Oncology

Question 1

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

Answer 1

130

Question 2

What are the most common children cancers?

Answer 2

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

Question 3

How is child cancer classified?

Answer 3

International classification of childhood cancer (ICCC)

Based un tumour morphology and primary site

Question 4

What cancer does red light reflex detect?

Answer 4

Retinoblastoma

Question 5

What is the most common age group to get cancer?

Answer 5

0-4

Question 6

What are risk factors for childhood cancer?

Answer 6

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

Question 7

What genetic conditions increase cancer risk?

Answer 7

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

Question 8

What is the typical presentation of child cancer?

Answer 8

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

Question 9

Who should be given immediate referral for cancer risk?

Answer 9

Patient with unexplained petechiae

Hepatosplenomegaly

Question 10

Who should be given urgent referral for cancer risk?

Answer 10

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

Question 11

Who should be referred to hospital or for urgent investigation?

Answer 11

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

Question 12

What investigations are done for tumours?

Answer 12

Scans - MRI if possible
Biopsy/pathology
Tumour markers

Question 13

How is cancer treated?

Answer 13

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

Question 14

What are acute risks of chemotherapy?

Answer 14

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

Question 15

What are chronic risks of chemotherapy?

Answer 15

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

Question 16

What are acute risks of radiotherapy?

Answer 16

Lethargy
Skin irritation
Swelling
Organ inflammation

Question 17

What are chronic risks of radiotherapy?

Answer 17

Fibrosis/scarring
Second cancer
Reduced fertility

Question 18

What is the biggest cause of death in treatment?

Answer 18

Infection

Question 19

When is someone at risk of infection?

Answer 19

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

Question 20

What are common infections on cancer treatment?

Answer 20

Pseudomonas aeruginosa
Enterobacteriaciae
Enterococci
Strep pneumoniae
Staph
Fungi

Question 21

How does sepsis/febrile neutropenia present?

Answer 21

Fever or low temp
Rigors
Drowsiness
Shock

Question 22

How is sepsis/febrile neutropenia managed?

Answer 22

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

Question 23

How does early raised ICP present?

Answer 23

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

Question 24

How does late raised ICP present?

Answer 24

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

Question 25

How is raised ICP investigated?

Answer 25

Imaging mandatory - MRI best but CT is good for screening

Question 26

How is raised ICP managed?

Answer 26

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

Question 27

What pathological processes cause spinal cord impression?

Answer 27

Invasion from paravertebral disease Vertebral body compression CSF seeding Direct invasion

Question 28

What cancer patients get spinal cord compression?

Answer 28

Ewing's sarcoma Medulloblastoma Neuroblastoma

Question 29

How does spinal cord compression present?

Answer 29

Weakness Pain Sensory problems Sphincter disturbance

Question 30

How is spinal cord compression managed?

Answer 30

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

Question 31

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

Answer 31

Severity of impairment

Question 32

What is superior vena cava syndrome?

Answer 32

Tumour compresses SVC

Question 33

What are common causes of SVC syndrome?

Answer 33

Lymphoma Neuroblastoma Germ cell tumour Thrombosis

Question 34

How does SVC syndrome present?

Answer 34

``` Facial, neck, and upper thoracic plethora Oedema Cyanosis Distended veins Ill Anxious Reduced GCS ```

Question 35

What are features of severe mediastinal compression?

Answer 35

``` Dyspnoea Tachypnoea Cough Wheeze Stridor Orthopnoea ```

Question 36

What investigations are done for SVC/SMS?

Answer 36

CXR/CT chest | ECHO

Question 37

How is SVC/SMS syndrome managed?

Answer 37

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

Question 38

What is tumuour lysis syndrome?

Answer 38

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

Question 39

What are lab features of tumour lysis syndrome?

Answer 39

``` Raised potassium Raised urate Raised phosphate Decreased calcium Acute renal failure ```

Question 40

How is tumour lysis syndrome treated?

Answer 40

ECG monitoring Hyperhydrate Diuresis Treat hyperkalaemia - NEVER GIVE POTASSIUM