Oncology Flashcards
What is the most common type of childhood cancer?
Leukaemia
What is the most common leukaemia in children?
ALL
What is the peak age of ALL?
2-3yo
What is the 2nd most common leukaemia?
AML
What is the peal age of AML?
<2yo
What is the presentation of leukaemia?
Fever Weight loss Night sweats Bleeding and bruising Lymphadenopathy one/joint pain HEepatosplenomegaly Pancytopenia- anaemia, thrombocytopenia, leukopenia
What is an indication for investigation of leukaemia?
Any unexplained bruising/bleeding
What investigations are done for acute leukaemia?
FBC- pancytopenia, very high or low WCC
Blood film- blast cells
Bone marrow and lymph node biopsy
What is the management of acute leukaemia?
Chemotherapy
Bone marrow transplant
What is the prognosis for childhood leukaemia?
ALL= 80% cure AML= worse
What is the 2nd most common childhood cancer>
Brain tumours
What is the most common primary brain tumour in children>
Pilocytic astrocytoma
What is the presentation of pilocytic astrocytoma?
Dependent on size and location
Most common= increased ICP
Slow growing
What investigation and management if for pilocytic astrocytoma?
CT/MRI
Surgery
Who is osteosarcoma sen in?
10-20yo
What are the common sites of osteosarcoma?
Femur= most common
Tibia, humerus
What is the presentation of osteosarcoma?
Persistent bone pain, worse at night
Bone swelling
Palpable mass
Restricted joint movement
What is done for unexplained bone pain/swelling?
Urgent XR within 48 hours
What is seen on XR with osteosarcoma?
Destruction of norma bone and fluffy appearance
Sunburst appearance
What investigations are done for osteosarcoma?
XR Bloods- elevated ALP Staging- CT/MRI PET Biopsy
What is the management of osteosarcoma?
Surgical resection, often with amptation
Adjuvant chemo
What is a complication of osteosarcoma?
Pathological fracture
Who gets Ewing sarcoma?
M>F
10-20yo
What is the presentation of Ewing sarcoma?
Persistent bone pain0 worse at night
Bone swelling
Restricted joint movement
What investigations are one for Ewing sarcoma?
XR- onion skin periosteal reaction, wide transition zone
MRI/CT= moth eaten destructive radiolucencies
What is the management of Ewing sarcoma?
Chemo and surgery/radio
Who is retinoblastoma seen in?
Almost exclusively young children
What is the presentation of retinoblastoma?
Leukocoria- white appearance of retina
Detrioration of vision
Red irritated eye
Strabismus- squint
What is the screening for retinoblastoma?
Red reflex
Hirschberg test
Eye exam
What is the most common cancer in babies?
Neuroblastoma
What s the median age of neuroblastoma?
20 months
What is neuroblastoma?
Arises from neural crest tissue of adrenal medulla and sympathetic nervous system
What is the presentation of neuroblastoma?
Abdo mass
Pallor
Weight loss
Hepatomegaly
What is the investigation for neuroblastoma?
AXR
Biopsy
What is nephroblastoma and when does it present?
Rare renal tumour of childhood
Presents usually in first 4 years
What is the presentation of nephroblastoma?
Loin pain Haematuria Lethrgy Pyrexia Early mets
What investigations are done for nephroblstoma?
US
CT/MRI
Biopsy
What is the management of nephroblastoma?
Nephrectomy
+/- adjuvant chemo or radio
What are some oncological emergencies
Febrile neutropenia Raised ICP Spinal cord compression Superior vena cava syndrome Superior mediastinal syndrome Tumour lysis syndrome
What is the management of raised ICP?
Emergency= dexamethasone and refer to neurosurgery
What is the neurosurgical management of raised ICP?
Ventriculostomy
EVD= temporary
VP shunt
What is the management of spinal cord compression?
Urgent MRI
Start dexamethasone
Refer for surgery/radiotherapy
What causes superior vena cava syndrome?
Mediastinal tumur compression of SVC
Usually lymphoma
What is the presentation of SVC syndrome?
Oedema Cyanosis Distended veins Ill, anxious Reduced GCS
What is the management of SVC syndrome?
Keep upright and calm
Urgent referral
What is superior mediastinal syndrome?
Mediastinal tumour compression of trachea
Usually lymphoma
What is the presentation of superior mediastinal syndrome?
Dyspnoea
Tachypnoea
Wheeze, cough
What is the management of superior mediastinal syndrome?
Keep upright and calm
Urgent referral
What are the features of tumour lysis syndrome?
Hyperkalaemia, hyperuricaemia, hyperphosphataemia
Hypocalcaemia
AKI
What is the management of tumour lysis syndrome?
NEVER give potassium
Dialysis
Manage K= IV calcium gluconate, insulin-dextrose, salbutamol
What is the prevention of tumour lysis syndrome?
Allopurinol
What cancers are particularly associated with tumour lysis syndrome?
High grade lymphoma
Acute leukaemia
