Oncology

Question 1

What are the features of cancer?

Answer 1

Abnormal cells dividing incontrolled way
Gene changes
Stimulate own blood supply
Local invasion
Metastatic spread via blood/lymphatics

Question 2

What are the most common paediatric malignancies?

Answer 2

Leukaemias
Brain tumours
- Extracranial solid tumours
Lymphomas

Question 3

What is the classification for childhood cancers?

Answer 3

International Classification of Childhood Cancer (ICCC)

Question 4

Which age group is most likely to get childhood cancer?

Answer 4

0-4yrs

Question 5

What is the aetiology of childhood cancers?

Answer 5

Genes
Environment: radiation/infection
Iatrogenic: chemo/radiotherapy

Question 6

What symptoms merit immediate referral?

Answer 6

Unexplained petechiae

Hepatosplenomegaly

Question 7

What symptoms merit urgent referral?

Answer 7

Repeat attendance, same problem, no clear diagnosis

New neurological symptoms, abdominal mass

Question 8

What symptoms merit referral?

Answer 8

Rest pain, back pain, unexplained lump

Question 9

What are symptoms of brain tumours in under 5s?

Answer 9

Persistent/recurrent vomiting
Abnormal balance/walking/coordination
Abnormal eye movements
Behaviour change, letheragy
Fits or seizures (no fever)
Abnormal head position

Question 10

What are symptoms of brain tumours in 5-11yrs?

Answer 10

Persistent/recurrent vomiting
Persistent/recurrent headache
Abnormal balance/walking/coordination
Abnormal eye movements
Blurred or double vision
Behaviour change
Fits or seizures
Abnormal head position

Question 11

What are symptoms of brain tumours in young people (12-18)?

Answer 11

Persistent/recurrent vomiting
Persistent/recurrent headaches
Abnormal eye movements
Blurred or double vision
Abnormal balance/walking/coordination
Behaviour change
Fits or seizures
Delayed or arrested puberty

Question 12

What investigations can be done?

Answer 12

Scans
Biopsy/pathology
Tumour markers

Question 13

What are the acute risks of chemotherapy?

Answer 13

Hair loss
N&V
Mucositis
Diarrhoea/constipation
Bone marrow suppression: anaemia, bleeding, infection

Question 14

What are the chronic risks of chemotherapy?

Answer 14

Organ impairment
Reduced fertility
Second cancer

Question 15

What are the acute risks of radiotherapy?

Answer 15

Lethargy
Skin irritation
Swelling
Organ inflammation

Question 16

What are the chronic risks of radiotherapy?

Answer 16

Fibrosis/scarring
Second cancer
Reduced fertility

Question 17

What are oncological emergencies?

Answer 17

Sepsis/febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass
Tumour lysis syndrome

Question 18

What can cause sepsis/febrile neutropenia?

Answer 18

ANC <0.5x10^9
Indwelling catheter
Mucosal inflammation
High dose chemo

Question 19

How does sepsis/febrile neutropenia present?

Answer 19

Fever
Rigors
Drowsiness
Shock: tachycardia, tachypnoea, hypotension, prolonged cap refill time, reduced UO, metabolic acidosis

Question 20

What is the management for sepsis/febrile neutropenia?

Answer 20

Sepsis 6

Question 21

What is the early presentation of raised ICP?

Answer 21

Early morning headache/vomiting
Tense fontanelle
Increasing head circumference

Question 22

What are late presentation signs of raised ICP?

Answer 22

Constant headache
Papilloedema
Diplopia
Loss of upgaze
Neck stiffness
Status epilepticus
Reduced GCS
Cushing's triad: low HR, high BP

Question 23

What are the investigations for raised ICP?

Answer 23

CT

MRI - more accurate

Question 24

What is the management for raised ICP?

Answer 24

Dexamethasone - if tumour

Neurosurgery - urgent CSF diversion

Question 25

What are the options for neurosurgery in raised ICP?

Answer 25

Ventriculostomy EVD VP shunt

Question 26

What is a potential complication of nearly all paediatric malignancies?

Answer 26

Spinal cord compression

Question 27

What is the presentation of spinal cord compression?

Answer 27

Weakness Pain Sensory Sphincter disturbance

Question 28

What is the management of spinal cord compression?

Answer 28

Urgent MRI Dexamethasone Chemotherapy

Question 29

What is SVC syndrome or SMS?

Answer 29

Superior vena cava syndrome | Superior mediastinal syndrome (SMS) consists of SVCS with tracheal compression

Question 30

What is the most common cause of SVC syndrome?

Answer 30

Lymphoma

Question 31

How does SVCS present?

Answer 31

``` Facial, neck and upper thoracic plethora Oedema Cyanosis Distended veins Reduced GCS ```

Question 32

How does SMS present?

Answer 32

``` Dyspnoea Tachypnoea Cough Wheeze Stridor Orthopnoea ```

Question 33

What are the investigations for SVCS/SMS?

Answer 33

CXR/CT chest | ECHO

Question 34

What is usually effective management for SVCS/SMS?

Answer 34

Chemotherapy

Question 35

What is tumour lysis syndrome?

Answer 35

A group of metabolic abnormalities that can occur as a complication during the treatment of cancer, where large amounts of tumor cells are killed off (lysed) at the same time by the treatment, releasing their contents into the bloodstream

Question 36

What are the clinical features of tumour lysis syndrome?

Answer 36

``` Increased potassium Increased urate Increased phosphate Decreased calcium Acute renal failure ```

Question 37

What is the treatment for tumour lysis syndrome?

Answer 37

``` Avoidance ECG monitoring Hyperhydrate Diuresis (RRT) Never give K+ ```