Oncology

Question 1

how is paediatric oncology classified?

Answer 1

international classification of childhood cancer (ICCC)

based on morphology and primary site

Question 2

what factors put children at risk of cancer?

Answer 2

radiation
infections - EBV
chemotherapy / radiotherapy

genes; 
Down's syndrome
BWS
Li-Fraumeni familial cancer syndrome
Neurofibromatosis 
Fanconi

Question 3

what is the average 5 year survival of childhood cancers?

Answer 3

5 yr survival 80%

Question 4

what type of cancer are children with downs syndrome at risk of?

Answer 4

leukaemia (AML & ALL)

Question 5

list symptoms/signs which would require referral to oncology.

Answer 5

immediate referral;
unexplained petechiae
hepatosplenomegaly

urgent referral;
repeated attendance, same problem but no clear diagnosis
new neurological symptoms
abdominal mass

refer;
rest pain / back pain
lymphadenopathy

Question 6

what imaging modality if most useful for assessing tumours in children?

Answer 6

MRI

Question 7

what are the acute side effects of chemotherapy?

Answer 7

hair loss
nausea and vomiting 
mucositis 
diarrhoea / constipation 
bone marrow suppression - anaemia, bleeding, infection

Question 8

what site is the most common area of metastasis of childhood cancer?

Answer 8

chest

Question 9

what are the chronic side effects of chemotherapy?

Answer 9

organ impairment - kidneys, heart, nerves, ears
reduced fertility
second cancer

Question 10

what are the acute side effects of radiotherapy?

Answer 10

lethargy
skin irritation
swelling
organ inflammation - bowel, lungs

Question 11

what are the chronic side effects of radiotherapy?

Answer 11

fibrosis / scaring
second cancer
reduced fertility

Question 12

list 5 oncology emergencies in children.

Answer 12

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

Question 13

what puts a child with cancer at risk of sepsis ?

Answer 13

indwelling catheter
mucosal inflammation
high dose chemo
absolute neutrophil count < 0.5 x10(9)

Question 14

what organisms can be responsible for sepsis in a neutropenic child with cancer?

Answer 14

pseudomonas aeuginosa 
escherichia coli 
klebsiella 
strep pneumonia
enterococci
staphylococcus
candida, Apergillus

Question 15

what investigation should you carry out if a child was showing signs of sepsis?

Answer 15

blood culture, FBC, coagulation, U & E, LFTs, CRP, lactate

CXR
IV access

Question 16

what its the management for febrile neutropenia?

Answer 16

oxygen 
IV fluids 
broad spectrum antibiotics 
consider ionotropic support 
PICU

Question 17

what are the early signs of raised ICP in a child?

Answer 17

early morning headache / vomiting
tense fontanelle
increased head circumference

Question 18

what is the management of raised ICP in children?

Answer 18

high dose steroids - dexamethasone
- 250 micro/kg IV then 125 micron/kg BD

neurosurgery for CSF diversion

• ventriculostomy
• external ventricular drain
• VP shunt

Question 19

what is the presentation of spinal cord compression due to the spread of a cancer?

Answer 19

weakness
pain
sensory changes
sphincter disturbance

Question 20

what is the management for spinal cord compression due to spread of cancer?

Answer 20

dexamthasone - reduce peri-tumour oedema

definitive treatment

• chemotherapy
• RT and surgery (other options)

Question 21

what are common causes of SVC syndrome ?

Answer 21

lymphoma
neuroblastoma
germ cell tumour
thrombosis

Question 22

what is the presentation of SVC syndrome?

Answer 22

facial, neck and upper thoracic plethora
oedema 
cyanosis 
distended veins 
anxious, ill 
reduced GCS (late stage)

Question 23

what is the definitive treatment for SVC syndrome?

Answer 23

chemotherapy - rapidly effective

radiotherapy - also effective

Question 24

what are the clinical features of tumour lysis syndrome?

Answer 24

increased potassium 
increased urate 
increased phosphate 
decreased calcium 
acute renal failure
- calcium phosphate deposition in renal tubules & urate load

Question 25

how would you treat hyperkalaemia in tumour lysis syndrome?

Answer 25

calcium resonium
salbutamol
insulin

Question 26

how would you decrease uric acid levels in tumour lysis syndrome?

Answer 26

urate oxidase uricozyme - rasburicase

allopurinol

Question 27

how would you manage a child who is at risk of tumour lysis syndrome?

Answer 27

hyper hydrate 2.5ml/m2
ECG monitoring
diuresis
quantum dot-sensitised electrolytes