Paediatric oncology Flashcards
Name 5 oncological emergencies
- Sepsis/febrile neutropenia
- Raised ICP
- Spinal cord compression
- Mediastinal mass
- Tumour lysis syndrome
Tumor lysis syndrome definition [2]
4 features on blood investigations
Metabolic derangement [1] due to rapid death of tumor cells [1]
Hyperphosphatemia, hypocalcemia
Hyperuricemia, hyperuricosuria
Tumor lysis syndrome treatment [6]
Hyperhydrate and diuresis Monitoring: ECG, phosphate Allopurinol, urate oxidase Phosphate binders Correction of hyperkalemia Dialysis
Treatment of hyperkalemia [3]
Calcium gluconate
Salbutamol
Insulin
Febrile neutropenia [2]
Neutrophils < 0.5 x 109/L and Fever > 38.0°
Spinal cord compression
Presentation in children [6]
Management [3]
Muscle weakness Spine tenderness Sphincter disturbance Sensory disturbance Back pain Gait disturbance
Dexamethasone
Chemotherapy
Surgery - debulking, laminectomy, lminotomy, laminoplasty
How to prevent tumour lysis syndrome? [1]
Pre-chemotherapy hydration measures
Define purpura
Differentials of purpura [6]
Bleeding into skin from small blood vessels to produce a non-blanching rash.
Differentials
• Meningococcal septicaemia
• ALL
• Viral infection e.g. measles, enteroviruses
• Vasculitis e.g. Kawasaki, Henoch Schonlein Purpura
• Idiopathic thrombocytopenic purpura
• Congenital bleeding disorders
Investigations [4]
FBC
Blood film
Coagulation screen
Von Willebrands factor screen
Idiopathic thrombocytopenia purpura Ax [2] Sxs Ix [3] Complication
Ax:
- Type II Hypersensitivity
- Follows viral infection
Sxs: platelet type bleeding
FBC & blood film
Bone marrow biopsy
CT head
Cx: intracranial haemorrhage
ITP
What would you see on FBC & blood film?
Management [3]
FBC & blood film - isolated thrombocytopenia
Mx:
- Avoid NSAIDs, contact sports
- Acute: gradual resolution over 3m, supportive tx optional, splenectomy (severe)
- Chronic: anti-D, RITUXIMAB, splenectomy
Generalized lymphadenopathy
Differentials [5]
Viral infection Bacterial infection Parasitic: toxo Autoimmune JIA Malignancy ALL
Examination of lymphadenopathy. What features of the LN would indicate:
Normal [3]
Malignancy [6]
Infection [4]
o Normal: bilateral anterior cervical nodes up to 2cm, axillary nodes up to 1cm, inguinal nodes up to 1.5cm
o Malignancy: supraclavicular (chest or abdo malignancy), epitrochlear (Hodgkin lymphoma), firm, non-tender, matted together or rubbery
o Infection: erythema, warmth, tenderness, fluctuance
Chronic non-specific lymphadenitis
Define [2]
Causative organisms [3]
Ix [2]
Chronic inflammation of LN in response to pathogens. Enlarged painless LN
Causative organisms:
- Cat scratch disease (bartonella hernselae)
- HSV, toxoplasmosis
- TB, atypical mycobacterium
Ix: FNAC or biopsy
Chronic non-specific lymphadenitis - Cat scratch disease
Sxs [3]
Mx
Fever, headache
Regional lymphadenopathy
Malaise
Mx: conservative
Henoch Schonlein Purpura
Define
Features [6]
IgA mediated small vessel vasculitis
Features:
- Palpable purpuric rash, localized edema
- Over buttocks and extensor surfaces of arms/legs
- 1-3d post infection
- Abdominal pain
- Polyarthritis
- IgA nephropathy eg haematuria, renal failure
HSP
Tx [2]
Prognosis [2]
Treatment
- analgesia for arthralgia
- treatment of nephropathy is generally supportive
Prognosis
- usually excellent, HSP is a self-limiting condition, especially in children without renal involvement
- around 1/3rd of patients have a relapse
Purpura NAI
Thrombocytopenic bleeding normally on legs or head in crying babies; be suspicious of NAI or severe congenital coagulation disorder if anywhere else
Abdominal mass differentials
Neuroblastoma
Wilms tumour
Neuroblastoma
Epidemiology
Ax [2]
Sxs [6]
Ep: 0-5y/o (most common solid tumour in under 5’s)
Ax:
- embryonal neoplasm derived from sympathetic neuroblasts
- most commonly adrenal in origin but can be anywhere along sympathetic chain
Sy/Si:
- abdominal mass
- lethargy, weight loss
- hypertension
- metastasis (lymph nodes, scalp, bone
- spinal cord compression
- bruising and swelling of eye
Neuroblastoma
Ix [5]
Mx [2]
Ix:
- FBC (thrombocytopenia)
- raised urinary vanillylmandelic acid (VMA) and homovanillic acid (HVA) levels
- CT chest abdo pelvis (MRI if suspect spinal lesions)
- MIBG radioisotope scan (specific to catecholamine)
- biopsy
Mx:
- chemotherapy e.g. (CYCLOPHOSPHAMIDE and DOXORUBICIN)
- RT, surgery
Wilms tumour
Ax
RF [3]
Ax: nephroblastoma Risk factors: - Bethwith-Wiedemann syndrome - WAGR syndrome - hemihypertrophy
Wilms tumour
Sxs [3]
Ix [5]
Sy/Si:
- abdominal mass
- painless haematuria, flank pain
- anorexia, weight loss, hypertension
Ix:
- FBC, U&E, urinalysis, CT chest abdo pelvis, AVOID transcutaneous needle biopsy
Wilms tumour
Mx [3]
Prognosis
Mx:
- Nephrectomy
- Chemotherapy
- RT if andvanced
Prognosis: 90% 5y survival
