paediatric oncology Flashcards
immediate referral indicators
- unexplained petechiae
- hepatosplenomegaly
urgent referral indicators
- repeat attendance, same problem, no clear diagnosis
- new neuro symptoms
- abdo mass
referral to doctor indicator
- rest pain
- back pain
- unexplained lump
- lymphadenopathy
acute risk factors chemotherapy
- hair loss
- N+V
- mucositis
- diarrhoea
- constipation
- bone marrow suppression
chronic risk factors chemotherapy
- organ impairment
- reduced fertility
- second cancer
acute risk factors radiotherapy
- lethargy
- skin irritation
- swelling
- organ inflammation
chronic risk factors radiotherapy
- fibrosis/ scarring
- second cancer
- reduced fertility
oncological emergencies
- sepsis
- febrile neutropenia
- raised ICP
- spinal cord compression
- media
- tumour lysis syndrome
early presentation raised ICP
- early morning headache/ vomitting
- tense fontanelle
- increasing HC
late presentation raised ICP
- constant headache
- papilloedema
- diplopia
- loss of upgaze
- neck stiffness
- status epilepticus
- reduced GCS
- cushings triad
Cushings triad
- low HR
- low RR
- increased BP
investigations at suspect raised ICP
- CT (screening)
- MRI (accurate diagnosis)
management of raised ICP if due to tumour
dexamethasone (reduces oedema, increased CSF flow)
when would neurosurgery be needed for raised ICP
- urgent CSF diversion
ventriculostomy
hole in membrane at base of 3rd ventricle with endoscope
spinal cord compression is a potential complication of nearly all paediatric malignancies
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pathological processes behind spinal cord compression
- invasive from paravertebral disease
- vertebral cord compression
- CSF seeding
- direct invasion
presentation spinal cord compression
- weakness
- pain
- sensory
- sphincter disturbance
symptoms vary with level
management spinal cord compression secondary to malignancy
- urgent MRI
- dexamethsosome to reduce peri-tumour oedema
- definitive treatment with chemo is appropriate when rapid response expected
- surgery/ radio are options
SVCS (superior vena cava syndrome)
group of symptoms that occur when there is pressure on the superior vena cava, or it is partially blocked and blood can’t flow back to the heart normally
presentation SVCS
- facial, neck and upper thoracic plethora
- oedema
- cyanosis
- distended veins
- ill
- anxious
- reduced GCS
initial management SVCS
- keep upright and calm
- urgent biopsy (ideally)
- FBC, pleural aspirate, GCT markers
definitive management SVCS
- chemo
- presumptive treatment may be needed in absence of a definitive histological diagnosis (steroids)
- radiotherapy
- rarely surgery
what is tumour lysis syndrome
occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood
clinical features tumour lysis syndrome
- increase potassium
- increase urate
- increase phosphate
- decrease calcium
consequence tumour lysis syndrome
acute renal failure
management of increased uric acid
- urate-oxidase-uricoenzyme
- allopurinol
management of hyperkalaemia
- Ca resonium
- salbutamol
- insulin
management tumour lysis syndrome
- ECG monitoring
- hyperhydrate
- QDS electrolytes
- diuresis
- irate-oxidase-uricoenzyme
- allopurinol
- Ca resonium
- salbutamol
- insulin
- renal replacement therapy
