oncology

Question 1

why do children get cancer

Answer 1

genetic ( downs, fanconi, Beckwith-Wiedemann syndrome, li-fraumeni familial cancer syndorme and neurofibromatosis)
environment ( radiation and viral infections - EBV, Hep B, HIV)
Iatrogenic - radiotherapy and chemotherapy

Question 2

red flag symptoms for referral

Answer 2

• unexplained petechiae, hepatosplenomegaly
• repeat attendance, same problem, no clear diagnosis
• rest pain, back pain, unexplained lump

Question 3

what is tumor lysis syndrome ? and clinical presentation

Answer 3

metabolic derangement caused by the rapid death of tumor cells. secondary to treatment - chemotherapy. the release of intracellular contents - massive increase in urate - > acute renal failure due to urate precipitate in tubules
clinical - increased potassium, urate and phosphate.
decreased calcium

Question 4

what is the outcome of tumor lysis syndrome if untreated

Answer 4

increased potassium can lead to arrhythmias and death

Question 5

treatment of tumor lysis syndrome?

Answer 5

avoid it occurring*
never give potassium*
hyperhydrate, diuresis, ECG monitoring, treat hyperkalaemia ( Ca resonium, salbutamol, insulin), decrease uric acid, monitor electrolytes, PO4 and urate. renal replacement therapy.

Question 6

what is febrile neutropenia ?

Answer 6

fever and deficiency of circulating neutrophils

neutrophils less than 0.5 and fever >38 C

Question 7

investigation for febrile neutropenia ?

Answer 7

culture, swab, stool, urine

Question 8

what is the relationship between neutropenia length and infection risk ?

Answer 8

the more neutropenic you are and the longer the duration of neutropenia then the more at risk you are of getting an infection

Question 9

how do you treat febrile neutropenia ?

Answer 9

broad spectrum antibiotics as fever and neutropenia = infection until proven otherwise

Question 10

what does a spinal cord compression look like on an MRI?

Answer 10

a dumb bell tumour

Question 11

what are some of the causes of spinal cord compression in children?

Answer 11

Ewings sarcoma, neuroblastoma

Question 12

what are the features of spinal cord compression in children?

Answer 12

weakness, spine tenderness, back pain, sphincter disturbances, sensory disturbance and gait disturbance

Question 13

how do you manage spinal cord compression?

Answer 13

MRI, dexamethosone, chemotherapy, DXT ( deep xray therapy = radiotherapy) , surgical - debulking, laminectomy.