Oncological emergencies - specific cancer types and immediate ED management Introduction
Oncological emergencies are acute, potentially life‑threatening complications of cancer or its treatment. Emergency clinicians must rapidly recognise life‑ or organ‑threatening problems, initiate stabilisation, perform focused investigations and activate time‑critical specialist pathways.
This section summarises high‑yield, cancer‑type-specific emergencies seen in the ED, emphasising red flags, immediate actions, investigations to order, and likely definitive/specialist interventions. National guidance (notably NICE, MHRA and Resuscitation Council UK) should inform local protocols and referral pathways.
Clinical approach in the ED
- Prioritise airway, breathing and circulation and prevent further organ injury while arranging investigations and specialist input.
- Obtain a focused history including cancer type, stage, recent or planned systemic therapy (including immuno/targeted agents), and presence of indwelling devices or vascular access.
- Record vital signs and baseline tests early (FBC, U&E, creatinine, LFTs, coagulation, ECG as indicated).
- Perform focused examinations targeted to the presenting problem (neurological exam for back pain, cardiorespiratory exam for dyspnoea, abdominal exam for pain, etc.).
- Notify oncology/haematology and relevant specialist teams early for time‑critical problems (spinal surgery, neurosurgery, interventional radiology, cardiothoracic surgery, nephrology, ICU).
Metastatic spinal cord compression (MSCC) (NICE NG234)
Recognition and why it matters
MSCC results from extradural tumour (bony collapse, epidural extension or paraspinal mass) compressing the spinal cord or cauda equina. Common primaries include breast, prostate and lung; myeloma...