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Paediatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

What are the more common paediatric malignancies?

A 
Leukaemias
Lymphomas
Retinoblastomas
Brain tumours
Extracranial solid tumours
Mostly sporadic
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2
Q

How is paediatric cancer classified?

A

International Classification of Childhood Cancer (ICCC)

Based on tumour morphology and primary site.

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3
Q

When do children get cancer?

A

Majority between 0-4 years old.

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4
Q

What are some factors increasing cancer risk in children?

A

Genes - down’s, fanconi, BWS, Li-Fraumeni familial cancer syndrome, neurofibromatosis.
Environment - radiation, infection
Iatrogenic - chemotherapy, radiotherapy.

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5
Q

What requires immediate referral?

A

Unexplained petechiae Hepatosplenomegaly.

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6
Q

What requires urgent referral?

A

Repeat attendance with same problem and no clear diagnosis.
New neurological symptoms
New abdominal mass

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7
Q

What requires referral to a doctor or urgent investigations?

A

Rest pain
Back pain
Unexplained lump
Lymphadenopathy

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8
Q

What are some treatment options for cancers?

A 
Multimodal therapy based on specific factors
MDT approach
Chemotherapy
Surgery
Radiotherapy
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9
Q

What are the side effects of chemotherapy?

A

Acute - hair loss, nausea, vomiting, mucositis, diarrhoea, constipation, bone marrow suppression

Chronic - organ impairment, reduced fertility, second cancer.

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10
Q

What are the side effects of radiotherapy?

A

Acute - lethargy, skin irritation, swelling, organ inflammation (bowel, lungs).

Chronic - fibrosis, second cancer, reduced fertility.

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11
Q

What are some oncological emergencies?

A 
Sepsis/febril neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass
Tumour lysis syndrome
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12
Q

What are some causes of Sepsis/febrile neutropenia?

A

Infection - pseudomonas aerginosa, enterobacteriaciae, strep pneumoniae
staph, fungi.

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13
Q

How does Sepsis/febrile neutropenia present?

A

Fever or hypothermia
Rigors
Drowsiness
Shock

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14
Q

What is the management of Sepsis/febrile neutropenia?

A 
ABCs
Oxygen
Fluids
Broad spectrum antibiotics
Inotropes
PICU
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15
Q

What are the investigations for sepsis/febrile neutropenia?

A 
Blood cultures
FBC
Coagulation factors
U&Es
LFTs
CRP
Lactate
CXR
Urine microscopy
Lumbar puncture
CT
US
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16
Q

What is the early presentation of raised ICP?

A

Early morning headache/vomiting
Tense fontanelle
Increasing HC

17
Q

What is the late presentation of raised ICP?

A 
Constant headache
Papilloedema
Diplopia (VI palsy)
Loss of upgaze
Neck stiffness
Status epilepticus
Reduced GCS
Cushing's triad - low HR, resp. rate, high systolic BP
18
Q

What investigations would you carry out for raised ICP?

A

Imaging mandatory:
CT is good for screening
MRI is best for accurate diagnosis.

19
Q

What is the management of raised ICP?

A

Dexamethasone if tumour - reduce oedema and increase CSF flow.

Neurosurgery if urgent CSF diversion - ventriculostomy (hole in base 3rd ventricle), EVD, VP shunt.

20
Q

What are some features of spinal cord compression?

A

Potential complication of nearly all paediatric malignancies. Common in Ewing’s sarcoma or medulloblastoma.
Pathological process of vertebral body compression, CSF seeding, direct invasion, invasion from paravertebral disease.

21
Q

What are the symptoms of Spinal cord compression?

A

Weakness
Pain
Sensory
Sphincter disturbance

22
Q

What are the investigations for Spinal cord compression?

A

Urgent MRI

23
Q

What is the treatment for spinal cord compression?

A

Dexamethasone urgently
Chemotherapy
Surgery
Radiotherapy

24
Q

What is SVC syndrome?

A

Superior vena cava syndrome is obstruction of blood flow through the superior vena cava. It is a medical emergency and most often manifests in patients with a malignant disease process within the thorax.

25
Q

What is SMS?

A

Superior mediastinum syndrome is when SVC syndrome coexists with tracheal obstruction.

26
Q

How does SVC syndrome present?

A 
Facial, neck and upper thoracic plethora (excess of bodily fluid esp. blood).
Oedema
Cyanosis
Distended veins
Anxious
Reduced GCS
27
Q

How does SMS present?

A 
Dyspnoea
Tachypnoea
Cough
Wheeze
Stridor
Orthopnoea
28
Q

What investigations do you carry out for SVCS and SMS?

A 
CXR
CT
Echo
Urgent biopsy
FBC
Pleural aspirate
GCT markers
29
Q

What is the treatment of SVCS and SMS?

A 
Keep upright
Chemotherapy
Steroids
Radiotherapy 
Rarely surgery
30
Q

What is tumour lysis syndrome?

A

Metabolic derangement
Rapid death of tumour cells
Release of intracellular contents shortly after presentation.

31
Q

What are the clinical features of tumour lysis syndrome?

A

Increased potassium, urate, phosphate.
Decreased calcium
Acute renal failure - urate load, CaPO4 deposition in renal tubules.

32
Q

What is the treatment for Tumour lysis syndrome?

A 
Never give potassium!
QDS electrolytes
Urate Oxidase-uricozyme
Allopurinol
Ca Resonium
Salbutamol
Insulin
Renal replacement therapy.
33
Q

What are some symptoms that may suggest a child has cancer?

A 
Not able to urinate
Blood in urine
Unexplained lump
Lymphadenopathy
Back pain
Headaches
Bruising
Tiredness
Seizures
Abdo pain
Vomiting
Sweating/fever
Unexplained weight loss
Eye changes
Frequent infections

Paediatrics (12 decks)

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