Oncology Flashcards
What increases the risk of a child getting cancer?
Genes -Down syndrome -Fanconi -BWS -Li-Fraumeni Familial Cancer Syndrome -Neurofibromatosis Environment -Radiation -Infection Iatrogenic -Chemotherapy -Radiotherapy
What are the side effects of chemotherapy?
Acute -Hair loss -Nausea & vomiting -Mucositis -Diarrhoea / constipation -Bone marrow suppression – anaemia, bleeding, infection Chronic -Organ impairment – kidneys, heart, nerves, ears -Reduced fertility -Second cancer
What are the side effects of radiotherapy?
Acute -Lethargy -Skin irritation -Swelling -Organ inflammation – bowel, lungs Chronic -Fibrosis / scarring -Second cancer -Reduced fertility
What is the presentation of a raised ICP?
Early -Early morning headache/vomiting -Tense fontanelle -Increasing HC Late -Constant headache -Papilloedema -Diplopia (VI palsy) -Loss of upgaze -Neck stiffness -Status epilepticus, -Reduced GCS -Cushings triad (low HR, high BP)
What is the management of a raised ICP?
Dexamethasone if due to tumour to reduce oedema and increase CSF flow
Neurosurgery - urgent CSF diversion
Ventriculostomy – hole in membrane at base of 3rd ventricle with endoscope
EVD (temporary)
VP shunt
What is the most common cancer that causes spinal compression?
Ewing’s sarcoma
Medulloblastoma
What is the management of spinal cord compression?
Urgent MRI
Start dexamethasone urgently to reduce peri-tumour oedema
Definitive treatment with chemotherapy is appropriate when rapid response is expected
Surgery or radiotherapy are other options
What is the presentation of superior vena cava syndrome?
Facial, neck and upper thoracic plethora Oedema Cyanosis Distended veins Ill Anxious Reduced GCS
What is the presentation of superior mediastinum syndrome?
Dyspnoea Tachypnoea Cough Wheeze Stridor Orthopnoea
What is the management of SVC and SMS syndrome?
Keep upright & calm
Urgent biopsy
FBC, BM, pleural aspirate, GCT markers
Definitive treatment is required urgently
Chemotherapy is usually rapidly effective
Presumptive treatment may be needed in the absence of a definitive histological diagnosis (steroids)
Radiotherapy is effective
May cause initial increased respiratory distress
Rarely surgery if insensitive
CVAD-associated thrombosis should be treated by thrombolytic therapy
What is tumour lysis syndrome?
As the tumour cells die they release their intracellular content which can be toxic to kidneys
More common in Burkitt’s lymphoma and leukaemias
Secondary to treatment
What are the clinical features of tumour lysis syndrome?
Hyperkalaemia Increased urate so get kidney stones Increased phosphate Hypocalcaemia Acute renal failure
What is the management of tumour lysis syndrome?
Avoidance
Hyperhydrate-2.5l/m2 but don’t give potassium
Electrolytes
Allopurinol to treat hyperuricaemia
Treat hyperkalaemia with Calcium Resonium/gluconate, salbutamol and insulin
Renal replacement therapy
