Recognizing & Managing Cancer Emergencies

Most side effects of cancer treatment can wait until Monday. A small number cannot. In these situations, a delay of hours changes the outcome. The right move is to call the number your team gave you, or to go to an emergency department. Do not wait to see whether it settles.

This page is not here to frighten you. It is here so that if one of these happens, you recognize it quickly and act on it without apologizing.

If you are on cancer treatment, you should have been given a phone number answered around the clock. It is usually a triage line (a nurse line that sorts out how urgent a problem is) at your cancer center, or an on-call oncology service. If you do not have one, ask at your next visit. Then put it in your phone, on the fridge, and in your wallet.

Use it. These lines exist precisely for the calls people worry are "not serious enough." The nurses would far rather assess a false alarm than hear about a problem two days late.

At an emergency department, tell the person checking you in that you are a cancer patient and that you are on chemotherapy. CDC says a fever during chemotherapy is life threatening and you should be seen quickly.

Many cancer treatments lower the white blood cells that fight infection. An ordinary infection can then turn dangerous fast. Fever may be the only sign you get. The usual redness, pus and swelling may never appear.

During chemotherapy, or any time your team has told you your white count is low, a temperature of 100.4 °F (38 °C) or higher means calling your care team right away, at any hour. One reading is enough. Do not wait an hour or check again first. CDC treats a fever during chemotherapy as a medical emergency and says to phone your doctor immediately (CDC). It also says to know which number to call when the office is closed. If your team gave you a lower number, use theirs. If you are unsure, call anyway. No oncology service minds being called.

NCI states that infections during cancer treatment can be life threatening. They require urgent medical attention. NCI also warns that fever-reducing medicines can lower a temperature, but they may mask signs of a more serious problem. So ask your team before you take them.

Call without waiting if you have:

• Fever at or above your team's threshold, or shaking chills even without a measured fever
• New cough, breathlessness, sore throat, or burning when you pass urine
• Redness, swelling, pain or discharge around a catheter, port or wound
• Confusion, dizziness on standing, or suddenly feeling inexplicably unwell

Cancer that has spread to the spine can press on the spinal cord. The American Cancer Society calls this an emergency. If it is not treated right away, the person can become paralyzed. That is why "I'll mention it at my appointment next week" is the wrong instinct here.

Watch for these warning signs:

• Back pain, sometimes with pain going down one or both legs
• Numbness of the legs or belly
• Leg weakness or trouble moving your legs
• Loss of control of urine or stool

If you have a history of cancer and new leg weakness, numbness or loss of control of urine or stool, go to the emergency room or call 911 right away. MedlinePlus says treatment for a spinal tumor should be given quickly. For back pain alone, call your team's 24-hour number right away. The risk is higher for people with cancer that has spread to bone. See metastatic cancer.

Three other emergencies are worth knowing by name. They are easily mistaken for ordinary side effects.

Tumor lysis syndrome happens when a large number of cancer cells break down at once. It is most common in people with large numbers of leukemia cells, early in treatment. The contents released by those cells can overwhelm the kidneys. They can also affect the heart and nervous system. Teams plan ahead for it with fluids and medicines. In the days after treatment begins, report any new symptoms to your team right away.

High calcium in the blood (hypercalcemia) can be life threatening if it is not found early and treated. Signs include constant thirst, passing urine often, constipation, belly pain, feeling sluggish or sleepy, muscle weakness and confusion. If you notice these, call your care team right away.

Superior vena cava syndrome happens when something blocks a large vein. That vein returns blood from the head and arms to the heart. Look for swelling of the face, neck, arms or upper chest, trouble breathing, headaches, dizziness, confusion, blurry vision or fainting. It can be life threatening and needs treatment right away. Call your care team right away. For severe trouble breathing, fainting or new confusion, call 911 or go to the ER. Do not drive yourself.

Not every worrying symptom is one of these. Most turn out to be something ordinary. But the cost of checking is an hour of your time. The cost of not checking can be much higher. Keep the 24-hour number where you can find it at 3 a.m. Tell whoever lives with you what these signs look like. Treat "something is wrong and I can't explain it" as reason enough to call. For symptoms that are troubling but not urgent, pain and symptom relief covers what to raise at a routine visit.

• National Cancer Institute — Infection and Neutropenia during Cancer Treatment
• MedlinePlus — Cancer treatment: preventing infection
• American Cancer Society — Fever and Infections
• CDC — Fever
• MedlinePlus — Spinal tumor
• American Cancer Society — Bone Metastases (spinal cord compression)
• American Cancer Society — Chemotherapy for AML (tumor lysis syndrome)
• American Cancer Society — Hypercalcemia
• American Cancer Society — Childhood Lymphoma Symptoms (superior vena cava syndrome)