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🍉paeds > oncology > Flashcards

oncology Flashcards

1
Q

cancer classification?

A

International Classification of Childhood Cancer (ICCC)

Based on tumour morphology and (primary site)

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2
Q

Main types of childhood cancer

A
  1. Leukaemia
  2. CNS tumours
  3. Lymphoma
  4. Soft tissue tumour
  5. Neuroblastoma
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3
Q

most common age for cancer?

A

0-4

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4
Q

genes which are responsible for cancers

A 
Down
Fanconi
BWS
Li-Fraumeni Familial Cancer Syndrome
Neurofibromatosis
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5
Q

% of cancer which are cured/

A

85%

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6
Q

example of oncological emergencies?

A 
Sepsis / febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass
Tumour lysis syndrome
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7
Q

rf for infection?

A

ANC < 0.5 x 109
Indwelling catheter
Mucosal inflammation
High dose chemo / SCT

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8
Q

bacteria responsible of sepsis/ febrile neutropenia?

A 
Pseudomonas aeruginosa
Enterobacteriaciae eg E coli, Klebsiella
Streptococcus pneumoniae
Enterococci
Staphylococcus 
Fungi eg. Candida, Aspergillus
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9
Q

presentation of infection in child?

A 
Fever (or low temp)
Rigors
Drowsiness
Shock
Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis
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10
Q

management of infection in child?

A 
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

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11
Q

what is the early presentation of raised ICP?

A

early morning headache/vomiting
tense fontanelle
increasing HC

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12
Q

late presentation of raised ICP?

A 
constant headache 
papilloedema 
diplopia (VI palsy) 
Loss of upgaze
neck stiffness
status epilepticus, 
reduced GCS 
Cushings triad (low HR, high BP)
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13
Q

management for brain tumour- raised ICP

A

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

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14
Q

when is spinal cord compression seen?

A 
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
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15
Q

what is the pathological process of spinal cord compression?

A 
Invasion from paravertebral disease via intervertebral foramina (40 % extradural)
Vertebral body compression (30 %)
CSF seeding (20 % intradural, extraspinal)
Direct invasion (10 % intraspinal)
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16
Q

sx of spinal cord compression?

A 
Symptoms vary with level
weakness (90 %) 
pain (55-95 %) 
sensory (10-55%) 
sphincter disturbance (10-35%)
17
Q

mx of spinal cord compression?

A

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

18
Q

common cause of SVC and SMS (superior vena cava syndrome, superior medial stink syndrome)

A

Lymphoma

Other – neuroblastoma, germ cell tumour, thrombosis

19
Q

presentation of SVCS

A

facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins

20
Q

SMS presentation

A

dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea

21
Q

ix of SVC/SMS

A

CXR / CT chest (if able to tolerate)

Echo

22
Q

management?

A 
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

23
Q

Tumour Lysis syndrome features?

A 
Metabolic derangement
Rapid death of Tumour Cells
Release of intracellular contents
At or shortly after presentation
Secondary to treatment
(rarely spontaneous)
24
Q

clinical features of tumour lysis syndrome?

A

Highpotassium
high urate, relatively insoluble
high phosphate
low calcium

Acute renal failure
Urate load
CaPO4 deposition in renal tubules

25
Q

treatment of tumour lysis

A 
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

26
Q

acute chemo side effects?

A 
Hair loss
Nausea & vomiting
Mucositis
Diarrhoea / constipation
Bone marrow suppression – anaemia, bleeding, infection
27
Q

chronic chemo side effects

A

Organ impairment – kidneys, heart, nerves, ears
Reduced fertility
Second cancer

28
Q

acute radiotherapy risk factors

A

Lethargy
Skin irritation
Swelling
Organ inflammation – bowel, lungs

29
Q

chronic radiotherapy side effects

A

Fibrosis / scarring
Second cancer
Reduced fertility

30
Q

long term effects of cancer on children?

A

Hearing impairment
Cognitive
Behaviour

Lifestyle advice

affects every aspect pof health essentially

Survivors have increasing cumulative toxicity

🍉paeds (42 decks)

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