Oncology Flashcards
What type of cancer is most common in children?
Leukaemia (32%), particularly acute lymphoblastic leukaemia (ALL - 20-25%)
What percentage of childhood cancers are CNS tumours?
24%
List the eight most common childhood cancers
- Leukaemia
- CNS tumours
- Lymphomas
- Neuroblastoma
- Soft tissue e.g. rhabdomyosarcoma
- Wilm’s tumour
- Bone tumours
- Retinoblastoma
What type of tumour is Wilm’s tumour?
Nephroblastoma (kidney cancer)
Which genetic conditions are associated with high risk of childhood cancer?
- Down syndrome
- Fanconi syndrome
- Beckwith-Wiedemann syndrome (BWS)
- Li-Fraumeni Familial Cancer syndrome
- Neurofibromatosis
Which types of cancer are associated with neurofibromatosis?
Nervous system cancers:
- low-grade glioma
- benign neurofibromas
- neurofibrosarcomas
- malignant peripheral nerve sheath tumours
Give three viral infections which are associated with an increased risk of cancer in children.
EBV - Burkitt/Hodgkin lymphomas, nasopharyngeal cancers
Hep B - hepatic carcinoma
HIV - Kaposi sarcoma
Which cancer drug is associated with an increased risk of leukaemia?
Etoposide - chemo drug associated with AML
What are the “red flag” symptoms that suggest childhood cancer?
- Neurological symptoms
- Headache
- Lymphadenopathy
- Lump/mass/swelling
- Fatigue
- Back pain
- Bruising
- Urinary symptoms
- Hepatosplenomegaly
URGENT REFERRAL
Give three oncological emergencies that can arise as complications of cancer treatment
- Tumour lysis syndrome
- Febrile neutropenia
- Spinal cord compresssion
What substance is the greatest cause of concern in tumour lysis syndrome?
Urate
Describe the pathophysiology of tumour lysis syndrome
massive release of urate due to breakdown of tumour cells and release of intracellular contents
What are the clinical features of tumour lysis syndrome?
- Raised potassium
- Raised urate, relatively insoluble
- Raised phosphate
- Low calcium
- Acute renal failure
How is tumour lysis syndrome managed?
- Prevention is key
- ECG monitoring
- Hyperhydrate
- Diuresis
- ***Never give potassium***
- Treat hyperkalaemia
- Rasburicase (high-risk cases only)
- Allopurinol (reduces urate level)
- Dialysis in severe cases
Define febrile neutropenia
Low neutrophils (< 1 x 10^9 /L) plus fever ( > 38 degrees C)
In oncology, what diagnosis should be assumed to be causing febrile neutropenia until proven otherwise?
Infection - treat as potential bacterial septicaemia
Describe the investigations needed for a patient with febrile neutropenia
- Cultures
- Swabs
- Stool sample
- Urine sample
What percentage of solid tumours present with spinal cord compression in paeds?
around 5% (much more common in the terminal phase)
What are the clinical features of spinal cord compression in children?
Weakness Spine tenderness Back pain Sphincter disturbance Sensory disturbance Gait disturbance
What is meant by a “dumbbell tumour”?
a tumour which has both a component within the spinal canal and a component in the paravertebral space contiguous with each other via a thinner tumour component traversing the neural exit foramen
What are the management options for spinal cord compression?
- Dexamethasone 1mg/kg (max 16mg)
- Chemo
- Surgery
- debulking
- laminectomy
- laminotomy
- laminoplasty
List the possible complications and emergencies which can arise in paediatric oncology
- Bleeding
- SVC obstruction
- Airway obstruction
- Leukostasis (white cell plugs in microvasculature)
- Veno-occlusive disease
- Raised ICP
- Bone marrow failure
- Pancreatitis
- Encephalopathy
- Thrombosis
- Refeeding syndrome
Describe the pathophysiology of refeeding syndrome
Refeeding triggers synthesis of glycogen, fat and protein in cells, causing a decrease in serum concentrations of potassium, magnesium and phosphorus
What systems are most affected by refeeding syndrome?
Cardio
Pulmonary
Neuro
Which minerals are decreased in the serum in patients with refeeding syndrome?
- potassium
- magnesium
- phosphorus
What is a neuroblastoma?
A solid tumour arising from the developing sympathetic nervous system. Most commonly arises in the adrenal gland but can also arise in the neck, chest, abdomen and spine. Commonly affects the sympathetic chain.
Describe the presenting signs and symptoms of neuroblastoma
Variable and non-specific; tends to present late and/or with metastases
If the sympathetic chain is affected: sweating, pallor, HTN
If there are liver metastases: abdo pain/discomfort, respiratory difficulties, generally unwell
Other signs/symptoms may present as a result of metastases
Where are neuroblastomas most likely to metastasise to?
- Bone marrow
- Bone
- Liver
- Lymph nodes
- (Skin, brain)
How are neuroblastomas diagnosed?
- Imaging: USS, CT, MRI (usually abdomen)
- Bone marrow biopsy
- Biopsy of any identified mass
- Urinary catecholamine intermediates
Which cancers are only found in children?
- Neuroblastoma
- Wilm’s tumour
- Rhabdomyosarcoma
- Retinoblastoma
Give three types of brain tumour which can arise in children
- Astrocytoma
- Medulloblastoma
- Ependymoma
Describe the signs and symptoms present in a patient with Wilm’s tumour
- large abdominal mass, usually painless
- systemically well
- rare symptoms: haematuria, fever, anorexia, N+V, hypertension
Describe the diagnosis/management options for Wilm’s tumour
- Abdominal ultrasound, CT and/or MRI
- NOT biopsy
- Nephrectomy
- CT chest to exclude mets
- Chemotherapy
What type of genetic condition is neurofibromatosis?
Autosomal dominant
