Oncology

Question 1

Cancer aetiology

Answer 1

• Unclear in most cases.
• Usually an interaction between and environmental factor and a genetic predisposition
• May be associated with syndromes eg Downs and leukaemia, neurofibromatosis and glioma

Question 2

Clinical presentation

Answer 2

• Localised mass
• Consequences of disseminated disease
• Consequences of pressure from a mass

Question 3

Investigation

Answer 3

• Full blood count
• Solid tumours- xray, CT, MRI
• Nuclear medicine imaging- bone/bone marrow disease, neuroblastomas
• Magnetic resonance spectroscopy can differentiate between normal and malignant tissue- useful for brain tumours

Question 4

Management

Answer 4

• Counselling and education

* Co-ordinated multidisciplinary care

Question 5

Treatment

Answer 5

• Primarily curative eg leukaemia
• Adjunct to deal with residual disease and presumed micrometastases after surgery eg Wilm’s
• To control primary or metastatic disease prior to surgery/ radiotherapy eg sarcoma or neuroblastome

Question 6

Radiotherapy

Answer 6

Risk of damage to growth of normal tissue is high in children. Used with care for well defined tumours

Question 7

Surgery

Answer 7

• Biopsy

* Removal of residual tumour after chemo/radiation

Question 8

High dose therapy with bone marrow rescue

Answer 8

• Chemo and radiation can cause irreversible tissue damage, esp to bone marrow.
• Can treat with bone marrow stem cell transplantation
• Allogenic- compatible donor
• Autologous- harvested from patient prior to treatment

Question 9

Chemotherapy S/E

Answer 9

Infection from immunosuppression
•Bone marrow suppression
•GIT damage, nausea, vomiting, and nutritional compromise
•Cardiotoxicity -doxorubicin
•Renal failure and deafness- cisplatin
•Neuropathy- vincristine
•Haemorragic cystitis-cyclophosphamide

Question 10

Supportive care

Answer 10

• Manage infection promptly
• Early nutritional support
• Control nausea and vomiting
• Pain control

Question 11

Psychosocial support

Answer 11

• Counselling
• Transport/ finances/ accommodation/care of siblings
• Educational material
• Siblings
• Return to school
• Long term support- poor growth/ infertility/ sexual dysfunction

Question 12

Physio Rx

Answer 12

• Chest physio
• Bed mobility
• Maintenance programme
• Strengthening
• Endurance
• PAIN
• Peripheral neuropathy
• Reintegration family/ school