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What is the treatment for tumor lysis syndrome? Allopurinol and rasburicase are known to reduce uric acid levels. Allopurinol has no effect on existing hyperuricemia; thus, it can be preferentially used in patients with low or intermediate risk for TLS. Rasburicase, on the other hand, rapidly reduces existing hyperuricemia.
What is the treatment for tumor lysis syndrome?
Tumour lysis syndrome is usually diagnosed by:
- complete blood count (CBC)
- blood chemistry and uric acid levels in the blood.
- urinalysis.
What labs indicate tumor lysis syndrome?
Tumour lysis syndrome (TLS) is an oncological emergency characterised by metabolic and electrolyte abnormalities that can occur after the initiation of any cancer treatment, but can also occur spontaneously.
What does tumor lysis syndrome mean?
Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation.
What causes tumor lysis syndrome (TLS)?
What is the pathophysiology of Tumour lysis syndrome?
The pathophysiology involves massive tumor cell lysis resulting in the release of large amounts of potassium, phosphate, and uric acid. Deposition of uric acid and calcium phosphate crystals in the renal tubules may lead to acute renal failure, which is often exacerbated by concomitant intravascular volume depletion.
What are the signs and symptoms of tumor lysis syndrome?
What are the symptoms of tumor lysis syndrome?Nausea and vomiting.Diarrhea.Changes in how much pee you produce.Weakness and lethargy.Blood in your pee (hematuria).Seizures.Muscle cramps.Fainting (syncope}.More items...•
What is a complication of tumor lysis syndrome?
Potential complications of tumor lysis syndrome include uremia and oliguric renal failure due to tubule precipitation of uric acid, calcium phosphate, or hypoxanthine. Severe electrolyte disturbances, such as hyperkalemia and hypocalcemia, predispose patients to cardiac arrhythmia and seizures.
What happens when a tumor breaks down?
When cancer cells break down and die, they release substances into the blood. If cancer cells break down so quickly that the kidneys can't remove these substances from the blood, it can lead to tumour lysis syndrome (TLS).
Who is at highest risk for tumor lysis syndrome?
Patients with a large “tumor burden” of cancer cells and/or tumors that typically have rapidly dividing cells, such as acute leukemia or high-grade lymphoma, as well as tumors that are highly responsive to therapy, are at greatest risk of developing TLS.
When should you suspect a tumor lysis syndrome?
Laboratory diagnosis of tumor lysis syndrome is based on having two or more abnormal lab values including hyperuricemia, hyperkalemia, hyperphosphatemia, and/or secondary hypocalcemia occurring within 3 days prior to or up to 7 days after the initiation of cytotoxic therapy for malignancy.
What are the 4 key electrolyte abnormalities in tumor lysis syndrome?
The metabolic derangements associated with tumor lysis syndrome are hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia.
What is treatment for tumor lysis syndrome?
A single, fixed dose of rasburicase (6 mg maximum) for treatment of tumor lysis syndrome in adults.
How do you manage tumor lysis syndrome?
Prevention and treatment of tumor lysis syndrome Monitoring, hydration, and hypouricemic therapy are the fundamental preventive measures in patients who are at risk for TLS[5]. Intravenous hydration is the cornerstone of preventing TLS.
Can the body destroy tumors?
Immune cells eliminate tiny tumours In the very early stages of cancer our immune cells do a good job of killing individual cancer cells as they arise. This is known as the 'eliminating phase', where immune cells are in control of the tumour and calmly carry out their work.
Do tumors bleed when they shrink?
Tumor bleed is commonly seen in locally progressive tumors, which have directly infiltrated blood vessels. However, tumor bleed secondary to rapid shrinkage has not been reported previously. We report on a patient who had a torrential bleed after initiation of multi-agent chemotherapy.
Does cutting a tumor make it spread?
You may have heard that surgery for cancer can cause the cancer to spread. It's very rare for surgery to cause cancer to spread. Advances in equipment used during surgery and more detailed imaging tests have helped make this risk very low.
What are the 4 key electrolyte abnormalities in tumor lysis syndrome?
The metabolic derangements associated with tumor lysis syndrome are hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia.
Which are the most common signs and symptoms of leukemia related to bone marrow involvement?
Common leukemia signs and symptoms include:Fever or chills.Persistent fatigue, weakness.Frequent or severe infections.Losing weight without trying.Swollen lymph nodes, enlarged liver or spleen.Easy bleeding or bruising.Recurrent nosebleeds.Tiny red spots in your skin (petechiae)More items...
What medication is used to treat tumor lysis?
A single, fixed dose of rasburicase (6 mg maximum) for treatment of tumor lysis syndrome in adults.
What is the treatment of Tumour lysis syndrome?
In general, treatment of TLS consists of intensive hydration, stimulation of diuresis, and, more specifically, in the use of allopurinol and rasburicase.
What Is Tumor Lysis Syndrome?
Tumor lysis syndrome (TLS) is a condition that happens when cancer cells die quickly. Dying cells release large amounts of potassium, phosphate, an...
What Are The Signs and Symptoms of TLS?
1. Fatigue or confusion 2. Nausea, vomiting, or diarrhea 3. Muscle weakness, cramps, or spasms 4. Tingling around your mouth or in your hands or fe...
How Can I Help Manage TLS Symptoms?
1. Increase liquids as directed. Ask your healthcare provider how much and what you should drink. 2. Limit caffeine, alcohol, aspirin, and vitamin...
When Should I Seek Immediate Care Or Call 911?
1. You have a seizure. 2. You feel your heart flutter, or beat faster or slower than normal. 3. You vomit repeatedly. 4. You have tingling around y...
What happens to the kidneys after chemo?
As tumors break down, they release their contents into the blood stream. Most of the time, your kidneys can filter out these substances without any problems.
What are the effects of TLS?
These substances include: Potassium. High levels of potassium can lead to neurological changes and heart problems. Uric acid. Excess uric acid (hyperuricemia) can cause kidney stones and kidney damage.
What is the best medicine to stop uric acid from forming?
allopurinol (Aloprim, Lopurin, Zyloprim) to stop your body from making uric acid. rasburicase (Elitek, Fasturtec) to break down uric acid. sodium bicarbonate or acetazolamide (Diamox Sequels) to prevent uric acid from forming crystals. There are also two newer types of medications that may help as well:
How long after chemo can you get a urine test?
If you are undergoing chemotherapy and have any risk factors for TLS, your doctor will perform regular blood and urine tests in the 24 hours immediately after your first treatment. This allows them to check for any signs that your kidneys aren’t filtering everything out. The types of tests they use include:
What is the goal of cancer treatment?
The goal of cancer treatment is to destroy tumors. When cancerous tumors break down very quickly, your kidneys have to work extra hard to remove all the substances that were in those tumors. If they can’t keep up, you can develop something called tumor lysis syndrome (TLS).
How do you know if you have TLS?
While the symptoms of TLS are usually mild in the beginning, as the substances build up in your blood, you might experience: restlessness, irritability. weakness, fatigue. numbness, tingling. nausea, vomiting. diarrhea.
How long after chemo can you see urine?
These measures can continue for two or three days after the chemotherapy session, but your doctor might continue to monitor your blood and urine throughout the rest of your treatment.
What is tumor lysis syndrome?
Tumor lysis syndrome (TLS) is a condition that happens when cancer cells die quickly. Dying cells release large amounts of potassium, phosphate, and uric acid into the blood. This can cause heart or kidney problems and lead to kidney failure. TLS can become life-threatening if is not managed or treated. It most commonly happens after chemotherapy or radiation treatment, but may also occur after other forms of cancer treatment.
How can I help manage TLS symptoms?
Increase liquids as directed. Ask your healthcare provider how much and what you should drink.
How to treat TLS?
How is TLS treated? 1 Liquids are given to help you stay hydrated and urinate more . These may be given orally or through an IV. 2 Medicines help decrease potassium and uric acid levels in your blood. Medicine may also be given to help you urinate more. 3 Dialysis may be needed to decrease potassium levels in your blood. It also helps protect your heart and kidneys.
Why do we give liquids?
Liquids are given to help you stay hydrated and urinate more . These may be given orally or through an IV.
Can TLS cause kidney failure?
This can cause heart or kidney problems and lead to kidney failure. TLS can become life-threatening if is not managed or treated. It most commonly happens after chemotherapy or radiation treatment, but may also occur after other forms of cancer treatment.
Can you refuse treatment?
You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
What should be the history and physical examination of patients with tumor lysis syndrome?
The history and physical examination of patients with tumor lysis syndrome should be focused on the primary causes of the tumor lysis.
What is the electrolyte imbalance associated with tumor lysis syndrome?
Hyperphosphatemia is another electrolyte imbalance associated with tumor lysis syndrome. The nucleic acid has a phosphate group, and the breakdown of the tumorous cell will lead to the release of a significant amount of phosphorus into the bloodstream. Most of the phosphorus is renally excreted. This ability of the kidney to handle a high load of phosphorus is inhibited by acute kidney injury or chronic kidney disease.
How much potassium is in a tumor?
The concentration of potassium within the cell is about 120 to 130 meq/L. The lysis of tumorous cells leads to a massive release of intracellular potassium. The excess potassium is usually taken up by the liver and skeletal muscle. The rest is excreted via the gastrointestinal system or the kidney. Obstructive uropathy from uric acid salts can limit the excretion of potassium. Sometimes the hyperkalemia from the solid tumor can reach a potentially life-threatening level. The risk of hyperkalemia is cardiac arrest from arrhythmia.
What is tumor lysis syndrome?
Tumor lysis syndrome is a clinical condition that can occur spontaneously or after initiation of chemotherapy associated with the following metabolic disorders: hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia leading to end-organ damage. It is most common in patients with solid tumors. [1][2][3]
What are the factors that favor the formation of crystals in the kidney?
The factors that favor the formation of crystals include low urine flow, low solubility, and high levels of solutes. The deposition of crystals in the renal pelvis, calyxes, and the ureter can cause inflammation leading to obstruction of urinary flow. Longstanding obstruction creates hydroureter, hydronephrosis, and subsequent acute kidney failure.
What should be the focus of a physical exam for tumor lysis?
The physical examination should focus on the electrolyte abnormalities that are associated with tumor lysis syndrome. The physical findings associated with these abnormalities are listed below.
What is the name of the disease that has elevated lactate dehydrogenase?
Early-stage leukemia or Burkitt lymphoma with elevated lactate dehydrogenase
What causes crystals in the kidney?
Crystal-induced tissue injury occurs in the tumor lysis syndrome when calcium phosphate, uric acid, and xanthine precipitate in renal tubules and cause inflammation and obstruction (Fig. 2).20,23A high level of solutes, low solubility, slow urine flow, and high levels of cocrystallizing substances favor crystal formation and increase the severity of the tumor lysis syndrome.24-26High levels of both uric acid and phosphate render patients with the tumor lysis syndrome at particularly high risk for crystal-associated acute kidney injury, because uric acid precipitates readily in the presence of calcium phosphate, and calcium phosphate precipitates readily in the presence of uric acid. Also, higher urine pH increases the solubility of uric acid but decreases that of calcium phosphate. In patients treated with allopurinol, the accumulation of xanthine, which is a precursor of uric acid and has low solubility regardless of urine pH, can lead to xanthine nephropathy or urolithiasis (Fig. 1).20,27
What are the crystals of uric acid?
Crystals of Uric Acid, Calcium Phosphate, and Calcium Oxalate. Crystallization of uric acid and calcium phosphate are the primary means of renal damage in the tumor lysis syndrome. The presence of crystals of one solute can promote crystallization of the other solutes.
What is released during lysis of tumor cells?
Lysis of Tumor Cells and the Release of DNA, Phosphate, Potassium, and Cytokines
What is tumor lysis syndrome?
The tumor lysis syndrome is the most common disease-related emergency encountered by physicians caring for children or adults with hematologic cancers. 1-4Although it develops most often in patients with non-Hodgkin’s lymphoma or acute leukemia, its frequency is increasing among patients who have tumors that used to be only rarely associated with this complication.5-8The tumor lysis syndrome occurs when tumor cells release their contents into the bloodstream, either spontaneously or in response to therapy, leading to the characteristic findings of hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.1-3These electrolyte and metabolic disturbances can progress to clinical toxic effects, including renal insufficiency, cardiac arrhythmias, seizures, and death due to multiorgan failure.
Why do you need hydration for tumor lysis?
All patients who are at risk for the tumor lysis syndrome should receive intravenous hydration to rapidly improve renal perfusion and glomerular filtration and to minimize acidosis ( which lowers urine pH and promotes the precipitation of uric acid crystals) and oliguria (an ominous sign).
What is the normal uric acid level?
Uric acid >8.0 mg/dl (475.8 μmol/liter) in adults or above the upper limit of the normal range for age in children
What is the protocol for acute lymphoblastic leukemia?
For example, some protocols for acute lymphoblastic leukemia begin with a week of prednisone monotherapy , and others begin with a combination of a glucocorticoid, vincristine, asparaginase, and daunorubicin. A patient treated on the latter protocol would have a higher risk of the tumor lysis syndrome.
What is spontaneous tumor lysis syndrome?
Pretreatment spontaneous tumor lysis syndrome. This entity is associated with acute kidney failure due to uric acid nephropathy prior to the institution of chemotherapy and is largely associated with lymphoma and leukemia. The important distinction between this syndrome and the post-chemotherapy syndrome is that spontaneous TLS is not associated with hyperphosphatemia. One suggestion for the reason of this is that the high cell turnover rate leads to high uric acid levels through nucleobase turnover but the tumor reuses the released phosphate for growth of new tumor cells. In post-chemotherapy TLS, tumor cells are destroyed and no new tumor cells are being synthesized. TLS is most common during cytotoxic treatment of hematologic neoplasms.
What is the process of converting adenine and guanine into uric acid?
Hyperuricemia and hyperuricosuria. Massive cell death and nuclear breakdown generates large quantities of nucleic acids. Of these, the purines (adenine and guanine) are converted to uric acid via the purine degradation pathway and excreted in the urine. However, at the high concentrations of uric acid generated by tumor lysis, uric acid is apt to precipitate as monosodium urate crystals.
What causes kidney failure in tumor lysis syndrome?
Hyperphosphatemia causes acute kidney failure in tumor lysis syndrome, because of deposition of calcium phosphate crystals in the kidney parenchyma. Hypocalcemia. Because of the hyperphosphatemia, calcium is precipitated to form calcium phosphate, leading to hypocalcemia. Symptoms of hypocalcemia include (but are not limited to): tetany.
How does allopurinol work?
Allopurinol works by preventing the formation of uric acid following tumor cell lysis. Rasburicase is an alternative to allopurinol and is reserved for people who are high-risk in developing TLS, or when xanthine oxidase inhibition is contraindicated (taking 6-MP or azathioprine ).
What is TLS in medical terms?
TLS. Specialty. Oncology, hematology. Tumor lysis syndrome is a group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off ( lysed) at the same time by the treatment, releasing their contents into the bloodstream. This occurs most commonly after the treatment ...
What is the urine output of acute uric acid nephropathy?
Acute uric acid nephropathy is associated with little or no urine output. The urinalysis may show uric acid crystals or amorphous urates. The hypersecretion of uric acid can be detected with a high urine uric acid - creatinine ratio > 1.0, compared to a value of 0.6–0.7 for most other causes of acute kidney failure.
What are the characteristics of a tumor?
Tumor Characteristics: Tumors with a high cell turnover rate, rapid growth rate, and high tumor bulk tend to be more associated with the development of tumor lysis syndrome. The most common tumors associated with this syndrome are poorly differentiated lymphomas (such as Burkitt's lymphoma ), other Non-Hodgkin Lymphomas (NHL), acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myelogenous leukemia (CML). Other cancers (such as melanoma) have also been associated with TLS but are less common.
What is Tumor Lysis Syndrome (TLS)?
Tumor lysis syndrome (TLS) happens when cells in your body break down too quickly. This breakdown causes chemicals and electrolytes in your body to get out of balance. TLS can be caused by cancer or its treatments. TLS is an oncologic emergency and needs to be treated right away.
What are the two most common medications for hyperuricemia?
Hypouricemic Medication – These medications cause your body to make less uric acid, which then prevents hyperuricemia. Allopurinol and Rasburicase are the two most commonly used medications.
What is the treatment for TLS?
Treatment of TLS includes: heart and lab value monitoring, treating electrolyte changes with medications, allopurinol or rasburicase, and kidney dialysis if needed. Dialysis is a treatment where blood is filtered through a machine and returned to the body, performing the filtering action of the kidneys.
What are the symptoms of hypocalcemia?
Signs and symptoms of hypocalcemia are muscle twitching, numbness and tingling of fingers and toes, and confusion. When the minerals and electrolytes leave the dying cells too quickly, your body cannot keep up. TLS can cause renal failure, seizures, cardiac dysrhythmias, and if not quickly managed, death.
What happens when you leave electrolytes in your body?
When the minerals and electrolytes leave the dying cells too quickly, your body cannot keep up. TLS can cause renal failure, seizures, cardiac dysrhythmias, and if not quickly managed, death.
Why do you need IV hydration?
The goal of IV hydration is to improve renal perfusion (the movement of fluid through the kidneys). The more a patient urinates, the less uric acid and calcium phosphate can build up in the kidneys. However, you don’t want to give a patient so much fluid that their kidneys cannot handle it.
What is the name of the condition where phosphate is high?
Hyperphosphatemia – High level of phosphate. Phosphate makes energy in the body. It also helps muscle and nerves work, helps with bone growth, and maintains the acid-base balance in the body. It enters your body through food. It leaves the body through urine. There are no symptoms of hyperphosphatemia.
What is TLS in medical terms?
Simply, tumor lysis syndrome (TLS) is an emergency that can occur in people with cancer. Sounds straightforward, right? But TLS is nothing to take lightly. It can quickly sneak up on patients (like that pharmacology exam tomorrow morning you’ve procrastinated studying for) and can be fatal if not recognized and treated properly.
Which drugs act in the nucleic acid breakdown pathway?
For those visual learners, the graphic here shows how these drugs act in the nucleic acid breakdown pathway. Remember, allopurinol and febuxostat prevent the formation of uric acid, and rasburicase speeds up its conversion into allantoin, which is more soluble than uric acid and allows it to be excreted. (We’re not talking about probenecid here, just ignore that arm). ( Image)
How long does it take for TLS to show up?
It can occur in as little as a few hours after treatment but is most frequently seen in the first 2-3 days after treatment begins. It is important to note that, although rare, TLS can also occur spontaneously before any treatment is initiated 🤯.
How long does it take to take allopurinol?
Allopurinol is administered orally (unless critically ill) 1-2 days before, during, and 7-14 days after treatment and is the standard prevention medication. In clinical practice, 300 mg PO daily is the most common dosing. Febuxostat is an alternative to allopurinol and is administered similarly.
Why is it important to hydrate before treatment?
Hydration – this is KEY! Hydrating a patient before treatment keeps fluid moving through the kidneys so they can filter the increased electrolytes and to minimize acidosis (the cheerleader for uric acid crystal formation).
What happens if you increase cellular contents in your blood?
Well, the rapid increase of these cellular contents in the bloodstream can cause a variety of problems, such as renal dysfunction (you know, that vital organ that works like a horse to filter out your blood), cardiac arrhythmias, seizures, neurologic complications, and death.
How many ml of saline should I drink a day?
A typical hydration order is 2,500-3,000 mL/m2/day normal saline 2-3 days before, during, and 2-3 days following treatment - I know, it’s a lot of fluids for days on end, but it’s for a good cause!
How long does it take for allopurinol to reduce uric acid?
Allopurinol is usually given orally at a dose of 100 mg/m2 every 8 hours (maximum dose, 800 mg/day) at least 1 to 2 days prior to the start of therapy and continued for up to 3 to 7 days until there is normalization of the serum uric acid level; this dose should be reduced by 50% in a patient with renal failure. If oral intake is not possible, an intravenous formulation of allopurinol has been approved for prophylaxis. [27] In a study by Smalley et al, among the adult patients who received allopurinol for prophylaxis, prevention of hyperuricemia was seen in 93%. [27] However, even with allopurinol prophylaxis prior to the start of chemotherapy, elevations in uric acid levels can still be seen. [1]
What happens to tumor cells after chemotherapy?
TLS occurs when there is a rapid breakdown of nucleic acids and lysis of tumor cells during or in the days following chemotherapy initiation, resulting in characteristic electrolyte abnormalities. All of these abnormalities can have lethal consequences. Two of the most life-threatening complications are arrhythmias, due to hypocalcemia or hyperkalemia, and renal failure, due to hyperuricemia or hyperphosphatemia.
What happens to the cells after chemo?
TLS occurs when there is a rapid breakdown of nucleic acids and lysis of tumor cells during or in the days following chemotherapy initiation, resulting in characteristic electrolyte abnormalities. All of these abnormalities can have lethal consequences. Two of the most life-threatening complications are arrhythmias, due to hypocalcemia or hyperkalemia, and renal failure, due to hyperuricemia or hyperphosphatemia.
What is the term for a tumor cell that is rapidly broken down and its contents released into the extracellular space?
The syndrome characterized by these metabolic derangements is known as tumor lysis syndrome (TLS). TLS can cause life-threatening conditions and even death unless appropriately and immediately treated.
What is TLS in cancer?
When tumor cells are rapidly broken down and their contents released into the extracellular space, the released ions and compounds can cause metabolic disturbances too great to be neutralized by the body's normal mechanisms. Tumor lysis syndrome (TLS) is an oncology emergency that occurs as a result of rapid tumor cell breakdown and ...
How are purines reused?
Under normal circumstances, purines are reused by salvage pathways in the cells so as to minimize their excretion. However, with tumor cell lysis, the salvage pathways of the remaining cells become overwhelmed and there is a large net secretion of uric acid into the renal tubules after filtration in the kidneys. [21] .
How does hyperkalemia occur?
Because the potassium gradient across cell membranes is regulated by a sodium/potassium adenosine triphosphatase (ATPase), any disruption in the functioning of this enzyme can give rise to an efflux of potassium out of the cell. When exposed to chemotherapy or radiation therapy, cellular metabolism is increased and adenosine triphosphate (ATP) is consumed at a higher rate. Consequently, there is little ATP remaining for the ATPase enzyme to use to maintain the potassium gradient. Potassium therefore leaves the malignant cells even prior to lysis. [19] The second mechanism is the release of the intracellular stores of potassium into the blood upon lysis of tumor cells. Hyperkalemia is typically seen in the first 12 to 24 hours after therapy and is therefore the initial life-threatening abnormality seen in TLS. [20,21]
Why is Rasburicase contraindicated?
Rasburicase is contraindicated in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency because it may cause methemoglobinemia and hemolytic anemia. Those with this condition are given a different hypouricemic drug called Zyloprim (allopurinol).
What classification system is used for tumor lysis?
To aid in the diagnosis, doctors often use the Cairo and Bishop classification system. This system classifies two types of tumor lysis syndrome—laboratory TLS and clinical TLS.
What is tumor lysis syndrome?
Tumor lysis syndrome (TLS) occurs when a massive number of cancer cells die and release various electrolytes, proteins, and acids into a patient's bloodstream. The massive and sudden cell death most commonly occurs after a person with blood cancer (usually acute leukemia or an aggressive lymphoma, ...
What happens when cancer cells die suddenly?
Tumor lysis syndrome can develop when there is a large number of cancer cells that die suddenly. As tumor cells "lyse" or die and rapidly break open, their spilled contents—potassium, phosphate, and uric acid—are released in large amounts into the patient's bloodstream. 1
What is the best treatment for TLS?
Hydration and taking a hypouricemic agent are standard preventive therapies for TLS.
How many children with TLS will develop after cancer treatment?
Research has found that more than 1 in 4 children with acute lymphoblastic leukemia will develop TLS after undergoing cancer treatment. 2
What is a bulky tumor?
Bulky tumors (meaning the individual tumor masses are greater than 10 centimeters in diameter)
