Paediatric Oncology Flashcards
3 Categories of causes of cancer
Genetic
Environment
Iatrogenic
Genetic causes of cancer and associations with genetic conditions
Down's Syndrome Fanconi Beckwith Wiedemann Syndrome Li-Fraumeni Neurofibromatosis
Genetic mutation in Li-Fraumeni
p53
How is Fanconi monitored?
3 monthly Ultrasound until 7 years old
What is fanconi syndrome?
Disorder of proximal tubule. Excess glucose, potassium, bicarb, phosphates, sodium, uric acid excreted in urine
Environmental causes of cancer
Infection
Radiation
Iatrogenic causes of cancer
Chemotherapy
Radiotherapy
Signs and symptoms of cancer
Unexplained petechiae Hepatosplenomegaly New neurological symptoms Abdominal mass Recurring symptoms Pain at rest Back pain Unexplained lumps Lymphadenopathy (no preceding viral illness)
What two signs and symptoms of cancer indicate an urgent referral
Unexplained petechiae
Hepatosplenomegaly
Investigations for cancer
Imaging
Biopsy
Tumour markers
Staging - scans, bone marrow
Which tumour markers are measured in suspected cancer?
B-HCG
Testicular
3 treatment options for cancer
Chemotherapy
Radiotherapy
Surgery
Side effects of chemotherapy
Hair loss Nausea and vomiting Mucositis Diarrhoea/constipation Bone marrow suppression Organ impairment Reduced fertility Secondary cancer
Symptoms of bone marrow suppression (as caused by chemotherapy)
Anaemia
Bleeding
Infection
Side effects of radiotherapy
Lethargy Skin irritation Swelling Organ inflammation Fibrosis Secondary cancer Reduced fertility
Features of cancer treatment leading to sepsis - febrile neutropenia
Low neutrophils
Indwelling catheter
Mucosal inflammation
SCT/ high dose chemotherapy
Symptoms of sepsis
Fever Rigors Drowsiness Shock - tachycardia, tachypnoea Hypotension Prolonged capillary refill
Management of sepsis
Iv access Blood cultures Lactate Urine output IV fluids IV antibiotics High flow oxygen
What blood tests should be completed if child might be septic?
FBC U&Es CRP LFTs Lactate Blood gas
What other samples may be taken alongside blod if septic?
Urine and sputum cultures
Throat swabs
Symptoms of raised intracranial pressure
Early morning headache
Vomiting
Tense fontanelle
Late symptoms of raised intracranial pressure
Headache can become constant Papilloedema Diplopia Loss of upgaze Neck stiffness Status epilepticus Reduced GCS Cushing's traid - low HR, high BP
What is cushing’s triad?
Low heart rate
High blood pressure
Decreased respiration
Management of raised intracranial pressure
Imaging - CT, MRI
Dexamethasone
Neurosurgery - rapid CSF diversion
Tumours that result in spinal cord compression
Ewing’s sarcoma
Medulloblastoma
Neuroblastoma
Germ Cell Tumour
Symptoms of spinal cord compression
Weakness
Pain
Sensoey symptoms
Sphincter disturbance
Management of spinal cord compression
Imaging - MRI
Dexamethasone
Surgery
Presentation of Superior Vena Cava Syndrome
Facial/neck/thoracic plethora Oedema Cyanosis Disteneded veins Very ill Anxious Reduced GCS
What is Superior Mediastinal Syndrome?
Superior Vena Cava Syndrome in addition to obstruction of trachea
Presentation of Superior Mediastinal Syndrome
Dyspnoea Wheeze Cough Stridor Orthopnoea
Investigation for Superior Mediastinal Syndrome
CXR
ECHO
Sign of Superior Mediastinal Syndrome on X-ray
Complete whiteout with tracheal deviation
Management of SVCS and SMS
Chemotherapy rapidly effective
Biopsy
Steroids
Keep child calm
Why would radiotherapy be avoided in SMS/SVCS?
Increases respiratory distress
What occurs in Tumour Lysis Syndrome?
Cell dies and releases intracellular contents
Example of tumour in Tumour Lysis Syndrome
Burkitt’s lymphoma
Increased potassium, urate, phosphate
Management of tumour lysis syndrome
Hyperhydrate- no potassium
ECG monitoring
Diuresis
Check electrolytes
Decrease uric acid - Urate oxidase, uricozyme, allopurinol
Hyperkalaemia - calcium resonium, insulin, salbutamol
Renal replacement therapy
