Paediatric Oncology Flashcards
What are some causes of childhood cancers?
Genes - Down’s syndrome, Fanconi, BWS, Li-Fraumeni familial cancer syndrome and neurofibromatosis
Environment - radiation and infection (EBV)
Iatrogenic - chemo and RT
What are some immediate and urgent referral symptoms?
Immediate - unexplained petechiae and hepatosplenomegaly
Urgent - repeat attendance, same problem, no clear diagnosis, new neuro symptoms and abdominal mass
Refer - rest pain, back pain and unexplained lump
What are oncological emergencies?
Sepsis/ febrile neutropenia, raised ICP, spinal cord compression, mediastinal mass and tumour lysis syndrome
Describe the risks of sepsis/ febrile neutropenia
Infection is major cause of mortality/ morbidity
Risks - indwelling catheter, mucosal inflammation and high dose chemo
What is the presentation of sepsis?
Fever, rigors, drowsiness and shock - tachycardia, tachypnoea, prolonged capillary refill, hypotension, reduced UO and metabolic acidosis
What is the management of sepsis/ febrile neutropenia?
IV access, blood culture, CXR, FBC and other - urine microscopy, throat swab, LP, viral PCRs and CT/ USS
ABC, broad spectrum antibiotics, inotropes and PICU
What is the presentation of raised ICP in children?
Early - early morning headache/ vomiting, tense fontanelle and increasing HC
Late - constant headache, papilledema, diplopia, loss of up gaze, neck stiffness, status epilepticus, reduced GCS and Cushing’s triad
What is the investigation for raised ICP?
Is mandatory if safe
CT is good for screening
MRI is best for more accurate diagnosis
What is the management of raised ICP in children?
Dexamethasone if due to tumour - reduces oedema and increases CSF flow
Neurosurgery - urgent CSF diversion (Ventriculostomy, EVT and VP shunt)
Describe spina cord compression in childhood cancer
Complication of nearly all paediatric malignancies - affects 5% of all children cancers
Invasion from paravertebral disease via intervertebral foramina, vertebral body compression, CSF seeding or direct invasion
What is the presentation of spinal cord compression in children?
Vary to which level
Weakness, pain, sensory and sphincter disturbance
What is the management of spinal cord compression in children?
Urgent MRI, start dexamethasone and definitive treatment with chemo
Depends on severity of impairment rather than duration between symptoms and diagnosis
What is the causes and investigations for SVC (superior vena cava) syndrome/ SMS?
Lymphoma, neuroblastoma, germ cell tumour and thrombosis
CXR/ CT chest and echo
What is the presentation of SVC syndrome/ SMS?
SVC - facial, neck + upper thoracic plethora, oedema, cyanosis, distended veins, ill, anxious and reduced GCS
SMS - dyspnoea, tachypnoea, cough, wheeze, stridor and orthopnoea
What is the management of SVC syndrome/ SMS?
Keep upright and calm
Urgent biopsy
FBC, BM, pleural aspirate and GCT markers
Chemo, RT, rarely surgery and CVAD-associated thrombosis treated by thrombolytic therapy
What is tumour lysis syndrome?
Metabolic derangement
Rapid death of tumour cells - release of intracellular contents
At or shortly after presentation
Secondary to treatment, rarely spontaneous
What are the clinical features of tumour lysis syndrome?
Increased potassium, urate and phosphate
Decreased calcium
Acute renal failure - urate load and CaPO4 deposition in renal tubules
What is the treatment of tumour lysis syndrome?
Avoidance
ECG monitoring
Hyperhydrate, GDS electrolytes and diuresis
Never give potassium
Decrease urate - urate oxidase-uricozyme and allopurinol
Hyperkalaemia - Ca resonium, salbutamol and insulin
RRT
What is the next steps after diagnosing tumour in children?
Scans, biopsy/ pathology, cytogenetics and tumour markers
What do cannonball tumour seen in the chest suggest?
Sarcoma diagnosis
What are the treatment options for childhood cancer?
Localised tumour - surgery
Chemotherapy
Radiotherapy
Bone marrow transplant
Immunotherapy
New therapies
What are the risks of chemotherapy?
Acute - hair loss, N/V, mucositis, diarrhoea/ constipation and bone marrow suppression
Chronic - organ impairment, reduced fertility and second cancer
What are the risks of radiotherapy?
Acute - lethargy, skin irritation, swelling and organ inflammation
Chronic - fibrosis, scarring, second cancer and reduced fertility
What are the growth and development effects after childhood cancer?
Skeletal maturation, linear growth, emotional + social maturation, intellectual function and sexual development
