Colorectal Cancer-Associated Spontaneous Tumor Lysis Syndrome: a Case Report and Review of the Current Literature

摘要

Background: Tumor lysis syndrome (TLS) represents an oncologic emergency caused by the destruction of malignant cells and subsequent release of intracellular contents into the bloodstream. TLS is characterized by a constellation of laboratory abnormalities: hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia. TLS can be defined by the Cairo Bishop criteria [1], which defines laboratory TLS (TLS with only laboratory abnormalities and absent clinical manifestations) and clinical TLS. Tumor-specific risk factors for TLS include the proliferation rate, sensitivity to treatment, and baseline tumor burden while patient-specific risk factors include pre-existing kidney disease, and volume status [2]. Cellular lysis can occur in the setting of either systemic treatment or localized radiation; alternatively, spontaneous TLS can occur in the absence of any therapeutic intervention. As cellular breakdown products are released into the bloodstream, uric acid and calcium phosphate crystals can precipitate in the renal tubules. Acute renal failure may occur due to deposition of crystals in the tubules and by crystal-independent mechanisms of hyperuricemia-induced renal injury [3]. The resulting electrolyte disturbances may precipitate cardiac arrhythmias and seizures.