[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Cancer emergencies on the ward: cord compression, SVC syndrome, high calcium and tumour lysis

# Cancer emergencies on the ward: cord compression, SVC syndrome, high calcium and tumour lysis

- Assessment

New back pain, a swollen face, confusion or a falling urine output in a person with cancer can be an emergency: the nurse spots it and calls early.

Updated Nov 13, 2026

## Key points

- Any new or worsening back pain in a person with cancer should raise suspicion of cord compression; report it promptly, and at once if there is weakness, numbness or bladder or bowel change.
- Superior vena cava obstruction: swelling of the face, neck and arms, distended neck or chest veins and breathlessness, worse lying flat; stridor or confusion is urgent.
- High calcium: nausea, vomiting, constipation, passing a lot of urine, thirst, weakness, drowsiness and confusion.
- Tumour lysis after treatment of fast-growing cancers: close intake and output, rhythm watch and the ordered potassium, phosphate, calcium, uric acid and creatinine results.
- Fever with low neutrophils is its own emergency: see the neutropenia page.

## What it is

Some complications of cancer and its treatment threaten life or function within hours to days, and the first person to notice them is often the ward nurse. Spinal cord compression starts with new or worsening back pain and can progress to weakness and loss of bladder and bowel control; superior vena cava obstruction swells the face, neck and arms and worsens lying flat; high calcium causes nausea, constipation, thirst, weakness and confusion; tumour lysis after treatment of fast-growing cancers upsets potassium, phosphate, calcium and kidney function. Febrile neutropenia is covered on its own page. This page is about recognising these pictures, the first nursing response and calling for help; the treatment itself is decided by the medical team.

## What you need

- Knowing the person's cancer, recent treatment and risk factors for each emergency.
- A neurological check of the legs and a question about bladder and bowel for anyone with back pain.
- Strict intake and output, and the ordered laboratory results compared with the previous ones.
- Cardiac rhythm monitoring when the team orders it.
- The early-warning score and the unit's route for calling the medical team.

## How to measure it (and why)

- Ask every person with cancer about new back or neck pain, and whether coughing or straining worsens it — early pain is the main clue to cord compression.
- With back pain, check leg strength, sensation, walking and bladder and bowel control — weakness, numbness or retention mean a neurological emergency.
- Report suspected cord compression at once and record the time — treatment within 48 hours of a neurological deficit helps preserve function.
- Look at the face, neck, arms and chest veins and ask about breathlessness lying flat — these point to superior vena cava obstruction.
- Raise the head of the bed and watch the airway in a person with face and neck swelling — stridor or confusion needs immediate help.
- Ask about nausea, constipation, thirst, passing a lot of urine and new confusion — these suggest high calcium; check the latest calcium result.
- After treatment of a fast-growing cancer, record intake and output strictly and report a falling urine output — tumour lysis can damage the kidneys.
- Watch the cardiac monitor and the ordered potassium, phosphate, calcium, uric acid and creatinine results — high potassium can cause arrhythmia.
- Give the ordered fluids and medicines on time and reassess often, with the early-warning score — these conditions change quickly.

## How to read it

- Cord compression: the pain may come before any weakness; brisk reflexes, a sensory level and loss of anal tone are findings the medical team examines.
- Superior vena cava obstruction can also be caused by central lines or devices, not only by tumour.
- Hypercalcaemia is the most common metabolic emergency in cancer; severe cases can progress to coma and arrhythmias.
- Tumour lysis is defined by laboratory changes, sometimes with a rise in creatinine, an arrhythmia or a seizure.
- In a person who is dying, the team and family may decide on comfort-focused care; the end-of-life pages guide that care.

## Next step: when to call for help

- Call the medical team at once for: weakness, numbness or new bladder or bowel problems with back pain; stridor, severe breathlessness or confusion with face swelling; a seizure or new arrhythmia.
- Report promptly new or worsening back pain in a person with cancer, even with a normal examination: it needs medical evaluation within 24 to 48 hours.
- Report a falling urine output, a positive fluid balance or rising potassium, phosphate or creatinine after treatment of a fast-growing cancer.
- Report new confusion, drowsiness, vomiting or severe constipation, and check the calcium result.
- Use structured handover (for example SBAR) and record the time of the call and the response.

## Test yourself

Think of the answer, then tap the question to see it.

## Which early symptom should make the nurse think of spinal cord compression in a person with cancer?

New or worsening back pain, often worse with coughing or straining, even before any weakness appears.

## What are the signs of superior vena cava obstruction?

Swelling of the face, neck and arms, distended neck or chest veins, cough and breathlessness, typically worse when lying flat.

## Which symptoms suggest high calcium in a person with cancer?

Nausea, vomiting, constipation, passing a lot of urine, thirst, muscle weakness, drowsiness and confusion.

## What does the nurse monitor after treatment of a fast-growing cancer at risk of tumour lysis?

Strict intake and output, the heart rhythm and the ordered potassium, phosphate, calcium, uric acid and creatinine results.

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## Connections

## Related 3

- [Recognising deterioration and calling the rapid response team](https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/)
- [Neutropenia and low platelets: infection and bleeding precautions, and fever as an emergency](https://durgical.com/en/nursing/neutropenia-and-low-platelets-infection-and-bleeding-precautions-and-fever-as-an/)
- [Nursing care of the dying patient](https://durgical.com/en/nursing/nursing-care-of-the-dying-patient/)

## Related conditions 5

- [Malignant spinal cord compression](https://durgical.com/en/conditions/malignant-spinal-cord-compression/)
- [Superior vena cava syndrome](https://durgical.com/en/conditions/superior-vena-cava-syndrome/)
- [Hypercalcaemia of malignancy](https://durgical.com/en/conditions/hypercalcaemia-of-malignancy/)
- [Febrile neutropenia](https://durgical.com/en/conditions/febrile-neutropenia/)
- [Tumour lysis syndrome](https://durgical.com/en/conditions/tumour-lysis-syndrome/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Review of Hematology-Oncology Emergencies for Internal Medicine Residents (Baralo B et al.; Cureus)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9908426/) (PubMed Central (open access), 2023); [Common oncologic emergencies (Regnier L, Wilkinson AN; Canadian Family Physician)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9873297/) (PubMed Central (open access), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/cancer-emergencies-on-the-ward-cord-compression-svc-syndrome-high-calcium-and-tu/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/cancer-emergencies-on-the-ward-cord-compression-svc-syndrome-high-calcium-and-tu/