Paediatric Oncology

Question 1

What are 3 of the most common cancers in children?

Answer 1

• leukaemia
• CNS tumours
• lymphomas

Question 2

What is the trend at which children tend to develop cancer?

Answer 2

• in pre-school years

- second peak in adolescence

Question 3

Why do children get cancer?

Answer 3

• no particular reason why
• genetics
• environment

Question 4

What is an example of a genetic influence on developing childhood cancer?

Answer 4

children with Down’s syndrome are more likely to develop acute myeloid leukaemia, but also have a better prognosis

Question 5

What are examples of environmental factors that may contribute to a child developing cancer?

Answer 5

• 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

Question 6

What is the generally the prognosis in many childhood cancers?

Answer 6

good - many survive

Question 7

From primary care, what are red flag symptoms that should make a GP consider immediate referral for investigation of leukaemia or lymphoma?

Answer 7

unexplained hepatosplenomegaly, unexplained petechiae

Question 8

From primary care, what are red flag symptoms that should make a GP consider urgent referral for investigation of leukaemia or lymphoma?

Answer 8

• repeat attendance

- same problem, no clear diagnosis

Question 9

From primary care, what are red flag symptoms that should make a GP consider non-urgent referral for investigation of leukaemia or lymphoma?

Answer 9

• rest pain
• back pain and
• unexplained lump

Question 10

What are examples of alert symptoms in children that GPs should look out for?

Answer 10

• neurological symptoms
• headache
• lymphadenopathy
• lump/mass/swelling
• fatigue
• back pain
• bruising
• urinary symptoms
• hepatosplenomegaly

Question 11

What is tumour lysis syndrome?

Answer 11

• 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

Question 12

What are the clinical markers of tumour lysis syndrome?

Answer 12

• increased potassium
• increased urate
• increased phosphate
• decreased calcium
• may have acute renal failure due to urate load and to CaPO4 deposition in renal tubules

Question 13

How can we treat tumour lysis syndrome?

Answer 13

• 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

Question 14

How can we treat the hyperkalemia associated with tumour lysis syndrome?

Answer 14

• calcium resonium suppository binds potassium

- salbutamol or insulin (they will encourage uptake of potassium back up in to cells)

Question 15

What values are required to diagnose febrile neutropenia?

Answer 15

• neutrophils <0.5x109/L and

- fever> 38 degrees celsius

Question 16

How would you investigate febrile neutropenia in a child?

Answer 16

• cultures
• swabs
• stool
• urine

Question 17

How would you treat febrile neutropenia?

Answer 17

broad spectrum antibiotics and consider possibility that infection could be fungal

Question 18

What is another common complication of childhood cancer other than tumour lysis syndrome and febrile neutropenia?

Answer 18

spinal cord compression

Question 19

What are features of spinal cord compression in children?

Answer 19

• weakness (may be ambulatory, non ambulatory or paraplegic)
• spine tenderness
• sphincter disturbance
• sensory disturbance
• gait disturbance
• back pain

Question 20

How would spinal cord compression be managed in children?

Answer 20

• MRI
• dexamethasone
• chemo
• surgery