paediatric oncology

Question 1

immediate referral indicators

Answer 1

• unexplained petechiae

- hepatosplenomegaly

Question 2

urgent referral indicators

Answer 2

• repeat attendance, same problem, no clear diagnosis
• new neuro symptoms
• abdo mass

Question 3

referral to doctor indicator

Answer 3

• rest pain
• back pain
• unexplained lump
• lymphadenopathy

Question 4

acute risk factors chemotherapy

Answer 4

• hair loss
• N+V
• mucositis
• diarrhoea
• constipation
• bone marrow suppression

Question 5

chronic risk factors chemotherapy

Answer 5

• organ impairment
• reduced fertility
• second cancer

Question 6

acute risk factors radiotherapy

Answer 6

• lethargy
• skin irritation
• swelling
• organ inflammation

Question 7

chronic risk factors radiotherapy

Answer 7

• fibrosis/ scarring
• second cancer
• reduced fertility

Question 8

oncological emergencies

Answer 8

• sepsis
• febrile neutropenia
• raised ICP
• spinal cord compression
• media
• tumour lysis syndrome

Question 9

early presentation raised ICP

Answer 9

• early morning headache/ vomitting
• tense fontanelle
• increasing HC

Question 10

late presentation raised ICP

Answer 10

• constant headache
• papilloedema
• diplopia
• loss of upgaze
• neck stiffness
• status epilepticus
• reduced GCS
• cushings triad

Question 11

Cushings triad

Answer 11

• low HR
• low RR
• increased BP

Question 12

investigations at suspect raised ICP

Answer 12

• CT (screening)

- MRI (accurate diagnosis)

Question 13

management of raised ICP if due to tumour

Answer 13

dexamethasone (reduces oedema, increased CSF flow)

Question 14

when would neurosurgery be needed for raised ICP

Answer 14

• urgent CSF diversion

Question 15

ventriculostomy

Answer 15

hole in membrane at base of 3rd ventricle with endoscope

Question 16

spinal cord compression is a potential complication of nearly all paediatric malignancies

Answer 16

yeh

Question 17

pathological processes behind spinal cord compression

Answer 17

• invasive from paravertebral disease
• vertebral cord compression
• CSF seeding
• direct invasion

Question 18

presentation spinal cord compression

Answer 18

• weakness
• pain
• sensory
• sphincter disturbance

symptoms vary with level

Question 19

management spinal cord compression secondary to malignancy

Answer 19

• urgent MRI
• dexamethsosome to reduce peri-tumour oedema
• definitive treatment with chemo is appropriate when rapid response expected
• surgery/ radio are options

Question 20

SVCS (superior vena cava syndrome)

Answer 20

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

Question 21

presentation SVCS

Answer 21

• facial, neck and upper thoracic plethora
• oedema
• cyanosis
• distended veins
• ill
• anxious
• reduced GCS

Question 22

initial management SVCS

Answer 22

• keep upright and calm
• urgent biopsy (ideally)
• FBC, pleural aspirate, GCT markers

Question 23

definitive management SVCS

Answer 23

• chemo
• presumptive treatment may be needed in absence of a definitive histological diagnosis (steroids)
• radiotherapy
• rarely surgery

Question 24

what is tumour lysis syndrome

Answer 24

occurs when a large number of cancer cells die within a short period, releasing their contents in to the blood

Question 25

clinical features tumour lysis syndrome

Answer 25

• increase potassium
• increase urate
• increase phosphate
• decrease calcium

Question 26

consequence tumour lysis syndrome

Answer 26

acute renal failure

Question 27

management of increased uric acid

Answer 27

• urate-oxidase-uricoenzyme

- allopurinol

Question 28

management of hyperkalaemia

Answer 28

• Ca resonium
• salbutamol
• insulin

Question 29

management tumour lysis syndrome

Answer 29

• ECG monitoring
• hyperhydrate
• QDS electrolytes
• diuresis
• irate-oxidase-uricoenzyme
• allopurinol
• Ca resonium
• salbutamol
• insulin
• renal replacement therapy