Paediatric Oncology

Question 1

Common Paediatric Malignancy

Answer 1

33% Leukaemias
25% brain Tumours
40% are extracranial Solid tumours

Question 2

When is paediatric Cancer most common

Answer 2

0-4 > 5 -9 > 10 -14

Question 3

Factors Predisposing kids to cancer

Answer 3

Genetics Environment
Downs Radiation
Fanconi infection
BWS
Neurofibromatosis Iatrogenic
Chemotherapy
Radiotherapy

Question 4

Who should we be worried about

Answer 4

Unexplained petechiae + HSM = IMMEDIATE REFERRAL

Repeat attendance, same problem, no clear Dx + new neuro symptoms and abdo mass - URGENT REFERRAL

Rest pain, Back Pain, and unexpected lump - lymphadenopthy… = Refer to Dr for immediate assessment

Question 5

General Ix that an Oncologist will do

Answer 5

What is it…
Scans
Biopsy
Tumour markers

Where is it
Staging,
Scans
Bone Marrow

Question 6

Acute Risks of Chemo

Answer 6

Hair loss
N/V
Mucositis
Diarrhoea/Constipation
Bone marrow suspension - anaemia, bleeding, infection

Question 7

Chronic Risks of Chemo

Answer 7

Organ impairment - Kidneys, heart, Lungs, ears
Reduced fertility
Second Cancer

Question 8

Acute risks of Radiotherapy

Answer 8

Lethargy
Skin Irritation
Swelling
Organ Inflammation - Bowel and lungs

Question 9

Chronic Risks of Chemo

Answer 9

Fibrosis/Scaring
Second Cancer
Reduced fertility

Question 10

Oncological Emergencies

Answer 10

Sepsis/Febrile Neutropaenia 
Raised ICP
Spinal Cord compression
mediastinal mass
tumour lysis syndrome

Question 11

Sepsis/Febrile neutropaenia (organisms)

Answer 11

Pseudomonas argenosia 
E. coli/Klebsiela
Strep Pneumoniae 
Enterococci
Staphylococcus
Fingi e.g. candida/ aspergillis

Question 12

Risk Factors of Sepsis/Febrile Neutropaenia

Answer 12

ANC < 0.5 x 10^9
Indwelling catheter
Mucossal inflammation
High dose Chemo/SCT

Question 13

Presentation of Sepsis

Answer 13

Feser
Rigors
Drowsiness
Shock
   Tachycardia
   Tachypnoea
   Hypotension
   Prolong Cap Refill
   Reduced UO
   Metabolic Acidosis

Question 14

management of Neutropaenic Sepsis

Answer 14

IV Access
Blood culture, FBC, Coag, U&E, :LFTs, CRP, LACTIC LEVELS
CXR
Other
   Urine microscopy
   Throat swab
   Sputum Culture
   LP
   Viral PCRs
   CT/USS

ABC
O” and Fluids
Broad Spectrum Abx

Ionotropes and PICU

Question 15

Presentation of Raised ICP

Answer 15

Early
Morning headache/Vomiting
Tense fontanelle
Increasing HC

Late
   Constant Headache
   Papillodema
   Diploplia (CN VI palsy
   Loss of upgaze
   Neck Stiffness
   Status Epillepticus 
   Reduces GCS
   Cushing Triad
      Low HR, High BP

Question 16

Ix of ICP

Answer 16

Imaging is mandatory (if safe)
CT is good for screening
MRI for accurate Dx

DO NOT DO LP

Question 17

Mx of Raised ICP

Answer 17

Dexamethasone (if due to tumour)
Reduce oedema and increase CSF flow

Neurosurgery (urgent CSF diversion)
Ventriculostomy
EVD
VP shunt

Question 18

Presentation Of spinal Cord Compression

Answer 18

Symptoms vary with Level
   Weakness
Pain
Sensory
Sphincter disturbances

Question 19

Mx of Spinal cord compression

Answer 19

Urgent MRI
Start Dexa urgently to reduce peri-tumour oedema
Definitive Rxwith chemo is appropriate when rapid response is suspected
Sx or radiotherapy are other options

Question 20

Tumour Lysis Syndrome

Answer 20

Metabolic Derangement
Rapid Death of tumour cells
Release of intracellular contents
at/shortly after presentation 
secondary to treatment 
   (rarely Spontaneous)

Question 21

Clinical Features of TLS

Answer 21

Increased potassium 
Increased Urate - relatively insoluble
Increased phosphate
Decreased calcium 
Acute renal Failure
   urate load
  CaPO4 deposition in renal tubules.

Question 22

Rx of TLS

Answer 22

Avoidance
ECG moitoring
Hyperhysrate
Diuresis
Allopurino (to decrease urate) 
Ca resonium, Salbutamol, Insulin to Rx Hyperkalaemia

NEVER GIVE POTASSIUM

Renal replacement therapy