Paediatric Oncology Flashcards
What is the incidence of childhood cancer?
1:500 before 14
Slightly more common in boys
What are the major classes of paediatric cancers?
Leukaemias
Brain tumours
Extra-cranial solid tumours= rest grouped together
What portion of paediatric cancers have a genetic component?
~10%
What is the overall 5-year survival rate for paediatric cancer?
80%
In what age groups are paediatric cancers most common?
Very young children
Adolescents
What are the possible causes of childhood cancer?
Genes: -Down -Fancomi -BWS -Li-Fraumeni familial cancer syndrome -Neurofibromatosis Environment: -Radiation -Infection Iatrogenic: -Chemotherapy -Radiotherapy
What presentations require immediate, urgent and general referral to investigate for childhood cancer?
IMMEDIATE referral: -Unexplained petechiae -Hepatosplenomegaly Urgent referral: -Repeat attendance with same problem and no resolution -New neurological symptoms -Abdominal mass General Referral: -Pain at rest -Back pain -Unexplained lump -Lymphadenopathy
How do oncologists investigate suspected childhood cancer?
Scans- MRI gold standard (GA needed for MRI in children as they won’t stay still- difficult to arrange urgent scan + urgent anaesthesia so CT sometime used instead)
Biopsy/pathology
Tumour markers
Staging with scans (CT chest, bone scans PET scan) and bone marrow aspirate
How is paediatric malignancy managed?
Paediatric malignancy is managed with an MDT approach regarding chemotherapy, radiotherapy and surgery
What are the acute side effects of chemotherapy in children?
Hair loss N&V Mucositis Diarrhoea or constipation Bone marrow suppression- anaemia, bleeding, infection
What are the chronic side effects of chemotherapy in children?
Organ impairment- kidneys, heart, nerve, hearing
Reduced fertility
Second cancer
What are the acute side effects of radiotherapy?
Lethargy
Skin irritation
Swelling
Organ inflammation- bowel, lungs
What are the chronic side effects of radiotherapy?
Fibrosis/scarring
Second cancer
Reduced fertility
What are the different paediatric oncological emergencies?
Sepsis/febrile neutropenia Raised ICP Spinal cord compression Mediastinal mass Tumour lysis syndrome
What are the risk factors for febrile neutropenia in paediatric oncology?
ANC < 0.5 x 109 Indwelling catheter Mucosal inflammation High dose chemotherapy Stem cell transplant
What are the possible causative organisms of febrile neutropenia in paediatric oncology?
Pseudomonas aeruginosa Enterobacteriaciae eg E coli, Klebsiella Streptococcus pneumoniae Enterococci Staphylococcus Fungi eg. Candida, Aspergillus
How does febrile neutropenia present?
Fever >38 degrees Rigors (marker of serious infection) Drowsiness Shock: -Tachycardia -Tachypnoea -Hypotension -Prolonged capillary refill time -Metabolic acidosis -Decreased urine output
How is febrile neutropenia managed?
Gain IV access Blood culture, FBC, coagulations, Us+Es, LFTs, CRP and lactate Chest x-ray Other investigations as appropriate Oxygen Fluids Broad spectrum Abx Inotropes
What are the early features of raised ICP?
Early morning headache or vomiting
Tense fontanelle
What are the late signs of raised ICP?
Constant headache Papilloedema Diplopia- CNVI palsy Loss of upgaze Neck stiffness Status epilepticus Reduced GCS Cushings triad- low HR, high BP, reduced RR
How is raised ICP investigated and managed?
Imaging mandatory- MRI gold standard but can use CT
Management:
•Dexamethasone- reduces oedema and increases CSF flow- buys time
•Neurosurgery- urgent CSF diversion via ventriculostomy, EVD or VP shunt
What is the incidence of spinal cord compression?
Affects ~5% of children with cancer
Can be associated with most kinds of cancer
Most common in Ewing’s sarcoma
What pathological processes are associated with spinal cord compression?
Invasion from paravertebral disease via intervertebral foramina
Vertebral body compression
CSF seeding
Direct invasion
What are the symptoms of spinal cord compression?
Weakness
Pain
Sensory dysfunction
Sphincter disturbance
