Tumour Lysis Syndrome: Implications for Cancer Therapy

Abstract

Asian Pacific J Cancer Prev, 13, 3555-3560 IntroductionTumour lysis syndrome (TLS) is the development of an array of metabolic disturbances that may occur either spontaneously or in response to cancer therapies. It results when a huge number of rapidly dividing cancer cells, particularly leukemia and lymphoma, are killed or lysed by cytotoxic therapy such as chemotherapy and radiation. Normal intracellular components of cells include potassium, phosphorus and nucleic acids. These intracellular ions are present in large amounts in cancer cells as compared to those in normal cells.When malignant cells are killed by therapy they release their contents into the systemic circulation, which accumulate faster in the body than being eliminated from the body and the body's homeostatic mechanisms find it difficult to cope with. The release of these intracellular contents cause metabolic disturbances, which in turn manifest into life threatening complications such as hyperkalemia, hyperphosphotemia, hypocalcemia and hyperuricemia. Tumour lysis also releases cytokines that cause a systemic inflammatory response syndrome and often multiorgan failure (Hijiya et al., 2005;Nakamura et al., 2009;Soares et al., 2009).During the early stages, some patients do not experience any symptoms of TLS but have abnormal laboratory values, which is suggestive of its succession. Laboratory results will show high potassium, uric acid and phosphorus levels and low calcium levels in the blood.

Serum uric acid levels and cancer mortality risk among males in a large general population-based cohort study

“…The finding of an increased risk of cancer can be explained by the fact that SUA levels may have been altered by preexisting disease (cancer) at the time of measurement since hyperuricemia can be an indicator of the tumor lysis syndrome. The tumor lysis syndrome is a result of the rapid intracellular release of dying cancer cell’s contents, which may lead to hyperuricemia as well as other metabolic disorders [23]. Thus, an increased nucleic acid turnover in the rapid proliferation of neoplastic cells may lead to an increased level of SUA [7].…”

Chemotherapy-induced necrotising tumour lysis and perforation of a huge gastric cancer simulating emphysematous pancreatitis

“…Although the risk is low [18], tumour lysis of gastric cancer, either spontaneous [19,20] or induced by chemotherapy [21,22], occurred sporadically. Nevertheless, traditional concern about tumour lysis chiefly focus on life-threatening metabolic complications, including hyperuricemia, hyperkalaemia, hyperphosphatemia and hypocalcaemia, which result in renal failure, cardiac arrhythmia, and neurologic deficit [23,24].…”

Can conventional clinical chemistry tests help doctors in the monitoring of oncology patients?

“…A significant increase in serum phosphorus after tumour removal is a poor prognostic factor for patient survival [38]. Often, hyperphosphatemia is a typical sign of tumour lysis syndrome [39][40][41][42] and was proposed as one of the criteria of the laboratory tumour lysis syndrome diagnosis [43]. Since the development of tumour lysis syndrome threatens the patient's life due to the possible development of complications (acute renal failure, cardiac arrhythmia, convulsions, and multiple organ damage), the presence and severity of hyperphosphatemia (along with the content of creatinine and uric acid) can be an important prognostic factor [42,44,45].…”