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The recognition and nursing management of common oncological emergencies in children

13 January 2022
15 min read
Volume 31 · Issue 1

Abstract

An oncological emergency may be the initial presentation of a cancer, a sign of cancer progression, or a complication of cancer treatment. The most frequently encountered paediatric oncological emergencies include neutropenic sepsis, hyperleukocytosis, brain tumours presenting with raised intracranial pressure, tumour lysis syndrome and superior mediastinal syndrome. These are all life-threatening conditions that require urgent recognition and management. Health professionals working in an emergency department (ED) are likely to be involved in managing these children. This article brings together the current guidance and recommendations for these specific emergencies. It also includes two case studies that demonstrate the challenges health professionals can face while managing these situations. It is important that health professionals have an acute awareness of oncological emergencies. Confidence in recognising the presentations, diagnoses and initial management are essential because these conditions may be life-threatening and time critical.

An oncological emergency is caused by either a cancer or its treatment. It requires rapid intervention to avoid mortality and morbidity. Cancer is the leading cause of death in children up to 14 years of age with the exception of accidents (Public Health England (PHE), 2018). Oncological emergencies can present at the initial diagnosis but also may occur due to cancer progression, recurrence, or as a side-effect of cancer treatment. This article discusses the recognition and acute management of the most common oncological emergencies. These include neutropenic sepsis, hyperleukocytosis, raised intracranial pressure, tumour lysis syndrome (TLS) and superior mediastinal syndrome, which are likely to be encountered by nurses working in different non-specialist settings. Two illustrative case studies are included to demonstrate some of the challenges that nurses may encounter in clinical practice.

In the UK each year, around 1900 new cases of childhood (0-14 years) cancers are diagnosed (Children with Cancer UK, 2021). The most common are:

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