Oncology Flashcards
What are the features of cancer?
Abnormal cells dividing incontrolled way Gene changes Stimulate own blood supply Local invasion Metastatic spread via blood/lymphatics
What are the most common paediatric malignancies?
Leukaemias
Brain tumours
- Extracranial solid tumours
Lymphomas
What is the classification for childhood cancers?
International Classification of Childhood Cancer (ICCC)
Which age group is most likely to get childhood cancer?
0-4yrs
What is the aetiology of childhood cancers?
Genes
Environment: radiation/infection
Iatrogenic: chemo/radiotherapy
What symptoms merit immediate referral?
Unexplained petechiae
Hepatosplenomegaly
What symptoms merit urgent referral?
Repeat attendance, same problem, no clear diagnosis
New neurological symptoms, abdominal mass
What symptoms merit referral?
Rest pain, back pain, unexplained lump
What are symptoms of brain tumours in under 5s?
Persistent/recurrent vomiting Abnormal balance/walking/coordination Abnormal eye movements Behaviour change, letheragy Fits or seizures (no fever) Abnormal head position
What are symptoms of brain tumours in 5-11yrs?
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
What are symptoms of brain tumours in young people (12-18)?
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
What investigations can be done?
Scans
Biopsy/pathology
Tumour markers
What are the acute risks of chemotherapy?
Hair loss N&V Mucositis Diarrhoea/constipation Bone marrow suppression: anaemia, bleeding, infection
What are the chronic risks of chemotherapy?
Organ impairment
Reduced fertility
Second cancer
What are the acute risks of radiotherapy?
Lethargy
Skin irritation
Swelling
Organ inflammation
What are the chronic risks of radiotherapy?
Fibrosis/scarring
Second cancer
Reduced fertility
What are oncological emergencies?
Sepsis/febrile neutropenia Raised ICP Spinal cord compression Mediastinal mass Tumour lysis syndrome
What can cause sepsis/febrile neutropenia?
ANC <0.5x10^9
Indwelling catheter
Mucosal inflammation
High dose chemo
How does sepsis/febrile neutropenia present?
Fever
Rigors
Drowsiness
Shock: tachycardia, tachypnoea, hypotension, prolonged cap refill time, reduced UO, metabolic acidosis
What is the management for sepsis/febrile neutropenia?
Sepsis 6
What is the early presentation of raised ICP?
Early morning headache/vomiting
Tense fontanelle
Increasing head circumference
What are late presentation signs of raised ICP?
Constant headache Papilloedema Diplopia Loss of upgaze Neck stiffness Status epilepticus Reduced GCS Cushing's triad: low HR, high BP
What are the investigations for raised ICP?
CT
MRI - more accurate
What is the management for raised ICP?
Dexamethasone - if tumour
Neurosurgery - urgent CSF diversion
What are the options for neurosurgery in raised ICP?
Ventriculostomy
EVD
VP shunt
What is a potential complication of nearly all paediatric malignancies?
Spinal cord compression
What is the presentation of spinal cord compression?
Weakness
Pain
Sensory
Sphincter disturbance
What is the management of spinal cord compression?
Urgent MRI
Dexamethasone
Chemotherapy
What is SVC syndrome or SMS?
Superior vena cava syndrome
Superior mediastinalsyndrome(SMS) consists ofSVCSwith tracheal compression
What is the most common cause of SVC syndrome?
Lymphoma
How does SVCS present?
Facial, neck and upper thoracic plethora Oedema Cyanosis Distended veins Reduced GCS
How does SMS present?
Dyspnoea Tachypnoea Cough Wheeze Stridor Orthopnoea
What are the investigations for SVCS/SMS?
CXR/CT chest
ECHO
What is usually effective management for SVCS/SMS?
Chemotherapy
What is tumour lysis syndrome?
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
What are the clinical features of tumour lysis syndrome?
Increased potassium Increased urate Increased phosphate Decreased calcium Acute renal failure
What is the treatment for tumour lysis syndrome?
Avoidance ECG monitoring Hyperhydrate Diuresis (RRT) Never give K+
