Paediatric oncology Flashcards
Cancer // Sepsis // Raised ICP // SCV/SMS // Tumour lysis syndrome
What is the brief epidemiology of childhood cancer in UK?
It is very RARE
- 1/500 pre age 14
- GP sees 1 in career
- 10-15 per DGH catchment/year
- <1% all cancers
- Boys more than girls
What are the various types of paediatric malignancy and which of these are more common?
- 33% Leukaemias (require systemic treatment)
- 25% brain tumours
- 40% are extracranial solid tumours
Why do children get cancer?
- Genes
- Down
- Fanconi
- BWS
- Environment
- Radiation
- Infection
- Iatrogenic
- Chemotherapy
- Radiotherapy
Who should we be worried about….
Immediate referral?
Urgent referral?
Refer?
- Immediate referral
- unexplained petechia, hepatosplenomegaly
- Urgent referral
- repeat attendance, same problem, no clear diagnosis
- new neuro symptoms, abdo mass
- Standard referral
- rest pain, back pain, unexplained lump
- lymphadenopathy
Explain the rough guidelines of the headsmart campaign:
How can we detect what sort of cancer it is?
How can we detect where the cancer is?
- Scans
- Biopsy / pathology
- Tumour markers
- Staging eg scans, bone marrow
What are some of our Rx options for cancer?
- Multimodal therapy based on specific disease and extent (plus patient factors)
- MDT approach
- Chemotherapy
- Surgery
- Radiotherapy
Side effects/Risks of chemo?
Acute
- hair loss
- nausea vomiting
- mucositis
- diarrhoea
- bone marrow suppression
Chronic
- organ impairment
- reduced fertility
- second cancer
Side effects/Risks of radiotherapy?
Acute
- Lethargy
- Skin irritation
- Swelling
Chronic
- Fibrosis
- Second cancer
- Reduced fertility
What are the oncological emergencies?
- Sepsis / febrile neutropenia
- Raised ICP
- Spinal cord compression
- Mediastinal mass
- Tumour lysis syndrome
Risks of sepsis/febrile neutropenia?
Which organisms can cause this?
- ANC < 0.5 x 109
- Indwelling catheter
- Mucosal inflammation
- High dose chemo / SCT
Organisms:
- Pseudonomas aeroginosa
- E coli
- strep pneumonia
SSx of childhood sepsis?
- Fever (or low temp)
- Rigors
- Drowsiness
- Shock
Rx for childhood sepsis?
- IV access
- Blood culture, FBC, coag, UE, LFTs, CRP, lactate
- Urine culture
- Throat swab
- Sputum culture / BAL
- CXR
- ABC
- Oxygen
- Fluids
- Broad spectrum antibiotics
SSx of raised ICP?
Early
- early morning headache/vomiting
- tense fontanelle
- increasing HC
Late
- constant headache
- papilloedema
- diplopia (VI palsy)
- Loss of upgaze
- neck stiffness
- status epilepticus,
- reduced GCS
- Cushings triad (low HR, high BP)
How do we Ix raised ICP?
- Imaging is mandatory (if safe)
- CT is good for screening
- MRI is best for more accurate diagnosis
Rx for raised ICP?
- Dexamethasone if due to tumour
- Neurosurgery - urgent CSF diversion
Which cancers are likely to cause spinal cord compression?
•10-20 % Ewing’s or Medulloblastoma
5-10 % Neuroblastoma & Germ cell tumour
SSx for spinal cord compression?
- weakness (90 %)
- pain (55-95 %)
- sensory (10-55%)
- sphincter disturbance (10-35%)
Rx for spinal cord compression?
Outcomes?
- Urgent MRI
- Start dexamethasone urgently to reduce peri-tumour oedema
- Definitive treatment with chemotherapy is appropriate when rapid response is expected
- Surgery or radiotherapy are other options
- Mild impairment = 90% recovery
- Paraplegic = 65% recovery
What is SVC syndrome? What is SMS?
SSx?
Superior vena cava syndrome // Superior mediastinal syndrome
- SVCS: facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins, ill, anxious, reduced GCS
- SMS: dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea
CXR/CT chest
Echo
Rx for SVC syndrome/SMS?
- Keep upright & calm
- Urgent biopsy (ideally)•Look to obtain important diagnostic information without GA
- FBC, BM, pleural aspirate, GCT markers
- Definitive treatment is required urgently
- Chemotherapy is usually rapidly effective
- Presumptive treatment may be needed in the absence of a definitive histological diagnosis (steroids)
- Radiotherapy is effective
- May cause initial increased respiratory distress
- Rarely surgery if insensitive
- CVAD-associated thrombosis should be 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
SSx of tumour lysis syndrome?
- increased potassium
- increased urate, relatively insoluble
- increased phosphate
- reduced calcium
- Acute renal failure
- Urate load
- CaPO4 deposition in renal tubules
Rx for tumour lysis syndrome?
- Avoidance
- ECG Monitoring
- Hyperhydrate-2.5l/m2
- QDS electrolytes
- Diuresis
- Never give potassiuma
