Paediatric Oncology Flashcards
What are the most common paediatric malignancies?
- Leukaemias
- Brain tumours
- Lymphomas
- Extracranial solid tumours
How are paediatric cancers classified?
- International classification of childhood cancer
- Based on tumour morphology and primary site
Which genes can cause cancer in childhood?
- Down
- Fancomi
- BWS
- Li-Fraumeni syndrome
- Neurofibromatosis
What can cause childhood cancer?
- Genes
- Radiation and chemo
- Infection
Which type of cancer has the highest mortality?
Brain
Which presentations would have you worried that a child may have cancer?
- Unexplained petechiae and hepatosplenomegaly (immediate referral)
- Repeat attendance with the same problem, no clear diagnosis, new neuro symptoms and abdo mass (urgent referral)
- Rest pain, back pain and unexplained lump (refer for urgent investigation
What are the risks of chemotherapy (acute/chronic)?
- Acute: hair loss, nausea, vomiting, mucositis, diarrhoea, constipation and bone marrow suppression (anaemia, bleeding and infection)
- Chronic: organ impairment, reduced fertility and second cancer
What are the risks of radiotherapy (acute/chronic)?
Acute: lethargy, skin irritation, swelling and organ inflammation
-Chronic: fibrosis/scarring, second cancer and reduced fertility
What are the risks for developing sepsis/febrile neutropenia?
- ANC <0.5x10^9
- Indwelling catheter
- Mucosal inflammation
- High dose chemo/SCT
Which organisms cause sepsis/febrile neutropenia?
- Pseudomonas aeruginosa
- E coli
- Klebsiella
- Strep pneumoniae
- Enteroccoci
- Staph
- Fungi e.g. candida, aspergillus
How does sepsis/febrile neutropenia present?
- Fever (or low temp.)
- Rigors
- Drowsiness
- Shock (tachycardia, tachypnoea, hypotension, prolonged cap refill, reduced urine output and metabolic acidosis)
How can sepsis/febrile neutropenia be managed?
- IV access
- Blood culture, FBC, coag, U&Es, LFTs, CRP and lactate
- CXR
- Urine culture, throat swab, sputum culture, LP, viral PCRs, CT or USS
- ABC: oxygen and fluids
- Broad spectrum antibiotics
- Inotropes and PICU if necessary
How does raised ICP present?
- Early: early morning headache, tense fontanelle and increasing head circumference
- Late: constant headache, papilloedema, diplopia, loss of upgaze, neck stiffness, status epilepticus, reduced GCS, low HR and high BP
How should raised ICP be investigated?
- CT: good for screening
- MRI: more accurate diagnosis
How can raised ICP be treated?
- Dexamethasone (if due to tumour)
- Neurosurgery: ventriculostomy, EVD and VP shunt
How does spinal cord compression present?
- Weakness
- Pain
- Sensory disturbance
- Sphincter disturbance
How is spinal cord compression managed?
- Urgent MRI
- Dexamethasone
- Definitive treatment with chemo where appropriate (radiotherapy and surgery are also options)
What are the common causes of superior vena cava syndrome (SVC)?
- Lymphoma
- Neuroblastoma
- Germ cell tumour
How does SVC syndrome present?
- Face, neck and upper thoracic plethora
- Oedema
- Cyanosis
- Distended veins
- Ill and anxious
- Reduced GCS
How does SMS (genetic syndrome) present?
- Dyspnoea
- Tachypnoea
- Cough
- Wheeze
- Stridor
- Orthopnea
How can SVC syndrome and SMS be investigated?
- CXR/CT chest
- ECHO
How can SVC syndrome be managed?
- Keep upright and calm
- Urgent biopsy
- FBC, BM, pleural aspirate and GCT markers
- Chemo
- Steroids
- Radiotherapy
- Any thrombosis should be threated with thrombolytic therapy
What is tumour lysis syndrome?
Metabolic derangement caused by the death of tumour cells and the subsequent release of intracellular contents (secondary to treatment)
How does tumour lysis syndrome present?
- Increased potassium
- Increased urate
- Increased phosphate
- Reduced calcium
- Acute renal failure: urate load and CaPO4 deposition in renal tubules
How can tumour lysis syndrome be treated>
- Avoidance
- ECG monitoring
- Hyperhydrate
- Electrolytes x4 daily
- Diuresis
- Lowe uric acid: allopurinol etc.
- Treat hyperkalaemia: Ca resonium, salbutamol and insulin
- Renal replacement therapy
- Never give potassium
