What is Tumor Lysis?
Tumor Lysis is a syndromic condition when our kidneys cannot filter the substances that are obtained via breakdown of cancer cells.
It is also commonly defined as oncologic emergency where the massive tumor lysis occurs by releasing large amounts of nucleic acids, potassium and phosphates in a systemic circulation.
Cause of Tumor Lysis
It commonly occurs in patients who are undergoing chemotherapeutic treatments for blood and cancers.
In such cases there will be an increase in white blood cell count in response to that of tumor cells which divide rapidly during treatments and in such cases, it leads to certain diseases such as acute leukemia and cause of aggressive non-Hodgkin lymphoma.
Apart from chemotherapeutic treatments, Tumor lysis may also occur due to radiation therapies, and patients who are undergoing hormonal and biological therapies and, in some cases, it may also occur due to corticosteroids.
Effects of Tumor Lysis
Cancer cells break either by a natural immune process or through treatments. At this time there will be a release of oncogenic substances into the blood, and the kidney find difficult to filter these substances which effects the normal levels of potassium, phosphate, calcium and nucleic acids, in the blood and at times it may also lead to deposition of uric acid in the kidneys which on later results in the formation of kidney stones.
If this tumor lysis syndrome is not recognized or concerned at an early stage, it causes life threatening problems such as increase in count of WBC.
As we all know our body tends to increase in number of WBC’s if there is a pathogenic reaction in our body.
It also leads to abnormal levels of potassium and calcium, where potassium and phosphorus level increases and calcium level drops drastically, in the systematic circulation which has a high risk of affecting the heart rhythm or it may result in injury in the cardiac conduction system and causes arrhythmia and also in brain causing neurological changes which leads to irritability and confusion.
Due to the change in electrolyte contents in the blood, the catabolic reaction occurs on nucleic acids which convert it into uric acids which results in affecting the renal tubules by inducing vasoconstriction, decreased renal blood flow and it also leads to inflammation in renal tubules on a result acute kidney injury occurs.
Tumor Lysis Pathogenesis
The pathogenic cause for tumor lysis generally occurs due to high proliferation rate of tumor cells, large tumor burden etc. and it may also cause due to high sensitivity to treatments such as chemotherapy, cytolytic antibody therapies or glucocorticoid therapies.
Sometimes it may also occur due to intake or emergence of anticancerous drugs which results in complications of tumor lysis, which leads to Hyperuricemia due to the consequences of purine nucleic acids and uric acid catabolism.
Acute Kidney Injury: an Example of Tumor Lysis
As mentioned, before we all know that tumor lysis syndrome brings many complications in the functioning of kidney.
Thus, the most important reason for acute kidney injury is that When there is an increased amount of uric acid in the excreted urine, the precipitation of uric acid in the renal tubules occurs which induces vasoconstriction and impairs autoregulation as a result there will be a decreased blood flow to renal tubules which ends in inflammation.
Overproduction of uric acids also leads to deposition of crystals in the renal tubules.
Tumor Lysis Symptoms
As we go through the symptoms for tumor lysis it will be mild at the starting state of this syndrome and if left uncared these cells starts proliferating and effects many of the body functions such as heart rhythm and it may also lead to improper functioning of brain due to neurological abnormalities occurring through this.
Some of the mild symptoms are listed below such as nausea, vomiting, diarrhea, twitches and cramps in muscles, fatigue, fever, confusion and irritation along with headache, delirium, hallucinations, irregular heart rate, tingling, weakness and seizures.
Tumor Lysis Diagnosis
Tumor lysis syndrome is usually diagnosed by
1. Complete Blood Count (CBC)
Here the blood cells are counted especially for WBC count as it indicates the possibility of pathogenic condition.
2. Uric Acid Level in the Blood
By testing the chemical composition of blood along with uric acid levels it helps us to find the state of functioning of kidney in a particular individual.
This test helps us to diagnose the amount of uric acid and other minerals excreted through urine which helps in identifying the filtration capability of kidney and the renal tubule and to conclude the state and nature of the disease.
Tumor Lysis Treatment
The physician should undergo the patient’s medical history and they also identify the type of cancer and also diagnosis the stages of it along with the cause and decides how to medicate or treat a patient.
The vital step involved while giving treatment to the individual is that to check whether the patient is given fluids intravenously through needles so that the body gets enough fluids and it is also important to monitor the urine and to give diuretics for the good flow of urine.
Tumor Lysis Citations
- Tumor Lysis Syndrome. JAMA Oncol . 2018 Jun 1;4(6):895.
- Current understanding of tumor lysis syndrome. Hematol Oncol . 2019 Dec;37(5):537-547.
- Tumor lysis syndrome: review of pathogenesis, risk factors and management of a medical emergency. Expert Rev Hematol . 2016;9(2):197-208.