Paediatric Oncology Flashcards
Whay is cancer?
Group of abnormal cells dividing in uncontrollable way:
- Usually occurs due to gene changes
- Stimulates own blood supply
- Can cause local invasion or metastatic spread via blood or lymphatic systems
Cancer - aetiology
- Genes
- Down
- Fanconi
- BWS
- Li-Fraumeni familial cancer syndrome
- Neurofibromatosis
- Environment
- Radiation
- Infection
- Iatrogenic
- Chemotherapy
- Radiotherapy
Cancer - epidemiology
- Very rare
- GP sees 1 in career
- Usually at younger age
- Between 0-4
What are the most common cancers in children?
- Leukaemias
- CNS tumours
- Lymphomas
How are cancers in children classified?
Classified by cell origin, not on primary site:
- International Classification of Childhood Cancer (ICCC)
- Based on tumour morphology (and primary site)
Cancer - clinical features
- Unexplained petechiaea
- Hepatospenomegaly
- Neuro symptoms
- Abdominal mass
- Rest pain, back pain
- Unexplained lump
- Lymphadenopathy
- Unexplained vomiting
- Unexplained sweating or fever
What are some oncological emergencies?
- Sepsis/febrile neutropenia
- Raised ICP
- Spinal cord compression
- Mediastinal mass
- Tumour lysis syndrome
Sepsis/febrile neutropneia - risk factors
- ANC <0.5 x109
- Indwelling catheter
- Mucosal inflammation
- High dose chemo/SCT
Sepsis/febrile neutropneia - presentation
- Fever (or low temperature)
- Rigors
- Drowsiness
- Shock
- Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis
What are signs of shock?
- Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis
Sepsis/febrile neutropenia - investigations
- Bloods
- Culture, FBC, coagulation, U&Es, LFT, CRP, lactate
- CXR
- Other
- Urine microscopy/culture
- Throat swab
- Sputum culture
- LP
- Viral PCRs
- CT/USS
Sepsis/febrile neutropenia - management
- ABC
- Oxygen
- Fluids
- Broad spectrum antibiotics
- Inotropes
- PICU
Raised ICP - presentation
- Early
- Early morning headache/vomiting
- Tense fontanelle
- Increasing head circumference
- Late
- Constant headache
- Papilloedema
- Diplopia (VI palsy)
- Loss of upgaze
- Neck stiffness
- Status epilepticus
- Reduced GCS
- Cushing triad (low HR, high BP)
Raised ICP - investigations
- Imaging
- CT good for screening
- MRI best for accurate diagnosis
Raised ICP - management
- Dexamethasone if due to tumour
- Reduce oedema dn increase CSF flow
- Neurosurgery
- Ventriculostomy
- EVD (temporary)
- VP shunt
Spinal cord compression - pathophysiology
- Invasion from paravertebral disease via intervertebral foramina
- Vertebral body compression
- CSF seeding
- Direct invasion
Spinal cord compression - presentation
- Varies depending on where is compressed
- Weakness (90%)
- Pain (60%)
- Sensory
- Sphincter disturbance
Spinal cord compression - investigations
- MRI – urgent
Spinal cord compression - management
- Dexamethasone
- Urgently to reduce peri-tumour oedema
- Chemotherapy
- Surgery or radiotherapy other definitive treatment options
Spinal cord compression - prognosis
- Depends on severity of impairment rather than duration between symptoms and diagnosis
SVC syndrome - aetiology
- Lymphoma
- Neuroblastoma
- Germ cell tumour
- Thrombosis
SVCS - presentation
- SVCS
- Facial, neck and upper thoracic plethora
- Oedema
- Cyanosis
- Distended veins
- Ill
- Anxious
- Reduced GCS
- SMS
- Dyspnoea
- Tachypnoea
- Cough
- Wheeze
- Stridor
- Orthopnoea
SVC syndrome - investigations
- CXR/CT chest
- Echo
- Biopsy
- Bloods
- FBC, GCT markers
SVC syndrome - management
- Urgent biopsy
- Chemotherapy
- Radiotherapy
- Rarely surgery
- CVAD associated thrombosis
- Thrombolytic therapy
Tumour lysis syndrome - aetiology
- Secondary to treatment
Tumour lysis syndrome - pathology
- Rapidly growing tumour starts to die
- Releasing internal contents into blood stream
Tumour lysis syndrome - clinical features
- Increased potassium
- Increased urate
- Increased phosphate
- Decreased calcium
- Acute renal failure
- Urate overload
- CaPO4 deposition in renal tubules
How do the following change in tumour lysis syndrome:
- K
- urate
- PO
- Ca
- Increased potassium
- Increased urate
- Increased phosphate
- Decreased calcium
Tumour lysis syndrome - management
- Prophylaxis
- Give fluids, monitor electrolytes
- Diuresis
- NEVER give potassium or phosphate when giving fluid
- Decrease uric acid
- Urate oxidase uricozyme (Rasburicase)
- Allopurinol
- Treat hyperkalaemia
- Ca Resonium
- Salbutamol
- Insulin
- Renal replacement therapy
Paediatric cancer - investigations
- Scans
- MRI
- CT if unable to tolerate MRI
- Biopsy/pathology
- Cytogenetics
- Tumour markers
- Staging
- Chest x-ray or CT chest
- Bone scan
Paediatric cancer - treatment
- Surgery
- Chemotherapy
- Radiotherapy
- Immunotherapy
- Bone marrow transplants
- Newer drugs
- Clinical trials, biologics
What are the side effects of chemotherapy?
What are the side effects of radiotherapy?
