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Paediatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

About how many new cases of childhood cancer are seen each year?

A

130

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2
Q

What are the most common children cancers?

A

Leukaemia - 33%
Brain tumours - 25%
Extracranial solid tumours - 40%

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3
Q

How is child cancer classified?

A

International classification of childhood cancer (ICCC)

Based un tumour morphology and primary site

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4
Q

What cancer does red light reflex detect?

A

Retinoblastoma

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5
Q

What is the most common age group to get cancer?

A

0-4

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6
Q

What are risk factors for childhood cancer?

A

Environment - radiation and infection ie EBV
Iatrogenic - chemotherapy and radiotherapy
Genes

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7
Q

What genetic conditions increase cancer risk?

A 
Down's
Fanconi
Beckwith Weideman syndrome
Neurofibromatosis
Li-Fraumeni familial cancer syndrome
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8
Q

What is the typical presentation of child cancer?

A 
Biological onset of disease
Symptom onset
Seek medical attention
Doctor recognises cancer as a possibility
Investigation - diagnosis - treatment
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9
Q

Who should be given immediate referral for cancer risk?

A

Patient with unexplained petechiae

Hepatosplenomegaly

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10
Q

Who should be given urgent referral for cancer risk?

A

Repeat attendance with the same problem with no clear diagnosis
New neuro symptoms, abdo mass

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11
Q

Who should be referred to hospital or for urgent investigation?

A

Pain on rest, back pain, waking with pain
Unexplained lump
Lymphadenopathy

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12
Q

What investigations are done for tumours?

A

Scans - MRI if possible
Biopsy/pathology
Tumour markers

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13
Q

How is cancer treated?

A 
Multimodal therapy based on specific disease and extent
MDT approach
Chemotherapy
Surgery
Radiotherapy
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14
Q

What are acute risks of chemotherapy?

A 
Hair loss
Nausea and vomiting
Mucositis
Diarrhoea/constipation
Bone marrow suppression - anaemia, bleeding, infection, thrombocytopenia
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15
Q

What are chronic risks of chemotherapy?

A

Organ impairment - kidneys, heart, nerves, ears
Reduced fertility
Second cancer

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16
Q

What are acute risks of radiotherapy?

A

Lethargy
Skin irritation
Swelling
Organ inflammation

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17
Q

What are chronic risks of radiotherapy?

A

Fibrosis/scarring
Second cancer
Reduced fertility

18
Q

What is the biggest cause of death in treatment?

A

Infection

19
Q

When is someone at risk of infection?

A

Neutrophils <0.5
Indwelling catheter
Mucosal inflammation
High dose chemo/stem cell transplant

20
Q

What are common infections on cancer treatment?

A 
Pseudomonas aeruginosa
Enterobacteriaciae
Enterococci
Strep pneumoniae
Staph
Fungi
21
Q

How does sepsis/febrile neutropenia present?

A

Fever or low temp
Rigors
Drowsiness
Shock

22
Q

How is sepsis/febrile neutropenia managed?

A 
IV access
Blood culture, FBC, U&amp;Es, LFTs, CRP
Lactate
CXR
ABC - oxygen, fluids
Broad spectrum antibiotics
If child very unwell - Intotropes and referral to PICU
23
Q

How does early raised ICP present?

A

Early morning headache/vomiting
Tense fontanelle - younger children
Increasing head circumference in young children

24
Q

How does late raised ICP present?

A 
Constant headache
Papilloedema
Diplopia
Loss of upgaze
Neck stiffness
Status epilepticus
Reduced GCS
Cushings triad - low HR, high BP
25
Q

How is raised ICP investigated?

A

Imaging mandatory - MRI best but CT is good for screening

26
Q

How is raised ICP managed?

A

Dexamethasone if due to tumour - reduces oedema and increases CSF flow
Neurosurgery - ventriculostomy

27
Q

What pathological processes cause spinal cord impression?

A

Invasion from paravertebral disease
Vertebral body compression
CSF seeding
Direct invasion

28
Q

What cancer patients get spinal cord compression?

A

Ewing’s sarcoma
Medulloblastoma
Neuroblastoma

29
Q

How does spinal cord compression present?

A

Weakness
Pain
Sensory problems
Sphincter disturbance

30
Q

How is spinal cord compression managed?

A

Urgent MRI
Start dexamethasone urgently to reduce peritumour oedema
Definitive treatment with chemotherapy is appropriate when rapid response is expected
Surgery

31
Q

What is the main factor of outcome in spinal cord compression?

A

Severity of impairment

32
Q

What is superior vena cava syndrome?

A

Tumour compresses SVC

33
Q

What are common causes of SVC syndrome?

A

Lymphoma
Neuroblastoma
Germ cell tumour
Thrombosis

34
Q

How does SVC syndrome present?

A 
Facial, neck, and upper thoracic plethora
Oedema
Cyanosis
Distended veins
Ill
Anxious
Reduced GCS
35
Q

What are features of severe mediastinal compression?

A 
Dyspnoea
Tachypnoea
Cough
Wheeze
Stridor
Orthopnoea
36
Q

What investigations are done for SVC/SMS?

A

CXR/CT chest

ECHO

37
Q

How is SVC/SMS syndrome managed?

A

Keep upright and calm
Urgent biopsy
Look to obtain important diagnostic info without GA - FBC, pleural aspirate
Definitive treatment is required urgently - chemotherapy/radiotherapy

38
Q

What is tumuour lysis syndrome?

A

Tumour cells rapidly die and release intracellular contents leading to metabolic derangement

39
Q

What are lab features of tumour lysis syndrome?

A 
Raised potassium
Raised urate
Raised phosphate
Decreased calcium
Acute renal failure
40
Q

How is tumour lysis syndrome treated?

A

ECG monitoring
Hyperhydrate
Diuresis
Treat hyperkalaemia - NEVER GIVE POTASSIUM

Paediatrics (25 decks)

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