Paediatric Oncology

Question 1

What is the epidemiology of and types of childhood cancer?

Answer 1

Epidemiology
- rare 
- 1 in career of GP
- <1% all cancers 
- 1 in 500 children 
- roughly 1500 diagnosed in uk per year
What is diagnosed?
- 33% leukaemia
- 25% brain tumours
- 40% extracranial solid tumours

Classified via international classification of childhood cancer based on tumour morphology and primary site

Question 2

What presentations may suggest childhood cancer and what red flags should prompt urgent referral?

Answer 2

Immediate referral: unexplained petechiae, hepatosplenomegaly

Urgent referral: repeat attendance, same problem, no clear diagnosis or new neuro symptoms, abdominal mass

Refer (to doctor or for urgent investigation): rest pain, back pain and unexplained lump, lymphadenopathy (hard rough etc)

Question 3

What are potential oncological emergencies as part of the potential complications of treatment?

Answer 3

Sepsis/febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass 
Tumour lysis syndrome

Question 4

What are the principle sof management in: tumour lysis syndrome, febrile neutropenia and spinal cord compression?

Answer 4

Febrile neutropenia
Present: with fever or low temp, rigors, drowsiness, shock.
Management:
- IV access
- blood culture, FBC, coagulation factors, UE, LFTs, CRP, lactate
- CXR
- other: urine microscopy, culture, throat swab, sputum culture, LP, viral PCR, CT/USS
- ABCs eg oxygen, fluids
- broad spectrum antibiotics
- inotropes
- PICU

Tumour lysis syndrome
Present: increase potassium, urate, phosphate, decreased calcium, acute renal failure
Management: avoidance, ECG monitoring, hyper hydrate, QDS electrolytes, diuretics, decrease iris acid and treat hyperkalaemja, renal replacement therapy

Spinal cord compression
Present: symptoms vary with level eg weakness, pain, sensory, sphincter disturbance
Management:
- Urgent MRI
- dexamethasone
- chemotherapy (surgery, radiotherapy are other options)