Paediatric oncology Flashcards
What are the most common childhood cancers?
Leukaemias- ALL and AML
Brain and CNS tumours
What are the possible complications of cancer in children?
Tumour lysis syndrome Superior vena cava/superior mediastinal syndrome Spinal cord compression Raised ICP Febrile neutropenia
What are the features of tumour lysis syndrome?
Increased K, rate and phosphate
Decreased Ca
Acute renal failure
What is the management of tumour lysis syndrome?
Dialysis
NEVER give potassium
Decrease uric acid and K
What is SVC/superior mediastinal syndrome?
Mediastinal tumour compresses SVC or tumour
What type of cancer most commonly causes SVC/superior mediastinal syndrome?
Lymphoma
What are the clinical features of SVC syndrome?
oedema Cyanosis Distended veins Ill, anxious Reduced GCS
What are the features if superior mediastinal syndrome?
Compression of trachea
Dyspnoea
Tachypnoea
Wheeze, cough
What investigations should be done for SVC/superior mediastinal syndrome?
CXR/CT chest
Echo
What is the management of SVC/superior mediastinal syndrome?
Keep upright and calm
Urgent biopsy
Urgent referral
- chemo, steroids
hat are the clinical features of spinal cord compression?
Weakness
Pain
Sensory disturbance
Sphincter disturbance
What is the management of spinal cord compression?
Urgent MRI
Start dexamethasone
Definitive treatment- chemo, sometimes surgery or radio
Why start dexamethasone in spinal cord compression?
Reduce peri-tumour oedema
What are the early features of raised ICP
Early morning headache
Tense fontanelle
Increasing haematocrit
What are the late features of raised ICP?
Constant headache papilloedema Diplopia Loss of uptake Stiff neck Status epilepticus Reduced GCS
What investigations are done for raised ICP?
CT/MRI
What is the management of raised ICP?
Dexamethasone
Surgery- ventriculostomy, external ventricular drain, VP shunt
Why is dexamethasone started in raised ICP?
Reduce oedema dn increase CSF flow
What organisms can cause febrile neutropenia?
Pseudomonas aeroginosa Enterobacteria Enterococci Strep pneumonia Staph Fungi
What are the risk factors for febrile neutropenia?
Indwelling central line
Mucosal inflammation
High dose chemo
What are the clinical features of febrile neutropenia?
Fever
Rigors
Drowsiness
Shock
What investigations are done for febrile neutropenia?
Blood culture
FBC, U&E, LFTs, CRP, lactate
CXR
What is the management of febrile neutropenia?
ABC
Broad spec antibiotics
