oncological-emergency

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.