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Paediatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

How common is paediatric cancer?

A

<1% of all cancers

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2
Q

In which gender is childhood cancer more common?

A

Slightly more common in boys

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3
Q

When is the highest incidence of childhood cancer?

A

0-4y

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4
Q

What malignancies are most common in childhood?

A

Leukaemias (33%)
Brain tumours (25%)
40% are extracranial solid tumours

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5
Q

How does childhood cancer differ in its aetiology from adult cancer?

A

Not so much to do with wear and tear

More sporadic

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6
Q

What is the overall 5ys for childhood cancers?

A

> 80%

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7
Q

How are children’s cancers classified?

A

International classification of childhood cancer (ICCC)

Based on morphology and primary site

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8
Q

What are the aetiologies of childhood cancer?

A

Genes: down, Fanconis, BWS, Li-fraumeni familial cancer syndrome, neurofibromatosis
Environment: radiation (UV –> skin cancer), infections (e.g. HPV, EBV)
Iatrogenic: chemo/radio

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9
Q

What does Down syndrome increase the risk of?

A

ALL/AML (which may can be congenital)

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10
Q

What is Fanconi’s anaemia?

A

AD genetic condition assoc with short stature, developmental abnormalities, chromosomal fragility –> more likely to get adult cancers at younger age

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11
Q

What is BWS?

A

Beck-Weideman syndrome
Congenital disorder of growth with predisposition to tumour formation (get omphalocele, neonatal hypoglycaemia, macroglossia)

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12
Q

What is Li-Fraumeni familial cancer syndrome?

A

AD mutation of p53 gene (get sarcomas, leukaemias etc.)

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13
Q

What is neurofibromatosis?

A

Condition in which tumours grow in the nervous system (type I - café au lait spots, type 2 - vestibular schwannomas)

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14
Q

What things delay diagnosis of cancer?

A

Onset of symptoms after biological onset of disease
Symptoms (pressure/organ dysfunction)
Seeking of medical attention
Doctor recognising cancer as a possibility
Ix and diagnosis

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15
Q

What things merit immediate referral?

A

Unexplained petechiae, hepatosplenomegaly –> Ix for leukaemia/lymphoma that day

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16
Q

What things merit urgent referral?

A

Repeat attendance, same problem, no clear diagnosis, new neuro symptoms/abdo mass
See specialist within 48h

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17
Q

What things may get a normal referral within 2 weeks?

A

Rest pain, back pain, unexplained lump, lymphadenopathy

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18
Q

What programme has increased awareness of brain tumours in children?

A

Head smart campaign

has posters with symptoms - persistent/recurrent & neurological symptoms are ones to be aware of

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19
Q

What investigations can you do in paediatric oncology?

A

Scans, biopsy/pathology, tumour markers

Staging - scans, bone marrow

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20
Q

What are the common places for spread of cancer?

A

Bone, liver, lung, brain

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21
Q

What is involved in the treatment of childhood cancer?

A

Chemo, radio, surgery, immunotherapy

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22
Q

What are the acute side effects of chemo?

A

Hair loss, NV, diarrhoea/constipation, bone marrow suppression (anaemia, bleeding, infections)

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23
Q

What are the chronic side effects of chemo?

A

Organ impairment (heart, kidneys, eyes, nerves), reduced fertility, second cancer

24
Q

What are the acute side effects of radiotherapy?

A

Skin irritation, lethargy, swelling, organ inflammation (lungs, bowel)

25
Q

What are the chronic side effects of radiotherapy?

A

Fibrosis/scarring, second cancer, reduced fertility

26
Q

What are the serious oncological emergencies?

A 
Sepsis/febrile neutropenia
Raised ICP 
Spinal cord compression 
Mediastinal mass
Tumour lysis syndrome
27
Q

What is the biggest cause of mortality/morbidity in paediatric oncology?

A

Sepsis/febrile neutropenia

28
Q

What things put oncology patients at greater risk of sepsis/febrile neutropenia?

A

ANC <0.5x10^9, indwelling catheter, mucositis, high dose chemo/SCT

29
Q

What opportunistic pathogens may cause sepsis/febrile neutropenia in cancer patients?

A

Pseudomonas aerginosa, eneterobacteriaeciae, e.g. E. coli, klebsiella, strep pneumoniae, eneterococci, staphylococcus, fungi, esp candida & aspergillus

30
Q

What is the presentation of febrile neutropenia/sepsis?

A

Fever/hypothermia, rigors, drowsiness, shock (tachycardia, tachyopnoea, hypotension, prolonged cap refill, reduced UO, metabolic acidosis)

31
Q

How do you investigate sepsis/febrile neutropenia?

A

IV access, blood culture, FBC, coag, UE, LFTs, CRP, lactate, CXR, other (urine microscopy, culture, throat swab, sputum culture/BAL, LP, viral PCRs, CT, USS

32
Q

How do you manage febrile neutropenia/sepsis?

A

Oxygen, fluids, broad spectrum antibiotics, inotropes, PICU

33
Q

In what age will you not see raised ICP?

A

Before 9-12m as fontantelles not fully closed yet

34
Q

As pressure goes up what goes down and causes problems in RICP?

A

BP does down

35
Q

What are the early signs of RICP?

A

Early morning headache/vomiting, tense fontanelle, increased head circumference

36
Q

What are the late signs of RICP?

A

Constant headache, papilloedema, diplopia (VI palsy), loss of upgaze (if tumour near pineal gland), neck stiffness, status epilepticus, reduced CGD, cushing’s triad

37
Q

What is cushing’s triad?

A

Low HR, high BP, low RR

Indicative of raised intracranial pressure

38
Q

How do you Mx RICP?

A

Dexamethasone if due to tumour (reduces oedema/increases CSF flow), neurosurgery (urgent CSF diversion - ventriculostomy, EVD, VP shunt)

39
Q

What is a ventriculostomy?

A

Hole in membrane of base of 3rd ventricle with endoscope

40
Q

How long can you use an EVD for?

A

Only temporarily

41
Q

Spinal cord compression is a potential complication of nearly all paediatric malignancies, but in which ones is it most common?

A

Ewings sarcoma (esp. in vertebral bodies), tumours in abdomen, germ cell tumours, neuroblastomas, medulloblastomas

42
Q

What are the pathological processes in cancer that lead to cord compression?

A

Invasion from paravertebral disease via intervertebral foramina
Veretebral body compression
CSF seeding
Direct invasion

43
Q

What sort of presentation do you get with spinal cord compression?

A

Weakness, pain, sensory, sphincter disturbance

44
Q

How do you investigate spinal cord compression?

A

Urgent MRI

45
Q

How do you treat spinal cord compression?

A

Start dexamethasone urgently to reduce peri-tumour oedema, definitive Rx with chemo when rapid response expected (or radio/surgery)

46
Q

What does outcome of cord compression depend on?

A

Severity of impairment

47
Q

What can mediastinal masses cause?

A

SVCS (superior vena cava syndrome) or SMS (superior mediastinal syndrome - obstruction of airway)

48
Q

What can commonly cause SMS/SVCS?

A

Lymphoma

Neuroblastoma, germ cell tumours, thrombosis of the vena cava due to tumour compression

49
Q

What does SVCS present like?

A

Facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins, ill, anxious, reduced GCS

50
Q

What does SMS present like?

A

Dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea

51
Q

How do you investigate suspected SMS/SVCS?

A

CXR/CT chest

Echo

52
Q

How do you manage SMS/SCVS?

A 
Keep upright &amp; calm 
Urgent biopsy 
FBC, BM, pleural aspirate, GCT markers 
Chemo (may need presumptive Rx in absence of definitive histological diagnosis - steroids) 
Radio
Rarely surgery if insensitive 
CVAD assoc. thrombosis - thrombolytics
53
Q

What is tumour lysis syndrome?

A

Cancer cells grow so quickly, they can’t sustain themselves and start to die off (or lots of chemo –> lots of death at one time) –> release of intracellular content into plasma –> high levels K and phosphate –> flood kidneys and can’t be cleared –> arrhythmias

54
Q

What are the clinical features of tumour lysis syndrome?

A

High potassium, urate, phosphate, low calcium

Acute renal failure - urate load, CaPO4 deposition in renal tubules

55
Q

What is the treatment for tumour lysis syndrome?

A 
Avoidance, ECG monitoring
Hyperhydrate - 2.5ml/m2
QDS electrolytes
Diuresis 
Never give potassium 
Decreas uric acid (allopurinol/urate oxidase/uricozyme)
Treat hyperK - Ca resonium, salbutamol, insulin 
Renal replacement therapy (dialysis)

Paediatrics (35 decks)

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