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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
What are the chronic side effects of radiotherapy?
Fibrosis/scarring, second cancer, reduced fertility
26
What are the serious oncological emergencies?
``` Sepsis/febrile neutropenia Raised ICP Spinal cord compression Mediastinal mass Tumour lysis syndrome ```
27
What is the biggest cause of mortality/morbidity in paediatric oncology?
Sepsis/febrile neutropenia
28
What things put oncology patients at greater risk of sepsis/febrile neutropenia?
ANC <0.5x10^9, indwelling catheter, mucositis, high dose chemo/SCT
29
What opportunistic pathogens may cause sepsis/febrile neutropenia in cancer patients?
Pseudomonas aerginosa, eneterobacteriaeciae, e.g. E. coli, klebsiella, strep pneumoniae, eneterococci, staphylococcus, fungi, esp candida & aspergillus
30
What is the presentation of febrile neutropenia/sepsis?
Fever/hypothermia, rigors, drowsiness, shock (tachycardia, tachyopnoea, hypotension, prolonged cap refill, reduced UO, metabolic acidosis)
31
How do you investigate sepsis/febrile neutropenia?
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
How do you manage febrile neutropenia/sepsis?
Oxygen, fluids, broad spectrum antibiotics, inotropes, PICU
33
In what age will you not see raised ICP?
Before 9-12m as fontantelles not fully closed yet
34
As pressure goes up what goes down and causes problems in RICP?
BP does down
35
What are the early signs of RICP?
Early morning headache/vomiting, tense fontanelle, increased head circumference
36
What are the late signs of RICP?
Constant headache, papilloedema, diplopia (VI palsy), loss of upgaze (if tumour near pineal gland), neck stiffness, status epilepticus, reduced CGD, cushing's triad
37
What is cushing's triad?
Low HR, high BP, low RR | Indicative of raised intracranial pressure
38
How do you Mx RICP?
Dexamethasone if due to tumour (reduces oedema/increases CSF flow), neurosurgery (urgent CSF diversion - ventriculostomy, EVD, VP shunt)
39
What is a ventriculostomy?
Hole in membrane of base of 3rd ventricle with endoscope
40
How long can you use an EVD for?
Only temporarily
41
Spinal cord compression is a potential complication of nearly all paediatric malignancies, but in which ones is it most common?
Ewings sarcoma (esp. in vertebral bodies), tumours in abdomen, germ cell tumours, neuroblastomas, medulloblastomas
42
What are the pathological processes in cancer that lead to cord compression?
Invasion from paravertebral disease via intervertebral foramina Veretebral body compression CSF seeding Direct invasion
43
What sort of presentation do you get with spinal cord compression?
Weakness, pain, sensory, sphincter disturbance
44
How do you investigate spinal cord compression?
Urgent MRI
45
How do you treat spinal cord compression?
Start dexamethasone urgently to reduce peri-tumour oedema, definitive Rx with chemo when rapid response expected (or radio/surgery)
46
What does outcome of cord compression depend on?
Severity of impairment
47
What can mediastinal masses cause?
SVCS (superior vena cava syndrome) or SMS (superior mediastinal syndrome - obstruction of airway)
48
What can commonly cause SMS/SVCS?
Lymphoma | Neuroblastoma, germ cell tumours, thrombosis of the vena cava due to tumour compression
49
What does SVCS present like?
Facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins, ill, anxious, reduced GCS
50
What does SMS present like?
Dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea
51
How do you investigate suspected SMS/SVCS?
CXR/CT chest | Echo
52
How do you manage SMS/SCVS?
``` Keep upright & 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
What is tumour lysis syndrome?
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
What are the clinical features of tumour lysis syndrome?
High potassium, urate, phosphate, low calcium | Acute renal failure - urate load, CaPO4 deposition in renal tubules
55
What is the treatment for tumour lysis syndrome?
``` 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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