Paediatric Oncology Flashcards

1
Q

Whay is cancer?

A

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
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2
Q

Cancer - aetiology

A
  • Genes
    • Down
    • Fanconi
    • BWS
    • Li-Fraumeni familial cancer syndrome
    • Neurofibromatosis
  • Environment
    • Radiation
    • Infection
  • Iatrogenic
    • Chemotherapy
    • Radiotherapy
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3
Q

Cancer - epidemiology

A
  • Very rare
    • GP sees 1 in career
  • Usually at younger age
    • Between 0-4
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4
Q

What are the most common cancers in children?

A
  1. Leukaemias
  2. CNS tumours
  3. Lymphomas
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5
Q

How are cancers in children classified?

A

Classified by cell origin, not on primary site:

  • International Classification of Childhood Cancer (ICCC)
  • Based on tumour morphology (and primary site)
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6
Q

Cancer - clinical features

A
  • Unexplained petechiaea
  • Hepatospenomegaly
  • Neuro symptoms
  • Abdominal mass
  • Rest pain, back pain
  • Unexplained lump
  • Lymphadenopathy
  • Unexplained vomiting
  • Unexplained sweating or fever
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7
Q

What are some oncological emergencies?

A
  • Sepsis/febrile neutropenia
  • Raised ICP
  • Spinal cord compression
  • Mediastinal mass
  • Tumour lysis syndrome
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8
Q

Sepsis/febrile neutropneia - risk factors

A
  • ANC <0.5 x109
  • Indwelling catheter
  • Mucosal inflammation
  • High dose chemo/SCT
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9
Q

Sepsis/febrile neutropneia - presentation

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

What are signs of shock?

A
  • Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis
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11
Q

Sepsis/febrile neutropenia - investigations

A
  • Bloods
    • Culture, FBC, coagulation, U&Es, LFT, CRP, lactate
  • CXR
  • Other
    • Urine microscopy/culture
    • Throat swab
    • Sputum culture
    • LP
    • Viral PCRs
    • CT/USS
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12
Q

Sepsis/febrile neutropenia - management

A
  • ABC
    • Oxygen
    • Fluids
  • Broad spectrum antibiotics
  • Inotropes
  • PICU
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13
Q

Raised ICP - presentation

A
  • 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)
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14
Q

Raised ICP - investigations

A
  • Imaging
    • CT good for screening
    • MRI best for accurate diagnosis
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15
Q

Raised ICP - management

A
  • Dexamethasone if due to tumour
    • Reduce oedema dn increase CSF flow
  • Neurosurgery
    • Ventriculostomy
    • EVD (temporary)
    • VP shunt
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16
Q

Spinal cord compression - pathophysiology

A
  • Invasion from paravertebral disease via intervertebral foramina
  • Vertebral body compression
  • CSF seeding
  • Direct invasion
17
Q

Spinal cord compression - presentation

A
  • Varies depending on where is compressed
    • Weakness (90%)
    • Pain (60%)
    • Sensory
    • Sphincter disturbance
18
Q

Spinal cord compression - investigations

A
  • MRI – urgent
19
Q

Spinal cord compression - management

A
  • Dexamethasone
    • Urgently to reduce peri-tumour oedema
  • Chemotherapy
    • Surgery or radiotherapy other definitive treatment options
20
Q

Spinal cord compression - prognosis

A
  • Depends on severity of impairment rather than duration between symptoms and diagnosis
21
Q

SVC syndrome - aetiology

A
  • Lymphoma
  • Neuroblastoma
  • Germ cell tumour
  • Thrombosis
22
Q

SVCS - presentation

A
  • SVCS
    • Facial, neck and upper thoracic plethora
    • Oedema
    • Cyanosis
    • Distended veins
    • Ill
    • Anxious
    • Reduced GCS
  • SMS
    • Dyspnoea
    • Tachypnoea
    • Cough
    • Wheeze
    • Stridor
    • Orthopnoea
23
Q

SVC syndrome - investigations

A
  • CXR/CT chest
  • Echo
  • Biopsy
  • Bloods
    • FBC, GCT markers
24
Q

SVC syndrome - management

A
  • Urgent biopsy
  • Chemotherapy
  • Radiotherapy
  • Rarely surgery
  • CVAD associated thrombosis
    • Thrombolytic therapy
25
Q

Tumour lysis syndrome - aetiology

A
  • Secondary to treatment
26
Q

Tumour lysis syndrome - pathology

A
  • Rapidly growing tumour starts to die
  • Releasing internal contents into blood stream
27
Q

Tumour lysis syndrome - clinical features

A
  • Increased potassium
  • Increased urate
  • Increased phosphate
  • Decreased calcium
  • Acute renal failure
    • Urate overload
    • CaPO4 deposition in renal tubules
28
Q

How do the following change in tumour lysis syndrome:

  • K
  • urate
  • PO
  • Ca
A
  • Increased potassium
  • Increased urate
  • Increased phosphate
  • Decreased calcium
29
Q

Tumour lysis syndrome - management

A
  • 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
30
Q

Paediatric cancer - investigations

A
  • Scans
    • MRI
    • CT if unable to tolerate MRI
  • Biopsy/pathology
  • Cytogenetics
  • Tumour markers
  • Staging
    • Chest x-ray or CT chest
    • Bone scan
31
Q

Paediatric cancer - treatment

A
  • Surgery
  • Chemotherapy
  • Radiotherapy
  • Immunotherapy
  • Bone marrow transplants
  • Newer drugs
    • Clinical trials, biologics
32
Q

What are the side effects of chemotherapy?

A
33
Q

What are the side effects of radiotherapy?

A