26. Oncology Part 2

Question 1

Discuss the epidemiology of spinal cord compression in children?

Answer 1

10-20% of Ewing or medulloblastlmas

5-10% of neuroblasmtoma and germ cell tumours

Question 2

What may spinal cord compression lead to?

Answer 2

Vertebral body compression
Invasion through intervertebral foramina
CSF seeding
Direct invasion of the spinal tissue

Question 3

How do kids with a spinal compression present?

Answer 3

Weakness
Pain
Sensory
Sphincter disturbance (bowel opening)

Question 4

How do you manage someone with spinal cord compression?

Answer 4

Urgent MRI
Red,Ethan one to reduce peri oedema
Definitive treatment with chemo
Surgery or radiotherapy are other options

Question 5

What causes compression of the mediastinum

Answer 5

Retinoblastoma
Lymphoma
Germ cell tumour

Question 6

What are the symptoms of mediastinal compression?

Answer 6

Facial, neck and Upper thoracic plethora, oedema, cyanosi, distended veins

If airways compressed- dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea

Question 7

How do you treat mediastinal compression?

Answer 7

Keep upright and calm
Urgent biopsy
Give dexmathosone
Chemo
Radiotherpay
Rarely surgery 

Investigate with CXR/CT chest
Echo

Question 8

What is tumour lysis syndrome?

Answer 8

Metabolic derangement
Rapid death of tumour cells
Release of intracellular contents
Secondary to treatment 
Mainly Burkett lymphomas or leukaemias

Question 9

What are the signs of tumour lysis syndrome?

Answer 9

High potassium
High urea
High phosphate
Low calcium
Acute renal failure 
Urate load- CaPO4, deposition in renal tubules

Question 10

How do you manage tumour lysis syndrome?

Answer 10

ECG montoring
Hyper hydrate
Check electrolytes 
Diuresis 
NEVER GIVE POTASSIUM
Decrease uric acid