Oncology Flashcards
Most common childhood cancer?
Leukaemia
Which type of cancer are children with Down syndrome at more risk of developing?
Leukaemia
Which types of cancer are children with Beckwith-Wiedemann syndrome at more risk of developing?
Neuroblastoma or nephroblastoma
Okayy so what are some signs that need immediate referral for suspected cancer in children?
Unexplained petechiae
Unexplained hepatosplenomegaly
Okayy so what are some signs that need urgent referral for suspected cancer in children?
Repeat attendance, same problem, no clear diagnosis
New neuro symptoms or abdominal mass
Okayy so what are some signs that need referral for suspected cancer in children?
Rest pain, back pain, unexplained lump
Lymphadenopathy
Symptoms in children under five which may be a brain tumour?
Persistent/recurrent vomiting
Abnormal balance, walking, coordination
Abnormal eye movements
Behaviour change, especially lethargy
Fits or seizures, not with a fever
Abnormal head position such as head tilt or stiff neck
Symptoms in children aged 5-11 which may be a brain tumour?
Persistent/recurrent vomiting
Persistent/recurring headache
Abnormal balance, walking, coordination
Abnormal eye movements
Blurred or double vision
Behaviour change
Abnormal head position
Symptoms in children aged 12-18 which may be a brain tumour?
Persistent/recurrent vomiting
Persistent/recurring headache
Abnormal balance, walking, coordination
Abnormal eye movements
Blurred or double vision
Behaviour change
Fits or seizures
Delayed or arrested puberty
How does raised ICP present in the early stages?
Early morning headache/vomiting
Tense fontanelle
Increased head circumference
How does raised ICP present in the later stages?
Constant headache
Papilloedema
Diplopia (VI palsy)
Loss of upgaze
Neck stiffness
Status epilepticus
Reduced GCS
Imaging for raised ICP?
CT good for screening
MRI better more for accurate diagnosis
If raised ICP is due to a tumour, what is the management?
Dexamethasone
->reduces oedema and increases ICF flow
Other general management of raised ICP?
Neurosurgery- VP shunt, ventriculostomy (hole in membrane of 3rd ventricle)
Spinal cord compression is a potential complication of nearly all paediatric malignancies.
In which cancers is it more common?
Ewing’s sarcoma
Medulloblastoma
Management of spinal cord compression?
Urgent MRI
Start dexamethasone urgently to reduce peri-tumour oedema
Definitive treatment is with chemotherapy
What is SVC syndrome?
Superior vena cava syndrome
Rare but occurs is <1% of new paediatric malignancies
Common causes of SVC syndrome?
Lymphoma
Other causes- neuroblastoma, germ cell tumour, thrombosis
How does SVC syndrome present?
Oedema
Cyanosis
Distended veins
Ill
Anxious
Reduced GCS
Investigations for SVC syndrome?
CXR/CT chest
Echo
What is tumour lysis syndrome?
Rapidly growing tumour starts to die and releases intracellular electrolytes into bloodstream
Clinical features of tumour lysis syndrome?
Raised potassium
Raised urate
Raised phosphate
Low calcium
Acute renal failure- due to urate load and CaPO4 deposition in renal tubules
Treatment of tumour lysis syndrome?
ECG monitoring
Hyperhyrdate
Diuresis
Reduce uric acid using allopurinol
Treat hyperkalaemia- calcium gluconate, salbutamol, insulin
Renal replacement therapy
What is preferred in paediatrics, MRI or CT?
MRI as no radiation
However, to get good pictures in MRI, children need to lie still so often a general anaesthetic is given
Cannonball appearance on CXR is suggestive of what type of cancer?
Sarcoidosis
Which investigation will all children with a solid tumour have done to check for spread of cancer?
CXR or CT chest as often metastasize to the lungs
Short term risks of chemo?
Hair loss
Nausea and vomiting
Mucositis
Diarrhoea/constipation
Bone marrow suppression- anaemia, bleeding, infection
Long term risks of chemo?
Organ impairment- kidneys, heart, nerves, ears
Reduced fertility
Second cancer
Short term risks of radiotherapy?
Lethargy
Skin irritation
Swelling
Organ inflammation- bowel, lungs
Long term risks of radiotherapy?
Fibrosis/scarring
Second cancer
Reduced fertility
