Paediatric Oncology Flashcards
what are the main types of childhood cancer in children aged 0-14 years?
- leukaemias 31%
- lymphomas 10%
- CNS tumours 26%
what red flag symptoms warrant an immediate referral?
- unexplained petechiae
- hepatosplenomegaly
what red flag symptoms warrant an urgent referral?
- repeat attendance, same problem, no clear diagnosis
- new neuro symptoms, abdo mass
what symptoms warrant a referral (to doctor or for urgen investigation)?
- rest pain, back pain and unexplained lump
- lymphadenopathy
list some oncological emergencies
- sepsis/febrile neutropenia
- raised ICP
- spinal cord compression
- mediastinal mass
- tumour lysis syndrome
risk factors for sepsis/febrile neutropenia in an oncology patient
- ANC < 0.5 x 20^9
- indwelling catheter
- mucosal inflammation
- high dose chemo/SCT
what is the early presentation of raised ICP?
particularly in babies/children
- early morning headache/vomiting
- tense fontanelle
- increasing head circumference
what are the symptoms for a 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)
raised ICP investigations
Imaging:
- CT good for screening
- MRI best for a more accurate diagnosis
raised ICP management
- dexamethasone if due to tumour > reduce oedema and increase CSF flow
- neurosurgery > urgent CSF diversion:
ventriculostomy - hole in membrane at base of 3rd ventricle with endoscope
EVD (temporary)
VP shunt
Spinal cord compression is a potential complication of nearly all paediatric malignancies.
What is the clinical presentation of this complication?
symptoms vary with level:
- weakness (90%)
- pain (55-95%)
- sensory (10-55%)
- sphincter disturbance (10-35%)
spinal cord compression management
- urgent MRI
- start dexamethasone urgently to reduce peri-tumour oedema
- definitive treatment with chemotherapy is appropriate when rapid response is expected, surgery and radiotherapy are other options
what is superior vena cava syndrome (SVC)?
- a collection of symptoms that occur when the superior vena cava is blocked or compressed
what is superior mediastinal syndrome (SMS)?
- a life-threatening condition that occurs when the SVC and trachea are compressed.
what are some common causes of SVC or SMS?
- lymphoma
- other: neuroblastoma, germ cell tumour, thrombosis
what is the presentation of SVC syndrome?
- facial, neck and upper thoracic plethora (swelling with fluid or blood)
- oedema
- cyanosis
- distended veins
- ill
- anxious
- reduced GCS
what is the presentation of superior mediastinal syndrome (SMS)?
- same symptoms as SVC syndrome +
- dyspnoea,
- tachypnoea,
- cough,
- wheeze,
- stridor,
- orthopnoea
SVC syndrome or SMS investigations
- CXR/CT chest (if able to tolerate)
- echo
management of SVS syndrome or SMS
- keep upright and calm
- urgent biopsy (ideally)
- look to obtain important diagnostic info without GA: FBC, BM, pleural aspirate, GCT markers
Definitive treatment required urgently:
- chemotherapy usually rapidly effective
- presumptive treatment of steroids may be needed in absence of definitive histological diagnosis
- radiotherapy is effective
- rarely surgery if insensitive
- CVAD-associated thrombosis should be treated by thrombolytic therapy
what is tumour lysis syndrome?
- an oncological emergency
- caused by rapid breakdown of cancer cells and subsequent release of intracellular contents into the bloodstream
- secondary to treatment
clinical features of tumour lysis syndrome
- increased potassium, urate and phosphate
- decreased calcium
- acute renal pailure due to urate load and CaPO4 deposition in renal tubules
tumour lysis syndrome treatment
- avoidance
- ECG monitoring
- hyperhydrate 2.5l/m^2
- QDS electrolytes, NEVER give potassium
- diuresis
decrease uric acid:
- urate oxidase-uricozyme (rasburicase)
- allopurinol
treat hyperkalaemia:
- Ca resonium
- salvutamol
- insulin
Renal replacement therapy
what are the acute risks of chemotherapy?
- hair loss
- nausea and vomiting
- mucositis
- diarrhoea/constipation
- bone marrow suppression: anaemia, bleeding, infection
what are the chronic risks of chemotherapy?
- organ impairment: kidneys, heart, nerves and ears
- reduced fertility
- secondary cancer
