messengers, causing fever, low blood pressure and breathing trouble: cytokine release syndrome. Any fever after CAR T-cell therapy needs the treating centre at once. Teams grade it from 1 to 4 and treat with tocilizumab and, if needed, steroids; infection is treated at the same time because the two look alike."},{"id":"febrile-neutropenia-first-hour","kind":"protocol","name":"Suspected febrile neutropenia (neutropenic sepsis): the first hour","route":"/protocols/febrile-neutropenia-first-hour/","tldr":"Anyone having cancer treatment who feels unwell, with or without a high temperature, should ring their 24-hour cancer line and be seen in hospital straight away. There they should be given a strong antibiotic through a drip within about an hour, without waiting for the blood count to come back."},{"id":"hypercalcaemia-of-malignancy-management","kind":"protocol","name":"Hypercalcaemia of malignancy: assessment, intravenous fluids, bisphosphonate or denosumab","route":"/protocols/hypercalcaemia-of-malignancy-management/","tldr":"Some cancers raise the calcium level in the blood. It causes thirst, passing a lot of urine, constipation, sickness, tiredness and confusion, and can be dangerous. A blood test confirms it. Treatment is a drip of fluid, then a medicine that stops calcium leaving the bones (a bisphosphonate such as zoledronic acid, or denosumab), alongside treatment of the cancer itself."},{"id":"hyperleukocytosis-leukostasis","kind":"protocol","name":"Hyperleukocytosis and leukostasis in acute leukaemia: supportive care, cytoreduction and leukapheresis","route":"/protocols/hyperleukocytosis-leukostasis/","tldr":"In some leukaemias the white cell count is so high that the blood thickens and blocks small vessels in the lungs, brain and kidneys. This leukostasis is an emergency. The cells are brought down quickly with hydroxyurea and then chemotherapy; sometimes a machine filters them out. Blood transfusions are avoided unless really needed, because they thicken the blood further."},{"id":"hyponatraemia-siadh","kind":"protocol","name":"Hyponatraemia and SIADH in cancer: emergency hypertonic saline, safe correction and treating the cause","route":"/protocols/hyponatraemia-siadh/","tldr":"Low sodium in the blood is common in cancer, especially small-cell lung cancer, and can also come from some cancer drugs, sickness or diarrhoea. Vomiting, confusion, drowsiness or a fit with low sodium is an emergency: hospital teams give a strong salt drip in small doses and check often, because raising sodium too fast can damage the brain. Then the cause is treated."},{"id":"icans-grading-and-management","kind":"protocol","name":"ICANS after CAR T-cell therapy: ICE score, ASTCT grading, steroids and seizure management","route":"/protocols/icans-grading-and-management/","tldr":"In the weeks after CAR T-cell therapy, some people become confused, struggle to find words or write, become very sleepy, or rarely have seizures. This is ICANS. Nurses check a short test of orientation, naming, writing and counting (the ICE score). Steroids such as dexamethasone treat it, and most people recover. A carer who notices confusion or odd speech should call the centre at once."},{"id":"iec-hs-management","kind":"protocol","name":"IEC-HS after CAR T-cell therapy: recognition and stepwise treatment","route":"/protocols/iec-hs-management/","tldr":"Rarely after CAR T-cell therapy the immune system stays switched on after cytokine release syndrome has settled, and starts damaging the blood, liver and clotting (IEC-HS). It shows as very high ferritin, falling blood counts, low clotting proteins and liver test changes. It is treated with anakinra and steroids, adding other drugs if it worsens, while infection and relapse are ruled out."},{"id":"irae-colitis","kind":"protocol","name":"Immune-related diarrhoea and colitis from checkpoint inhibitors, by grade","route":"/protocols/irae-colitis/","tldr":"Immunotherapy drugs such as pembrolizumab, nivolumab and ipilimumab can make the immune system attack the bowel, causing diarrhoea, tummy pain or blood in the stool. Ring your cancer team's 24-hour line as soon as diarrhoea starts. Mild cases are watched; anything more is treated with steroids, and if steroids do not work within a few days, with a drip such as infliximab."},{"id":"irae-diabetes","kind":"protocol","name":"Immune-related type 1 diabetes and diabetic ketoacidosis from checkpoint inhibitors","route":"/protocols/irae-diabetes/","tldr":"Rarely, immunotherapy destroys the cells that make insulin. Blood sugar can rise within days and become dangerous (diabetic ketoacidosis). Thirst, passing a lot of urine, being sick or feeling drowsy need urgent help. It is treated with insulin, which is almost always lifelong, and not with steroids."},{"id":"irae-hepatitis","kind":"protocol","name":"Immune-mediated hepatitis from checkpoint inhibitors, by grade","route":"/protocols/irae-hepatitis/","tldr":"Immunotherapy can inflame the liver, usually without symptoms, so liver blood tests are checked before every dose. If the tests rise, immunotherapy is paused and steroids are given; severe cases mean stopping immunotherapy. Yellow skin or eyes, dark urine or pale stools need a call to your cancer team the same day."},{"id":"irae-hypophysitis-adrenal","kind":"protocol","name":"Checkpoint inhibitor hypophysitis and adrenal insufficiency: emergency treatment, replacement and steroid emergency card","route":"/protocols/irae-hypophysitis-adrenal/","tldr":"Immunotherapy can damage the pituitary or adrenal glands so the body stops making cortisol, a hormone needed to survive illness. Anyone on immunotherapy who becomes very unwell should be treated for low cortisol at once while tests are done. Most then need hydrocortisone tablets for life, a steroid emergency card, and to know how to double the dose when ill. Immunotherapy can usually carry on."},{"id":"irae-myocarditis","kind":"protocol","name":"Immune-related myocarditis from checkpoint inhibitors","route":"/protocols/irae-myocarditis/","tldr":"Rarely, immunotherapy inflames the heart muscle. It usually starts in the first three months and can be fatal, so new chest pain, breathlessness, palpitations, fainting, or new muscle weakness, drooping eyelids or double vision need urgent assessment. It is treated in hospital with very high-dose steroids straight away."},{"id":"irae-neurological","kind":"protocol","name":"Neurological side effects of checkpoint inhibitors: myasthenia gravis, Guillain-Barré syndrome, meningitis and encephalitis","route":"/protocols/irae-neurological/","tldr":"Immunotherapy rarely inflames the nerves, the brain or the junction between nerve and muscle. Drooping eyelids, double vision, trouble swallowing or speaking, weakness spreading up the legs, numbness, severe headache with a stiff neck, confusion or a seizure need urgent assessment. Treatment is quick high-dose steroids, often with immunoglobulin or plasma exchange, and a neurologist."},{"id":"irae-pneumonitis","kind":"protocol","name":"Immune-related pneumonitis from checkpoint inhibitors, by grade","route":"/protocols/irae-pneumonitis/","tldr":"Immunotherapy can inflame the lungs. A new cough, breathlessness or chest pain during or after immunotherapy should be reported to your cancer team the same day. A CT scan of the chest confirms it, and steroids are the main treatment; severe cases need hospital and steroids through a drip."},{"id":"malignant-bowel-obstruction","kind":"protocol","name":"Malignant bowel obstruction in advanced cancer: medicines, decompression, stents, surgery and nutrition","route":"/protocols/malignant-bowel-obstruction/","tldr":"Advanced bowel, ovarian or other abdominal cancer can block the bowel. Cramping pain, a swollen tummy, being sick and not passing wind or stools need urgent assessment; a CT scan confirms it. Treatment depends on what you want from care and how well you are: some people have a stent or an operation, many have medicines for sickness and pain, sometimes with a tube to drain the stomach."},{"id":"malignant-pericardial-effusion","kind":"protocol","name":"Malignant pericardial effusion: tamponade, drainage, cytology and preventing recurrence","route":"/protocols/malignant-pericardial-effusion/","tldr":"Cancer can cause fluid to build up in the sac around the heart. When there is a lot, the heart cannot fill properly: breathlessness, a fast heartbeat, feeling faint or low blood pressure need emergency care. A heart ultrasound finds the fluid, and a needle and drain remove it. Because it often comes back, doctors may leave a drain in for a few days or make an opening in the sac."},{"id":"metastatic-spinal-cord-compression-emergency","kind":"protocol","name":"Metastatic spinal cord compression: recognition, MSCC coordinator, MRI, dexamethasone, radiotherapy and surgery","route":"/protocols/metastatic-spinal-cord-compression-emergency/","tldr":"Cancer that has spread to the spine can press on the spinal cord. New back or neck pain that is severe, worse at night or on coughing, or any weakness, numbness, or trouble passing urine or stools, needs a same-day call to your cancer team. The hospital should do an MRI of the whole spine within 24 hours, give dexamethasone, and plan radiotherapy or surgery quickly, to keep you walking."},{"id":"neutropenic-enterocolitis","kind":"protocol","name":"Neutropenic enterocolitis (typhlitis): imaging, cultures, antibiotics and conservative care","route":"/protocols/neutropenic-enterocolitis/","tldr":"During intensive chemotherapy, when white cells are very low, the bowel wall can become inflamed and infected. Fever with tummy pain, diarrhoea or bloating is an emergency: ring your treatment helpline at once. In hospital it is confirmed with an ultrasound or CT scan and treated with strong antibiotics through a drip, fluids, pain relief and resting the bowel, with surgeons asked to see you."},{"id":"raised-intracranial-pressure","kind":"protocol","name":"Raised intracranial pressure in cancer: recognition, urgent scan, dexamethasone and referral","route":"/protocols/raised-intracranial-pressure/","tldr":"Cancer in or spreading to the brain can raise the pressure inside the skull. A headache that is worse in the morning or on coughing, being sick without feeling sick, new confusion, a fit or a change in vision needs a same-day call to your cancer team. Usually a brain scan is done and a steroid called dexamethasone is started to reduce the swelling, then lowered as soon as it can be."},{"id":"svc-obstruction","kind":"protocol","name":"Superior vena cava obstruction in cancer: recognition, imaging, stenting and treatment of the cause","route":"/protocols/svc-obstruction/","tldr":"A cancer in the chest, most often lung cancer or lymphoma, can squeeze the large vein that brings blood back from the head and arms. The face, neck and arms swell, and breathing can become difficult: this needs urgent hospital assessment the same day. A CT scan confirms it; a small metal tube (stent) in the vein can relieve symptoms within days, and chemotherapy or radiotherapy treats the cancer."},{"id":"tumour-lysis-syndrome-prevention-and-treatment","kind":"protocol","name":"Tumour lysis syndrome: risk assessment, prophylaxis and treatment","route":"/protocols/tumour-lysis-syndrome-prevention-and-treatment/","tldr":"When a fast-growing cancer such as some leukaemias and lymphomas is first treated, many cancer cells can die at once and flood the blood with potassium, phosphate and uric acid, which can damage the kidneys and heart. Teams check who is at risk, give extra fluids and a medicine (allopurinol, or rasburicase for higher risk) before treatment, and check blood tests often in the first days."}]}