oncology Flashcards
cancer classification?
International Classification of Childhood Cancer (ICCC)
Based on tumour morphology and (primary site)
Main types of childhood cancer
- Leukaemia
- CNS tumours
- Lymphoma
- Soft tissue tumour
- Neuroblastoma
most common age for cancer?
0-4
genes which are responsible for cancers
Down Fanconi BWS Li-Fraumeni Familial Cancer Syndrome Neurofibromatosis
% of cancer which are cured/
85%
example of oncological emergencies?
Sepsis / febrile neutropenia Raised ICP Spinal cord compression Mediastinal mass Tumour lysis syndrome
rf for infection?
ANC < 0.5 x 109
Indwelling catheter
Mucosal inflammation
High dose chemo / SCT
bacteria responsible of sepsis/ febrile neutropenia?
Pseudomonas aeruginosa Enterobacteriaciae eg E coli, Klebsiella Streptococcus pneumoniae Enterococci Staphylococcus Fungi eg. Candida, Aspergillus
presentation of infection in child?
Fever (or low temp) Rigors Drowsiness Shock Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis
management of infection in child?
IV access Blood culture, FBC, coag, UE, LFTs, CRP, lactate CXR Other Urine microscopy / culture Throat swab Sputum culture / BAL LP Viral PCRs CT / USS
ABC
Oxygen
Fluids
Broad spectrum antibiotics
Inotropes
PICU
what is the early presentation of raised ICP?
early morning headache/vomiting
tense fontanelle
increasing HC
late presentation of raised ICP?
constant headache papilloedema diplopia (VI palsy) Loss of upgaze neck stiffness status epilepticus, reduced GCS Cushings triad (low HR, high BP)
management for brain tumour- raised ICP
Dexamethasone if due to tumour
Reduce oedema and increase CSF flow
250 micro/kg IV STAT then 125 microg/kg BD
Neurosurgery - urgent CSF diversion
Ventriculostomy – hole in membrane at base of 3rd ventricle with endoscope
EVD (temporary)
VP shunt
when is spinal cord compression seen?
Potential complication of nearly all paediatric malignancies Affects 5 % of all children with cancer 10-20 % Ewing’s or Medulloblastoma 5-10 % Neuroblastoma & Germ cell tumour Diagnosis (65 %), relapse, progression
what is the pathological process of spinal cord compression?
Invasion from paravertebral disease via intervertebral foramina (40 % extradural) Vertebral body compression (30 %) CSF seeding (20 % intradural, extraspinal) Direct invasion (10 % intraspinal)
sx of spinal cord compression?
Symptoms vary with level weakness (90 %) pain (55-95 %) sensory (10-55%) sphincter disturbance (10-35%)
mx 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
Outcome depends on severity of impairment rather than duration between symptoms and diagnosis
Mild impairment > 90 % recovery
Paraplegic 65 % recovery
common cause of SVC and SMS (superior vena cava syndrome, superior medial stink syndrome)
Lymphoma
Other – neuroblastoma, germ cell tumour, thrombosis
presentation of SVCS
facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins
SMS presentation
dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea
ix of SVC/SMS
CXR / CT chest (if able to tolerate)
Echo
management?
Keep upright & calm Urgent biopsy (ideally)
Look to obtain important diagnostic information without GA
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
Most of underlying malignancies have a good prognosis
Tumour Lysis syndrome features?
Metabolic derangement Rapid death of Tumour Cells Release of intracellular contents At or shortly after presentation Secondary to treatment (rarely spontaneous)
clinical features of tumour lysis syndrome?
Highpotassium
high urate, relatively insoluble
high phosphate
low calcium
Acute renal failure
Urate load
CaPO4 deposition in renal tubules
treatment of tumour lysis
Avoidance ECG Monitoring Hyperhydrate-2.5l/m2 QDS electrolytes Diuresis 1!!!Never give potassium!!!
decrease uric acid:
Urate Oxidase-uricozyme (rasburicase)
Allopurinol
treat hyperkalaemia:
Ca Resonium
Salbutamol
Insulin
renal replacement therapy
acute chemo side effects?
Hair loss Nausea & vomiting Mucositis Diarrhoea / constipation Bone marrow suppression – anaemia, bleeding, infection
chronic chemo side effects
Organ impairment – kidneys, heart, nerves, ears
Reduced fertility
Second cancer
acute radiotherapy risk factors
Lethargy
Skin irritation
Swelling
Organ inflammation – bowel, lungs
chronic radiotherapy side effects
Fibrosis / scarring
Second cancer
Reduced fertility
long term effects of cancer on children?
Hearing impairment
Cognitive
Behaviour
Lifestyle advice
affects every aspect pof health essentially
Survivors have increasing cumulative toxicity
