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Paediatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

What type of cancer is most common in children?

A

Leukaemia (32%), particularly acute lymphoblastic leukaemia (ALL - 20-25%)

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2
Q

What percentage of childhood cancers are CNS tumours?

A

24%

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3
Q

List the eight most common childhood cancers

A
  • Leukaemia
  • CNS tumours
  • Lymphomas
  • Neuroblastoma
  • Soft tissue e.g. rhabdomyosarcoma
  • Wilm’s tumour
  • Bone tumours
  • Retinoblastoma
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4
Q

What type of tumour is Wilm’s tumour?

A

Nephroblastoma (kidney cancer)

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5
Q

Which genetic conditions are associated with high risk of childhood cancer?

A
  • Down syndrome
  • Fanconi syndrome
  • Beckwith-Wiedemann syndrome (BWS)
  • Li-Fraumeni Familial Cancer syndrome
  • Neurofibromatosis
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6
Q

Which types of cancer are associated with neurofibromatosis?

A

Nervous system cancers:

  • low-grade glioma
  • benign neurofibromas
  • neurofibrosarcomas
  • malignant peripheral nerve sheath tumours
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7
Q

Give three viral infections which are associated with an increased risk of cancer in children.

A

EBV - Burkitt/Hodgkin lymphomas, nasopharyngeal cancers

Hep B - hepatic carcinoma

HIV - Kaposi sarcoma

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8
Q

Which cancer drug is associated with an increased risk of leukaemia?

A

Etoposide - chemo drug associated with AML

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9
Q

What are the “red flag” symptoms that suggest childhood cancer?

A
  • Neurological symptoms
  • Headache
  • Lymphadenopathy
  • Lump/mass/swelling
  • Fatigue
  • Back pain
  • Bruising
  • Urinary symptoms
  • Hepatosplenomegaly

URGENT REFERRAL

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10
Q

Give three oncological emergencies that can arise as complications of cancer treatment

A
  • Tumour lysis syndrome
  • Febrile neutropenia
  • Spinal cord compresssion
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11
Q

What substance is the greatest cause of concern in tumour lysis syndrome?

A

Urate

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12
Q

Describe the pathophysiology of tumour lysis syndrome

A

massive release of urate due to breakdown of tumour cells and release of intracellular contents

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13
Q

What are the clinical features of tumour lysis syndrome?

A
  • Raised potassium
  • Raised urate, relatively insoluble
  • Raised phosphate
  • Low calcium
  • Acute renal failure
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14
Q

How is tumour lysis syndrome managed?

A
  • 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
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15
Q

Define febrile neutropenia

A

Low neutrophils (< 1 x 10^9 /L) plus fever ( > 38 degrees C)

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16
Q

In oncology, what diagnosis should be assumed to be causing febrile neutropenia until proven otherwise?

A

Infection - treat as potential bacterial septicaemia

17
Q

Describe the investigations needed for a patient with febrile neutropenia

A
  • Cultures
  • Swabs
  • Stool sample
  • Urine sample
18
Q

What percentage of solid tumours present with spinal cord compression in paeds?

A

around 5% (much more common in the terminal phase)

19
Q

What are the clinical features of spinal cord compression in children?

A

Weakness Spine tenderness Back pain Sphincter disturbance Sensory disturbance Gait disturbance

20
Q

What is meant by a “dumbbell tumour”?

A

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

21
Q

What are the management options for spinal cord compression?

A
  • Dexamethasone 1mg/kg (max 16mg)
  • Chemo
  • Surgery
    • debulking
    • laminectomy
    • laminotomy
    • laminoplasty
22
Q

List the possible complications and emergencies which can arise in paediatric oncology

A
  • Bleeding
  • SVC obstruction
  • Airway obstruction
  • Leukostasis (white cell plugs in microvasculature)
  • Veno-occlusive disease
  • Raised ICP
  • Bone marrow failure
  • Pancreatitis
  • Encephalopathy
  • Thrombosis
  • Refeeding syndrome
23
Q

Describe the pathophysiology of refeeding syndrome

A

Refeeding triggers synthesis of glycogen, fat and protein in cells, causing a decrease in serum concentrations of potassium, magnesium and phosphorus

24
Q

What systems are most affected by refeeding syndrome?

A

Cardio

Pulmonary

Neuro

25
Q

Which minerals are decreased in the serum in patients with refeeding syndrome?

A
  • potassium
  • magnesium
  • phosphorus
26
Q

What is a neuroblastoma?

A

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.

27
Q

Describe the presenting signs and symptoms of neuroblastoma

A

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

28
Q

Where are neuroblastomas most likely to metastasise to?

A
  • Bone marrow
  • Bone
  • Liver
  • Lymph nodes
  • (Skin, brain)
29
Q

How are neuroblastomas diagnosed?

A
  • Imaging: USS, CT, MRI (usually abdomen)
  • Bone marrow biopsy
  • Biopsy of any identified mass
  • Urinary catecholamine intermediates
30
Q

Which cancers are only found in children?

A
  • Neuroblastoma
  • Wilm’s tumour
  • Rhabdomyosarcoma
  • Retinoblastoma
31
Q

Give three types of brain tumour which can arise in children

A
  • Astrocytoma
  • Medulloblastoma
  • Ependymoma
32
Q

Describe the signs and symptoms present in a patient with Wilm’s tumour

A
  • large abdominal mass, usually painless
  • systemically well
  • rare symptoms: haematuria, fever, anorexia, N+V, hypertension
33
Q

Describe the diagnosis/management options for Wilm’s tumour

A
  • Abdominal ultrasound, CT and/or MRI
  • NOT biopsy
  • Nephrectomy
  • CT chest to exclude mets
  • Chemotherapy
34
Q

What type of genetic condition is neurofibromatosis?

A

Autosomal dominant

Paediatrics (12 decks)

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