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paediatrics > paediatric oncology > Flashcards

paediatric oncology Flashcards

1
Q

what is cancer

A

abnormal cells dividing in an uncontrolled way
gene changes
stimulates own blood supply
local invasion, metastatic spread via blood/lymph

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2
Q

classification of paed cancers

A

international classification of childhood cancer (ICCC)

based on tumour morphology and cell of origin and then primary site

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3
Q

what 3 main cancers to children get

A

leukaemia
lymphomas
CNS

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4
Q

why do children get cancer: genes

A

down syndrome

neurofibromatosis

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5
Q

why do children get cancer: environment

A

radiation

infection

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6
Q

why do children get cancer: iatrogenic

A

chemotherapy

radiotherpy

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7
Q

immediate referral if:

A

unexplained petechiae

hepatosplenomegaly

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8
Q

urgent referral if

A

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

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9
Q

refer if

A

rest pain
back pain
unexplained lymph
lymphadenopathy

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10
Q

oncological emergencies

A 
sepsis/febrile neutropenia
raised ICP
spinal cord compression
mediastinal mass
tumour lysis syndrome
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11
Q

sepsis/febrile neutropenia risks

A

indwelling catheter
mucosal inflammation
ANA <0.5
high dose chemo/SCT

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12
Q

sepsis/febrile neutropenia organisms

A 
pseudomonas aeruginosa
e.coli
strep pneumoniae
enterococci
staphylococcus
candida
aspergillus
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13
Q

sepsis/febrile neutropenia presentation

A

fever/low temp
rigors
drowsiness
shock: tachycardia, hypotension, metabolic acidosis, reduced urine output

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14
Q

sepsis/febrile neutropenia investigations

A 
blood culture, FBC, coag, UE, LFTs, CRP, lactate
CXR
urine microscopy
throat swab
sputum culture
LP 
viral PCRs
CT/USS
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15
Q

sepsis/febrile neutropenia management

A 
fluid 
oxygen
broad spectrum antibiotics
inotropes, PICU
CXR
IV access
Bloods: lactate, culture, FBC, CRP
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16
Q

presentation of ICP: early features

A

morning headache/vomiting
tense fontanelle
increasing HC

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17
Q

presentation of ICP: late features

A 
constant headache
papilloedema 
diplopia - VI palsy 
loss upwards gaze
stiff neck
reduced GCS
low HR, inc BP 
status epilepticus
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18
Q

status epilepticus

A

1 seizure >5mins

2+ seziure within 5 mins

19
Q

raised ICP investigations

A

imaging -
MRI best
CT

20
Q

raised ICP Mx

A

dexamethasone if due to tumour

neurosurgery - urgent CSF redirection

21
Q

raised ICP - dexamethasone

A

give if due to tumour
lowers oedema and inc CSF flow

250mcg/kg IV stat then 125mcg/kg IV

22
Q

raised ICP - neurosurgery

A

redirect CSF flow
ventriculostomy
EVD
VP shunt

23
Q

spinal cord compression: different pathological processes

A
  • invasion from paravertebral disease via intervertebral foramina
  • vertebral body compression
  • CSF seeding (intradural, extraspinal)
  • direct invasion
24
Q

spinal cord compression presentation

A 
varies w level
pain 
weakness
sensory 
sphincter disturbance
25
Q

spinal cord compression Mx

A

urgent MRI
dexamethasone: reduce peri-tumour oedema
definitive Rx w chemo/radiotherapy/surgery is approp when rapid response is expected

26
Q

SVC syndrome

A

superior vena cava syndrome

27
Q

SMS

A

superior mediastinal syndorme

28
Q

SVCS/SMS pathology

A

blocked blood/air flow from head and neck into thorax

29
Q

SVCS SMS causes

A

lymphoma
neuroblastoma
germ cell tumour
thrombosis

30
Q

SVCS features

A 
facial, neck, upper thoracic plethora
oedema 
cyanosis 
reduced GCS
distended veins
31
Q

SMS features

A 
dyspnoea
tachypnoea
cough
wheeze, stridor
orthopnoea
32
Q

SVCS/SMS Ix

A

CXR/ct chest

ECHO

33
Q

SVCS/SMS Mx

A

keep upright and calm
urgent biopsy
FBC, BM, pleural aspirate, GCT markers
urgent definitive Rx

34
Q

SVCS/SMS urgent definitive treatment

A

chemotherpay
presumptive Rx in absence of histological diagnosis - steroids
radiotherapy
CVAD assoc thrombosis - thrombolytic therapy

35
Q

tumour lysis syndrome

A

rapid breakdown large amount tumour cells - intracellular contents released into bloodstream
metabolic dearragement

at/shortly after presentation
secondary to treatment

36
Q

tumour lysis syndrome features

A 
inc potassium
inc phosphate
inc urate
dec calcium 
acute renal failure: urate load, CaPO4 deposition in tubules
37
Q

tumour lysis syndrome Mx

A 
ECG monitoring 
never give potassium 
hyperhydrate - 2.5l/m2
QDS electrolytes
lower uric acid: urate oxidase, allopurinol 
treat hyperkalaemia: Ca renosium, salbutomol, insulin
diuresis 
renal replacement therapy
38
Q

where is it and what harm is it causing

A

MRI
biopsy
cytogenics
tumour markers

39
Q

Rx options

A 
single-mode or multimodal
chemo
raditherapy 
surgrey 
bone marrow transplant
immunotherapy
40
Q

chemo side affects: acute

A 
nausea and vomiting 
hair loss
diarrhoea/constipation 
mucositis
bone marrow - anaemia, bleeding, infection
41
Q

chemo side affects: chronic

A

reduced fertility
second cancer
organ impairment: kidney, heart, ears, nerve

42
Q

radiotherapy side effects: acute

A

lethargy
skin irritation
swelling
organ inflammation: bowel,lung

43
Q

radiotherapy side effects: chronic

A

fibrosis, scarring
2nd cancer
reduced fertility

paediatrics (68 decks)

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