Oncology

Question 1

Epidemiology

Answer 1

1800 cases in UK/year
130 in Scotland
boys>girls
1% of all cancers

Question 2

paediatric malignancy types

Answer 2

leukaemias
brain tumours
extracranial solid tumours

Question 3

classification

Answer 3

international classification for childhood cancer

tumour morphology

Question 4

peak age

Answer 4

0-4 years

Question 5

Why do they get cancer?

Answer 5

most sporadic
genes - downs, Fanconi, li fraumeni, neurofibromatosis
environment - infection, radiation
iatrogenic

Question 6

Immediate referral

Answer 6

unexplained petechiae

hepatosplenomegaly

Question 7

urgent referral

Answer 7

repeat attendance
new neuro symptoms
abdo mass

Question 8

refer

Answer 8

rest pain, back pain
lump
LN

Question 9

acute risks of treatment

Answer 9

hair loss
nausea and vomiting
diarrhoea/constipation
bone marrow suppression

Question 10

chronic risks of treatment

Answer 10

organ impairment
fertility
second cancer

Question 11

5 oncological emergencies

Answer 11

sepsis/febrile neutropenia
raised ICP 
spinal cord compression 
mediastinal mass
tumour lysis syndrome

Question 12

risks for sepsis

Answer 12

neutropenia
catheter
mucosal inflammation
high dose chemo

Question 13

sepsis - causative organisms

Answer 13

pseudomonas
E.coli
fungi
staph/strep

Question 14

sepsis presentation

Answer 14

fever
rigors
drowsiness
shock

Question 15

managing sepsis

Answer 15

IV antibiotics 
ABC - oxygen, fluids 
blood culture, lactate, FBC, coag, UE, LFT, CRP
CXR
swabs/BAL/viral PCR..

Question 16

late presentation of raised ICP

Answer 16

constant headache
papilloedema 
diplopia 
neck stiffness
loss of upgaze
cushings triad
reduced CGS
status epilepticus

Question 17

cushings triad

Answer 17

low HR, RR

high BP

Question 18

investigating raised ICP

Answer 18

MRI

Question 19

managing raised ICP

Answer 19

dexamethasone if due to tumour
neurosurgery 
- ventriculostomy 
- EVD
-VP shunt

Question 20

particular cancers at risk of spinal cord compression

Answer 20

ewings

neuroblastoma

Question 21

managing spinal cord compression

Answer 21

dexamethasone
MRI
chemo

Question 22

common cause of mediastinal masses

Answer 22

lymphoma
germ cell tumour
thrombosis

Question 23

SVCS

Answer 23

facial, neck, upper thorax plethora
oedema
cyanosis
reduced GCS

Question 24

SMS

Answer 24

dyspnoea 
tachycardia 
cough 
wheeze 
stridor

Question 25

Investigating mediastinal masses

Answer 25

CXR/CT chest

echo

Question 26

managing mediastinal masses

Answer 26

keep upright and calm 
urgent biopsy
FBC, pleural aspirate
chemo, steroids, radiotherapy 
thrombolytic therapy

Question 27

tumour lysis syndrome

Answer 27

metabolic derangement and rapid death of cancer cells releasing contents

Question 28

clinical features of tumour lysis syndrome

Answer 28

high potassium and phosphate and urate
low calcium
AKI

Question 29

Treating tumour lysis syndrome

Answer 29

ECG, hyperhydrate, diuresis
NEVER POTASSIUM
allopurinol, treat hyperkalaemia, RRT