Oncologic Emergencies

Ninja Nerd

Ninja Nerds!

In this episode of the Ninja Nerd Podcast, Zach and Rob deliver a high-yield, case-based breakdown of the most important oncologic emergencies that require rapid recognition and management.

We begin with neutropenic fever, highlighting when to suspect it, which labs to order, and why empiric IV antibiotics must be started immediately. From there, we move into tumor lysis syndrome, reviewing the hallmark lab abnormalities, urgent interventions with fluids, rasburicase, and electrolyte management, and the potential for acute renal failure.

Next, we explore spinal cord compression, a true emergency that presents with back pain, weakness, and bladder dysfunction. Zach emphasizes the importance of initiating steroids right away and consulting for surgical or radiation decompression to preserve neurologic function.

We then discuss leukostasis, a complication of acute leukemia that presents with respiratory distress, vision changes, and neurologic symptoms. Management focuses on emergent cytoreduction with hydroxyurea and leukapheresis while avoiding interventions that worsen blood viscosity.

The episode continues with cardiac tamponade, presenting with hypotension, JVD, and distant heart sounds. We review the urgent role of echocardiography, pericardiocentesis, and definitive management options.

In our sixth case, we cover hypercalcemia of malignancy, reviewing stepwise evaluation, the role of PTHrP, and treatment with IV fluids, calcitonin, and bisphosphonates, along with complications such as renal injury and arrhythmias.

Finally, we conclude with superior vena cava (SVC) syndrome, discussing key clinical features like facial swelling and venous distension, imaging findings, and management strategies including biopsy, chemoradiation, and stenting in unstable cases.

By the end of this session, you’ll have a clear, stepwise framework for approaching seven of the most time-sensitive oncologic emergencies, reinforced with clinical reasoning, red flag recognition, and immediate interventions.

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