3. Paediatric Oncology

Question 1

What type of Cancers occur in Paediatric Oncology?

Answer 1

1. Leukaemia - 32%
2. CNS Tumours - 24%
3. Lymphomas - 10%
4. Neuroblastoma - 7%
5. Soft Tissue Sarcomas - 7%
6. Wilm’s Tumour - 6%
7. Bone Tumours - 4%
8. Retinoblastoma - 3%
   Note - Paediatric Oncology is uncommon

Question 2

Why does Paediatric Malignancy occur?

Answer 2

1. Genes - Down / Fanconi / BWS / Epigenetics
2. Environment - Radiation (Ionising / Non-Ionising) / Viral
3. Iatrogenic - Radiotherapy / Chemotherapy

Question 3

What are the Referral Guidelines for Suspected Cancer, which would cause an:

1. Referral?
2. Urgent Referral?
3. Immediate Referral?

Answer 3

1. Rest Pain / Back Pain / Unexplained Lump
2. Repeat Attendance / Same Problem / No Clear Diagnosis
3. Unexplained Petechiae / Hepatosplenomegaly

Question 4

What are the Red Flag Symptoms / Signs of Paediatric Malignancy?

Answer 4

1. Pallor
2. Lump Mass Swelling (+/- Head and Neck)
3. Lymphadenopathy
4. Bruising
5. Fatigue
6. Bleeding
7. Headahce / Visual Symptoms
8. Pain / Musculoskeletal Problems / Abnormal Movement

Question 5

What are some Complications of Tumours / Therapies?

Answer 5

1. Tumour Lysis Syndrome
2. Febrile Neutropenia
3. Spinal Cord Compression

Question 6

What is Tumour Lysis Syndrome?

Answer 6

1. Metabolic Derangement leading to Rapid Death of Tumour Cells
2. This causes the Release of Intracellular Contents
   Note - This is Secondaru to Treatment

Question 7

What are the Clinical Features of Tumour Lysis Syndrome?

Answer 7

1. Increase in Potassium
2. Increase in Urate
3. Increase in Phosphate
4. Decrease in Calcium
5. Acute Renal Failure - Urate Load / CaPO4 Deposition

Question 8

What is the Treatment of Tumour Lysis Syndrome?

Answer 8

1. Avoidance
2. ECG Monitoring
3. Hyperhydrate
4. Diuresis
5. Treat Hyperkalaemia - Ca Resonium / Salbutamol / Insulin
6. Renal Replacement Therapy

Question 9

What are the Features of Febrile Neutropenia?

Answer 9

1. Neutrophils < 0.5 x 10^9/ L

2. Fever > 38 degrees

Question 10

What is the Treatment of Febrile Neutropenia?

Answer 10

1. Investigate - Culture / Swabs / Stool / Urine
2. Broad Spectrum I.V. Antibiotics
   Note - Don’t Forget Fungi

Question 11

What are the Features of Spinal Cord Compression in Children?

Answer 11

1. Weakness - Ambulatory / Non-Ambulatory / Paraplegic
2. Spine Tenderness
3. Sphincter Disturbance
4. Sensory Disturbance
5. Gait Disturbance
6. Back Pain

Question 12

What is the Management of Spinal Cord Compression?

Answer 12

1. MRI
2. Dexamethasone
3. Chemotherapy
4. DXT
5. Surgery - Debulking / Laminectomy / Laminotomy / Laminoplasty