In short, Tumor Lysis Syndrome (TLS) is a metabolic consequence of the dissolution of cancerous cells within the body. TLS typically occurs following cytotoxic (i.e. chemotherapeutic) intervention, meaning that a cancer patient might receive chemotherapy, and if their tumor (i.e. their cancer) is an aggressive one, the cancer cells that are killed by chemotherapy do not simply shrivel up and pass out of the body. Instead, they release their contents into the bloodstream. This throws the blood's metabolic state out of balance and produces several serious health issues resulting in TLS, which can be characterized by three conditions:
Hyperkalemia: A potassium build-up in the blood.
Hyperphosphatemia: A phosphate build-up in the blood.
Hyperuricemia: A uric acid build-up in the blood
The metabolic balance in our blood is maintained by our kidneys. Thus under normal circumstances, our kidneys see toit that there are normal levels of potassium, phosphates and uric acid in the blood, but TLS can overwhelm the kidneys and cause renal failure, which is a serious condition requiriing immediate treatnment.
Risk Factors for TLS
Patients with especially aggressive tumors are at the greatest risk of developing Tumor Lysis Syndrome because aggressive tumors respond to chemotherapy and similar anti-cancer interventions much better than indolent tumors. These tumors include:
-- Burkitt's lymphoma
-- Lymphoblastic Lymphoma
-- T-cell acute lymphoblastic leukemia
Lower risk tumors include:
-- Low grade lymphomas
-- Small cell carcinomas
-- Breast carcinomas
-- Multiple myelomas
Other risk factors include:
-- Bulky disease
-- Hepatosplenomegaly (the swelling of the liver and the spleen beyond normal size)
-- High leukocyte count
-- Elevated LDH levels (pre-treatment)
-- Elevated levels of uric acid (pre-treatment)
-- Compromised kidney functions
-- Decreased urine output
Treatment strategies
Several treatment strategies exist to deal with Tumor Lysis Syndrome, and patients should be made aware of their risk factors of developing TLS due to anti-cancer treatment by their physicians. In some cases preventive measures can be taken prior to beginning treatment to avoid TLS.
Sources
- Boyiadzis, Michael M. et al. Hematology-Oncology Therapy. 2007. New York: McGraw Hill, Medical Publishing Division.
- PubMed Health: Hyperkalemia
- MedlinePlus: Hepatomegaly
