paediatric oncology Flashcards
what is cancer
abnormal cells dividing in an uncontrolled way
gene changes
stimulates own blood supply
local invasion, metastatic spread via blood/lymph
classification of paed cancers
international classification of childhood cancer (ICCC)
based on tumour morphology and cell of origin and then primary site
what 3 main cancers to children get
leukaemia
lymphomas
CNS
why do children get cancer: genes
down syndrome
neurofibromatosis
why do children get cancer: environment
radiation
infection
why do children get cancer: iatrogenic
chemotherapy
radiotherpy
immediate referral if:
unexplained petechiae
hepatosplenomegaly
urgent referral if
repeated attendance, same problem, no clear diagnosis
new neuro symptoms
abdo mass
refer if
rest pain
back pain
unexplained lymph
lymphadenopathy
oncological emergencies
sepsis/febrile neutropenia raised ICP spinal cord compression mediastinal mass tumour lysis syndrome
sepsis/febrile neutropenia risks
indwelling catheter
mucosal inflammation
ANA <0.5
high dose chemo/SCT
sepsis/febrile neutropenia organisms
pseudomonas aeruginosa e.coli strep pneumoniae enterococci staphylococcus candida aspergillus
sepsis/febrile neutropenia presentation
fever/low temp
rigors
drowsiness
shock: tachycardia, hypotension, metabolic acidosis, reduced urine output
sepsis/febrile neutropenia investigations
blood culture, FBC, coag, UE, LFTs, CRP, lactate CXR urine microscopy throat swab sputum culture LP viral PCRs CT/USS
sepsis/febrile neutropenia management
fluid oxygen broad spectrum antibiotics inotropes, PICU CXR IV access Bloods: lactate, culture, FBC, CRP
presentation of ICP: early features
morning headache/vomiting
tense fontanelle
increasing HC
presentation of ICP: late features
constant headache papilloedema diplopia - VI palsy loss upwards gaze stiff neck reduced GCS low HR, inc BP status epilepticus
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
