Oncology Flashcards
What are the more common paediatric malignancies?
Leukaemias Lymphomas Retinoblastomas Brain tumours Extracranial solid tumours Mostly sporadic
How is paediatric cancer classified?
International Classification of Childhood Cancer (ICCC)
Based on tumour morphology and primary site.
When do children get cancer?
Majority between 0-4 years old.
What are some factors increasing cancer risk in children?
Genes - down’s, fanconi, BWS, Li-Fraumeni familial cancer syndrome, neurofibromatosis.
Environment - radiation, infection
Iatrogenic - chemotherapy, radiotherapy.
What requires immediate referral?
Unexplained petechiae Hepatosplenomegaly.
What requires urgent referral?
Repeat attendance with same problem and no clear diagnosis.
New neurological symptoms
New abdominal mass
What requires referral to a doctor or urgent investigations?
Rest pain
Back pain
Unexplained lump
Lymphadenopathy
What are some treatment options for cancers?
Multimodal therapy based on specific factors MDT approach Chemotherapy Surgery Radiotherapy
What are the side effects of chemotherapy?
Acute - hair loss, nausea, vomiting, mucositis, diarrhoea, constipation, bone marrow suppression
Chronic - organ impairment, reduced fertility, second cancer.
What are the side effects of radiotherapy?
Acute - lethargy, skin irritation, swelling, organ inflammation (bowel, lungs).
Chronic - fibrosis, second cancer, reduced fertility.
What are some oncological emergencies?
Sepsis/febril neutropenia Raised ICP Spinal cord compression Mediastinal mass Tumour lysis syndrome
What are some causes of Sepsis/febrile neutropenia?
Infection - pseudomonas aerginosa, enterobacteriaciae, strep pneumoniae
staph, fungi.
How does Sepsis/febrile neutropenia present?
Fever or hypothermia
Rigors
Drowsiness
Shock
What is the management of Sepsis/febrile neutropenia?
ABCs Oxygen Fluids Broad spectrum antibiotics Inotropes PICU
What are the investigations for sepsis/febrile neutropenia?
Blood cultures FBC Coagulation factors U&Es LFTs CRP Lactate CXR Urine microscopy Lumbar puncture CT US
What is the early presentation of raised ICP?
Early morning headache/vomiting
Tense fontanelle
Increasing HC
What is the late presentation of raised ICP?
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
What investigations would you carry out for raised ICP?
Imaging mandatory:
CT is good for screening
MRI is best for accurate diagnosis.
What is the management of raised ICP?
Dexamethasone if tumour - reduce oedema and increase CSF flow.
Neurosurgery if urgent CSF diversion - ventriculostomy (hole in base 3rd ventricle), EVD, VP shunt.
What are some features of spinal cord compression?
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.
What are the symptoms of Spinal cord compression?
Weakness
Pain
Sensory
Sphincter disturbance
What are the investigations for Spinal cord compression?
Urgent MRI
What is the treatment for spinal cord compression?
Dexamethasone urgently
Chemotherapy
Surgery
Radiotherapy
What is SVC syndrome?
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.
What is SMS?
Superior mediastinum syndrome is when SVC syndrome coexists with tracheal obstruction.
How does SVC syndrome present?
Facial, neck and upper thoracic plethora (excess of bodily fluid esp. blood). Oedema Cyanosis Distended veins Anxious Reduced GCS
How does SMS present?
Dyspnoea Tachypnoea Cough Wheeze Stridor Orthopnoea
What investigations do you carry out for SVCS and SMS?
CXR CT Echo Urgent biopsy FBC Pleural aspirate GCT markers
What is the treatment of SVCS and SMS?
Keep upright Chemotherapy Steroids Radiotherapy Rarely surgery
What is tumour lysis syndrome?
Metabolic derangement
Rapid death of tumour cells
Release of intracellular contents shortly after presentation.
What are the clinical features of tumour lysis syndrome?
Increased potassium, urate, phosphate.
Decreased calcium
Acute renal failure - urate load, CaPO4 deposition in renal tubules.
What is the treatment for Tumour lysis syndrome?
Never give potassium! QDS electrolytes Urate Oxidase-uricozyme Allopurinol Ca Resonium Salbutamol Insulin Renal replacement therapy.
What are some symptoms that may suggest a child has cancer?
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
