Oncology Flashcards
how is paediatric oncology classified?
international classification of childhood cancer (ICCC)
based on morphology and primary site
what factors put children at risk of cancer?
radiation
infections - EBV
chemotherapy / radiotherapy
genes; Down's syndrome BWS Li-Fraumeni familial cancer syndrome Neurofibromatosis Fanconi
what is the average 5 year survival of childhood cancers?
5 yr survival 80%
what type of cancer are children with downs syndrome at risk of?
leukaemia (AML & ALL)
list symptoms/signs which would require referral to oncology.
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
what imaging modality if most useful for assessing tumours in children?
MRI
what are the acute side effects of chemotherapy?
hair loss nausea and vomiting mucositis diarrhoea / constipation bone marrow suppression - anaemia, bleeding, infection
what site is the most common area of metastasis of childhood cancer?
chest
what are the chronic side effects of chemotherapy?
organ impairment - kidneys, heart, nerves, ears
reduced fertility
second cancer
what are the acute side effects of radiotherapy?
lethargy
skin irritation
swelling
organ inflammation - bowel, lungs
what are the chronic side effects of radiotherapy?
fibrosis / scaring
second cancer
reduced fertility
list 5 oncology emergencies in children.
sepsis / febril neutropenia raised ICP spinal cord compression mediastinal mass tumour lysis syndrome
what puts a child with cancer at risk of sepsis ?
indwelling catheter
mucosal inflammation
high dose chemo
absolute neutrophil count < 0.5 x10(9)
what organisms can be responsible for sepsis in a neutropenic child with cancer?
pseudomonas aeuginosa escherichia coli klebsiella strep pneumonia enterococci staphylococcus candida, Apergillus
what investigation should you carry out if a child was showing signs of sepsis?
blood culture, FBC, coagulation, U & E, LFTs, CRP, lactate
CXR
IV access
what its the management for febrile neutropenia?
oxygen IV fluids broad spectrum antibiotics consider ionotropic support PICU
what are the early signs of raised ICP in a child?
early morning headache / vomiting
tense fontanelle
increased head circumference
what is the management of raised ICP in children?
high dose steroids - dexamethasone
- 250 micro/kg IV then 125 micron/kg BD
neurosurgery for CSF diversion
- ventriculostomy
- external ventricular drain
- VP shunt
what is the presentation of spinal cord compression due to the spread of a cancer?
weakness
pain
sensory changes
sphincter disturbance
what is the management for spinal cord compression due to spread of cancer?
dexamthasone - reduce peri-tumour oedema
definitive treatment
- chemotherapy
- RT and surgery (other options)
what are common causes of SVC syndrome ?
lymphoma
neuroblastoma
germ cell tumour
thrombosis
what is the presentation of SVC syndrome?
facial, neck and upper thoracic plethora oedema cyanosis distended veins anxious, ill reduced GCS (late stage)
what is the definitive treatment for SVC syndrome?
chemotherapy - rapidly effective
radiotherapy - also effective
what are the clinical features of tumour lysis syndrome?
increased potassium increased urate increased phosphate decreased calcium acute renal failure - calcium phosphate deposition in renal tubules & urate load
how would you treat hyperkalaemia in tumour lysis syndrome?
calcium resonium
salbutamol
insulin
how would you decrease uric acid levels in tumour lysis syndrome?
urate oxidase uricozyme - rasburicase
allopurinol
how would you manage a child who is at risk of tumour lysis syndrome?
hyper hydrate 2.5ml/m2
ECG monitoring
diuresis
quantum dot-sensitised electrolytes
