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Paedriatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

What are the features of cancer?

A 
Abnormal cells dividing incontrolled way
Gene changes
Stimulate own blood supply
Local invasion
Metastatic spread via blood/lymphatics
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2
Q

What are the most common paediatric malignancies?

A

Leukaemias
Brain tumours
- Extracranial solid tumours
Lymphomas

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3
Q

What is the classification for childhood cancers?

A

International Classification of Childhood Cancer (ICCC)

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4
Q

Which age group is most likely to get childhood cancer?

A

0-4yrs

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5
Q

What is the aetiology of childhood cancers?

A

Genes
Environment: radiation/infection
Iatrogenic: chemo/radiotherapy

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6
Q

What symptoms merit immediate referral?

A

Unexplained petechiae

Hepatosplenomegaly

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7
Q

What symptoms merit urgent referral?

A

Repeat attendance, same problem, no clear diagnosis

New neurological symptoms, abdominal mass

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8
Q

What symptoms merit referral?

A

Rest pain, back pain, unexplained lump

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9
Q

What are symptoms of brain tumours in under 5s?

A 
Persistent/recurrent vomiting
Abnormal balance/walking/coordination
Abnormal eye movements
Behaviour change, letheragy
Fits or seizures (no fever)
Abnormal head position
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10
Q

What are symptoms of brain tumours in 5-11yrs?

A 
Persistent/recurrent vomiting
Persistent/recurrent headache
Abnormal balance/walking/coordination
Abnormal eye movements
Blurred or double vision
Behaviour change
Fits or seizures
Abnormal head position
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11
Q

What are symptoms of brain tumours in young people (12-18)?

A 
Persistent/recurrent vomiting
Persistent/recurrent headaches
Abnormal eye movements
Blurred or double vision
Abnormal balance/walking/coordination
Behaviour change
Fits or seizures
Delayed or arrested puberty
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12
Q

What investigations can be done?

A

Scans
Biopsy/pathology
Tumour markers

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13
Q

What are the acute risks of chemotherapy?

A 
Hair loss
N&V
Mucositis
Diarrhoea/constipation
Bone marrow suppression: anaemia, bleeding, infection
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14
Q

What are the chronic risks of chemotherapy?

A

Organ impairment
Reduced fertility
Second cancer

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15
Q

What are the acute risks of radiotherapy?

A

Lethargy
Skin irritation
Swelling
Organ inflammation

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16
Q

What are the chronic risks of radiotherapy?

A

Fibrosis/scarring
Second cancer
Reduced fertility

17
Q

What are oncological emergencies?

A 
Sepsis/febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass
Tumour lysis syndrome
18
Q

What can cause sepsis/febrile neutropenia?

A

ANC <0.5x10^9
Indwelling catheter
Mucosal inflammation
High dose chemo

19
Q

How does sepsis/febrile neutropenia present?

A

Fever
Rigors
Drowsiness
Shock: tachycardia, tachypnoea, hypotension, prolonged cap refill time, reduced UO, metabolic acidosis

20
Q

What is the management for sepsis/febrile neutropenia?

A

Sepsis 6

21
Q

What is the early presentation of raised ICP?

A

Early morning headache/vomiting
Tense fontanelle
Increasing head circumference

22
Q

What are late presentation signs of raised ICP?

A 
Constant headache
Papilloedema
Diplopia
Loss of upgaze
Neck stiffness
Status epilepticus
Reduced GCS
Cushing's triad: low HR, high BP
23
Q

What are the investigations for raised ICP?

A

CT

MRI - more accurate

24
Q

What is the management for raised ICP?

A

Dexamethasone - if tumour

Neurosurgery - urgent CSF diversion

25
Q

What are the options for neurosurgery in raised ICP?

A

Ventriculostomy
EVD
VP shunt

26
Q

What is a potential complication of nearly all paediatric malignancies?

A

Spinal cord compression

27
Q

What is the presentation of spinal cord compression?

A

Weakness
Pain
Sensory
Sphincter disturbance

28
Q

What is the management of spinal cord compression?

A

Urgent MRI
Dexamethasone
Chemotherapy

29
Q

What is SVC syndrome or SMS?

A

Superior vena cava syndrome

Superior mediastinalsyndrome(SMS) consists ofSVCSwith tracheal compression

30
Q

What is the most common cause of SVC syndrome?

A

Lymphoma

31
Q

How does SVCS present?

A 
Facial, neck and upper thoracic plethora
Oedema
Cyanosis
Distended veins
Reduced GCS
32
Q

How does SMS present?

A 
Dyspnoea
Tachypnoea
Cough
Wheeze
Stridor
Orthopnoea
33
Q

What are the investigations for SVCS/SMS?

A

CXR/CT chest

ECHO

34
Q

What is usually effective management for SVCS/SMS?

A

Chemotherapy

35
Q

What is tumour lysis syndrome?

A

A group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream

36
Q

What are the clinical features of tumour lysis syndrome?

A 
Increased potassium
Increased urate
Increased phosphate
Decreased calcium
Acute renal failure
37
Q

What is the treatment for tumour lysis syndrome?

A 
Avoidance
ECG monitoring
Hyperhydrate
Diuresis (RRT)
Never give K+

Paedriatrics (19 decks)

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