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Year 3 > Paediatric Oncology > Flashcards

Paediatric Oncology Flashcards

1
Q

types of cancer in children

A
  • Leukaemia – 33%
  • CNS tumours – 25%
  • Lymphomas – 10%
  • Neuroblastoma – 7%
  • Soft tissue sarcomas – 7%
  • Wilm’s tumour – 6%
  • Bone tumours – 4%
  • Retinoblastoma – 3%
  • Other – 7%
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2
Q

what is the overall 5 year survival for childhood cancer?

A

80%

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3
Q

genes implicated in childhood cancer

A

o Fanconi
o BWS
o Li-Fraumeni Familial Cancer Syndrome
o Neurofibromatosis

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4
Q

viral infections associated with childhood cancer

A 
§ EBV
• Burkitt, Hodgkin, nasopharyngeal
§ Hepatitis B
• Hepatic carcinoma
§ HIV
• Kaposi
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5
Q

iatrogenic causes of child cancer

A 
o Radiotherapy
§ Craniospinal
• CNS tumours
§ Chest
• Breast
o Chemotherapy
§ Etoposide
• AML
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6
Q

what to be worried about in child potential cancer: immediate referral

A

unexplained petechiae

hepatosplenomegaly

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7
Q

what to be worried about in child potential cancer: urgent referral

A

repeat attendance, same problem, no clear diagnosis

new neuro symptoms, abdo mass

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8
Q

what to be worried about in child potential cancer: refer (to doctor or for urgent investigations)

A

rest pain
back pain
unexplained lump
lymphadenopathy

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9
Q

risks of cancer chemotherapy: acute

A 
o Hair loss
o Nausea & vomiting
o Mucositis
o Diarrhoea / constipation
o Bone marrow suppression – anaemia,
o bleeding, infection
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10
Q

risks of cancer chemotherapy: chronic

A

o Organ impairment – kidneys, heart,
o nerves, ears
o Reduced fertility
o Second cancer

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11
Q

risks of cancer radiotherapy: acute

A

o Lethargy
o Skin irritation
o Swelling
o Organ inflammation – bowel, lungs

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12
Q

risks of cancer radiotherapy: chronic

A

o Fibrosis / scarring
Figure 2 Headsmart: Be Brain Tumour Aware
o Second cancer
o Reduced fertility

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13
Q

childhood oncological emergencies

A
  1. Sepsis/febrile neutropenia
  2. Raised ICP
  3. Spinal cord compression
  4. Mediastinal mass
  5. Tumour lysis syndrome
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14
Q

febrile neutropenia in children: risks

A

ANC < 0.5x109
indwelling catheter
mucosal inflammation
high dose chemo/SCT

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15
Q

febrile neutropenia in children: bacteria

A
  • Pseudomonas aeruginosa
  • Enterobacteriaciae eg E coli, Klebsiella
  • Streptococcus pneumoniae
  • Enterococci
  • Staphylococcus
  • Fungi eg. Candida, Aspergillus
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16
Q

febrile neutropenia in children: presentation

A

fever (or low temp)
rigors
drowsiness
shock

17
Q

febrile neutropenia in children: management

A 
• IV access
• Blood culture, FBC, coag, U+E, LFTs, CRP, lactate
• CXR
• Other
o Urine microscopy / culture
o Throat swab
o Sputum culture / BAL
o LP
o Viral PCRs
o CT / USS
• ABC
o Oxygen
o Fluids
• Broad spectrum antibiotics
• Inotropes
• PICU
18
Q

define febrile neutropenia

A

• Neutrophils <0.5x109/l and
• Fever > 38.0 C (assessed by any means)
• In addition, patients for whom there is a clinical suspicion of sepsis in the absence of fever
should be treated as potentially bacteraemic e.g. unexplained abdominal pain or generally
unwell

19
Q

raised ICP: presentation early

A 
• Early
o Early morning
• Headache/vomiting
o Tense fontanelle
o Increasing HC
20
Q

raised ICP: presentation late

A 
o Constant headache
o Papilloedema
o Diplopia (VI palsy)
o Loss of upgaze
o Neck stiffness
o Status epilepticus,
o Reduced GCS
o Cushings triad (low HR, high BP)
21
Q

raised ICP: investigation

A

CT for screening

MRI for accutate diagnosis

22
Q

raised ICP: managment

A

raised ICP:

23
Q

spinal cord compression who gets it

A

• Potential complication of nearly all paediatric malignancies
• Affects 5 % of all children with cancer
o 10-20 % Ewing’s or Medulloblastoma
o 5-10 % Neuroblastoma & Germ cell tumour
o Diagnosis (65 %), relapse, progression
• Pathological processes
o Invasion from paravertebral disease via intervertebral foramina (40 % extradural)
o Vertebral body compression (30 %)
o CSF seeding (20 % intradural, extraspinal)
o Direct invasion (10 % intraspinal)
• Rare but devastating
• ~5% of solid tumours at presentation
• Much more common in terminal phase
• Dumb bell tumour
o NBL 27%
o Ewing’s 23%
o Rhabdo 15%
o Osteo 12%

24
Q

spinal cord compression: clinical features

A 
• Weakness 90%
o Ambulatory 55%
o Non-ambulatory 33%
o Paraplegic 12-57%
• Spine tenderness ~70%
• Sphincter disturbance 51-57%
• Sensory disturbance 14-52%
• Gait disturbance ~10%
• Back pain 61-80%
25
Q

spinal cord compression: managment

A 
• MRI
• Dexamethasone 1mg/kg (max 16 mg)
• Chemo
• DXT
• Surgery
o Debulking
o Laminectomy
o Laminotomy
o Laminoplasty
• Bleeding
• SVC obstruction
• Airway obstruction
• Leucostasis
• VOD
• Raised ICP
• Bone marrow failure
• Pancreatitis
• Encephalopathy
• Thrombosis
• Refeeding syndrome
26
Q

SVC syndrome: causes

A

lymphoma

other - neuroblastoma, germ cell tumour, thrombosis

27
Q

SVC syndrome: presentation

A

o SVCS: facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins,
ill, anxious, reduced GCS
o SMS: dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea

28
Q

SVC syndrome: investigation

A

o CXR / CT chest (if able to tolerate)

o Echo

29
Q

SVC syndrome: management

A

• Keep upright & calm
• Urgent biopsy (ideally)
• Look to obtain important diagnostic information without GA
o FBC, BM, pleural aspirate, GCT markers
• Definitive treatment is required urgently
o Chemotherapy is usually rapidly effective
o Presumptive treatment may be needed in the absence of a definitive histological
diagnosis (steroids)
o Radiotherapy is effective
o May cause initial increased respiratory distress
o Rarely surgery if insensitive
o CVAD-associated thrombosis should be treated by thrombolytic therapy
• Most of underlying malignancies have a good prognosis

30
Q

tumour lysis syndrome: what is it

A
  • Metabolic derangement
  • Rapid death of tumour cells
  • Release of intracellular contents
  • At or shortly after presentation
  • Secondary to treatment
  • (rarely spontaneous)
31
Q

tumour lysis syndrome: clinical features

A 
• Increased potassium
• Increased urate, relatively insoluble
• Increased phosphate
• Decreased calcium
• Acute renal failure
o Urate load
o CaPO4 deposition in renal tubules
32
Q

tumour lysis syndrome: treatment

A 
• Treatment
• ECG monitoring
• Hyperhydrate 2.5l/m2
• Diuresis
• Never give potassium
• Treat hyperkalaemia
o Ca Resonium
o Salbutamol
o Insulin
• At least qds electrolytes
• Watch urate and PO4 closely
• Decrease uric acid
o Urate oxidase-uricozyme (rasburicase)
o Allopurinol
• Renal replacement therapy

Year 3 (164 decks)

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