paediatric oncology Flashcards by Honor Moffat

what is cancer

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

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classification of paed cancers

international classification of childhood cancer (ICCC)

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

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what 3 main cancers to children get

leukaemia
lymphomas
CNS

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why do children get cancer: genes

down syndrome

neurofibromatosis

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why do children get cancer: environment

radiation

infection

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why do children get cancer: iatrogenic

chemotherapy

radiotherpy

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immediate referral if:

unexplained petechiae

hepatosplenomegaly

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urgent referral if

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

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refer if

rest pain
back pain
unexplained lymph
lymphadenopathy

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oncological emergencies

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

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sepsis/febrile neutropenia risks

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

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sepsis/febrile neutropenia organisms

pseudomonas aeruginosa
e.coli
strep pneumoniae
enterococci
staphylococcus
candida
aspergillus

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sepsis/febrile neutropenia presentation

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

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sepsis/febrile neutropenia investigations

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

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sepsis/febrile neutropenia management

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

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presentation of ICP: early features

morning headache/vomiting
tense fontanelle
increasing HC

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presentation of ICP: late features

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

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status epilepticus

1 seizure >5mins

2+ seziure within 5 mins

raised ICP investigations

imaging -
MRI best
CT

raised ICP Mx

dexamethasone if due to tumour

neurosurgery - urgent CSF redirection

raised ICP - dexamethasone

give if due to tumour
lowers oedema and inc CSF flow

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

raised ICP - neurosurgery

redirect CSF flow
ventriculostomy
EVD
VP shunt

spinal cord compression: different pathological processes

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

spinal cord compression presentation

varies w level
pain 
weakness
sensory 
sphincter disturbance

spinal cord compression Mx

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

SVC syndrome

superior vena cava syndrome

SMS

superior mediastinal syndorme

SVCS/SMS pathology

blocked blood/air flow from head and neck into thorax

SVCS SMS causes

lymphoma neuroblastoma germ cell tumour thrombosis

SVCS features

``` facial, neck, upper thoracic plethora oedema cyanosis reduced GCS distended veins ```

SMS features

``` dyspnoea tachypnoea cough wheeze, stridor orthopnoea ```

SVCS/SMS Ix

CXR/ct chest | ECHO

SVCS/SMS Mx

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

SVCS/SMS urgent definitive treatment

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

tumour lysis syndrome

rapid breakdown large amount tumour cells - intracellular contents released into bloodstream metabolic dearragement at/shortly after presentation secondary to treatment

tumour lysis syndrome features

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

tumour lysis syndrome Mx

``` 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 ```

where is it and what harm is it causing

MRI biopsy cytogenics tumour markers

Rx options

``` single-mode or multimodal chemo raditherapy surgrey bone marrow transplant immunotherapy ```

chemo side affects: acute

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

chemo side affects: chronic

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

radiotherapy side effects: acute

lethargy skin irritation swelling organ inflammation: bowel,lung

radiotherapy side effects: chronic

fibrosis, scarring 2nd cancer reduced fertility