Paediatric Oncology Flashcards
What are 3 of the most common cancers in children?
- leukaemia
- CNS tumours
- lymphomas
What is the trend at which children tend to develop cancer?
- in pre-school years
- second peak in adolescence
Why do children get cancer?
- no particular reason why
- genetics
- environment
What is an example of a genetic influence on developing childhood cancer?
children with Down’s syndrome are more likely to develop acute myeloid leukaemia, but also have a better prognosis
What are examples of environmental factors that may contribute to a child developing cancer?
- exposure to radiation
- exposure to viral infections e.g. EBV is associated with increased risk of Burkitt, Hogkin and nasopharyngeal cancers
- iatrogenic e.g. because of radiotherapy or chemotherapy
What is the generally the prognosis in many childhood cancers?
good - many survive
From primary care, what are red flag symptoms that should make a GP consider immediate referral for investigation of leukaemia or lymphoma?
unexplained hepatosplenomegaly, unexplained petechiae
From primary care, what are red flag symptoms that should make a GP consider urgent referral for investigation of leukaemia or lymphoma?
- repeat attendance
- same problem, no clear diagnosis
From primary care, what are red flag symptoms that should make a GP consider non-urgent referral for investigation of leukaemia or lymphoma?
- rest pain
- back pain and
- unexplained lump
What are examples of alert symptoms in children that GPs should look out for?
- neurological symptoms
- headache
- lymphadenopathy
- lump/mass/swelling
- fatigue
- back pain
- bruising
- urinary symptoms
- hepatosplenomegaly
What is tumour lysis syndrome?
- when tumour cells die, they release all their contents to the rest of the body, causing disturbance of homeostasis
- lots of potassium released which is bad as can lead to hyperkalemia and arrhythmias as a result
- is usually secondary to treatment
What are the clinical markers of tumour lysis syndrome?
- increased potassium
- increased urate
- increased phosphate
- decreased calcium
- may have acute renal failure due to urate load and to CaPO4 deposition in renal tubules
How can we treat tumour lysis syndrome?
- avoidance
- ECG monitoring
- hyperhydrate to induce diuresis
- NEVER give potassium no matter what the levels are
- treat hyperkalemia
- watch urate and PO4 closely
- may want to decrease uric acid using allopurinol OR urate oxidase-uricozyme
- renal replacement therapy may be required
How can we treat the hyperkalemia associated with tumour lysis syndrome?
- calcium resonium suppository binds potassium
- salbutamol or insulin (they will encourage uptake of potassium back up in to cells)
What values are required to diagnose febrile neutropenia?
- neutrophils <0.5x109/L and
- fever> 38 degrees celsius
How would you investigate febrile neutropenia in a child?
- cultures
- swabs
- stool
- urine
How would you treat febrile neutropenia?
broad spectrum antibiotics and consider possibility that infection could be fungal
What is another common complication of childhood cancer other than tumour lysis syndrome and febrile neutropenia?
spinal cord compression
What are features of spinal cord compression in children?
- weakness (may be ambulatory, non ambulatory or paraplegic)
- spine tenderness
- sphincter disturbance
- sensory disturbance
- gait disturbance
- back pain
How would spinal cord compression be managed in children?
- MRI
- dexamethasone
- chemo
- surgery
