From the Research
Yes, tumor lysis syndrome (TLS) can occur in lung cancer without chemotherapy or radiation therapy, though it is rare. This condition can develop in patients with large, rapidly proliferating lung tumors, particularly small cell lung cancer, which has a high cell turnover rate 1. The most recent and highest quality study on this topic is from 2019, which reports a rare case of TLS after resection of a bulky carcinoid tumor of the lung 2. TLS occurs when cancer cells break down rapidly, releasing their contents into the bloodstream and causing metabolic abnormalities including hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Some key points to consider are:
- Risk factors for spontaneous TLS in lung cancer include large tumor burden, high proliferation rate, pre-existing kidney dysfunction, and dehydration.
- Patients may present with symptoms like nausea, vomiting, lethargy, heart arrhythmias, seizures, or acute kidney injury.
- Management includes aggressive hydration, allopurinol or rasburicase to control uric acid levels, correction of electrolyte abnormalities, and sometimes dialysis in severe cases.
- Clinicians should monitor high-risk lung cancer patients for TLS even before initiating cancer-directed therapy, as early recognition and intervention are crucial for preventing life-threatening complications 2. It's worth noting that while the majority of the evidence is from older studies, the most recent study from 2019 2 supports the idea that TLS can occur in lung cancer without chemotherapy or radiation therapy. Overall, clinicians should be aware of the potential for TLS in lung cancer patients, even in the absence of chemotherapy or radiation therapy, and take steps to monitor and manage these patients accordingly.