What is Tumour Lysis Syndrome?

As cancer cells break down in the body, they release substances into the blood. If the rate at which the cancer cells are breaking down is faster than your kidney’s ability to flush these substances from the body, it can cause Tumour Lysis Syndrome or TLS.
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Blood levels of someone suffering from TLS usually include high levels of phosphate, potassium, uric acid, and low levels of calcium.
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TLS can be life-threatening and needs to be treated immediately. If left untreated, abnormal blood levels can result in various problems throughout the body, including:

• Painful gout-like condition due to uric acid deposits in the joints.
• Kidney damage and stones due to build-up of uric acid in the kidneys and high phosphate levels
• Heart rhythm irregularities due to abnormal levels of potassium and calcium
• Neurological symptoms such as confusion, irritability and confusion.
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What causes Tumour Lysis Syndrome?

TLS is more likely to develop when certain cancers or blood disorders are treated with chemotherapy. These cancers, such as acute leukaemia, aggressive non-Hodgkin’s lymphoma or myeloproliferative disorders, have a high white blood cell count or rapidly dividing cells.
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TLS typically occurs at the beginning of chemotherapy. During the first 72 hours of chemotherapy, there are a large number of cancer cells being destroyed which increases the risk of TLS.
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TLS has also been linked to other treatments such as radiation therapy, biological therapy, hormonal therapy, and corticosteroids..
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How is Tumour Lysis Syndrome Diagnosed?

TLS is diagnosed through blood tests including Full Blood Count (FBC), blood chemistry and uric acid level, as well as an urinalysis.
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What are the Symptoms of Tumour Lysis Syndrome?

Symptoms associated with TLS may start off mild and increase as the levels of abnormal substances in the blood increase.
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Symptoms of tumour lysis syndrome include:

• Nausea, vomiting or diarrhoea
• Muscle cramps or twitches
• Weakness or fatigue
• Numbness or tingling
• Decreased urination
• Irregular heart rate
• Confusion, delirium, or hallucinations
• Restlessness and irritability
• Seizures
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Inform our doctor immediately if you experience any of these symptoms.
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How is Tumour Lysis Syndrome Treated?

Our doctor will determine your risk of developing tumour lysis syndrome before treatment.
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Risk factors include:

• Type of cancer
• Stage of cancer
• Heart disease
• High blood pressure
• Poor kidney function
• Abnormal laboratory tests
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If you are at a higher risk of developing tumour lysis syndrome, there are various methods to reduce this risk. This includes ensuring you get enough fluids. This is usually given intravenously 24 to 48 hours before your treatment is scheduled, and for several days after treatment is completed. Our medical team will also need to monitor your urine output during this period. You may be prescribed a diuretic to help urine production.
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Our doctors will perform blood tests to monitor symptoms of tumour lysis syndrome. Should symptoms develop, there are various treatments available.
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Medication
Allopurinol may be prescribed to stop your body from making uric acid. You may also be given a drug called Rasburicase to break down uric acid so that the body can get rid of it easily.
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Drugs to help stop uric acid from forming crystals may also be prescribed, making it easier for the kidneys to flush it from the body.
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Dialysis
Dialysis may be required if tumour lysis syndrome cannot be treated with medication and if the kidney failure worsens. This is to aid in the removal of waste from the body if the kidney function is compromised.
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Disclaimer:
The information on the Centre For Clinical Haematology website is intended for educational use.  It should not be considered or used as a substitute for medical advice, diagnosis or treatment from a qualified health professional.