25. Oncology

Question 1

What is cancer?

Answer 1

Unregulated dividing of cells

Grow outside the normal range

Question 2

What are the common cancers in children?

Answer 2

Leukaemia
Brain tumours
Extracranial solid tumours (the rest)

Question 3

What genes increase the risk of children getting cancer

Answer 3

Downs
Fan one
Belem- werdenen’s syndrome (kidney and liver tumours)
Li-fraumeni familial cancer syndrome p53 (breast cancer and osteosarcomas)
Neurofibromatosis

Question 4

What infections increase the risk of getting cancers?

Answer 4

EBV- burkett’s lymphoma

Question 5

What age of children are more likely to get disease?

Answer 5

0-4 year olds

Question 6

What are some symptoms that may indicate cancer?

Answer 6

Unexplained petechia, hepatosplenomegaly- immediate referral

Repeatedly present with the same symptoms e.g. abdo pain- urgent refer

New neuro symptoms- urgent refer

Unexplained mass- urgent referral

Rest pain, pain waking them up from night, lymphadenopathy, back pain- refer quickly

Question 7

Describe the appearance of a worrying lymph node

Answer 7

Craggy
Non mobile
Hard
Increasing in size

Question 8

What are some other symptoms that may cause concern

Answer 8

Blood in urine
Headaches
Bruising 
Tiredness
Persistant Seizures

Question 9

What are your first steps as an oncologist

Answer 9

Good quality scans (aim for MRI)
Biopsy/pathology
Tumour markers
Good history to narrow differentials

Question 10

How do you treat peadiatric cancer?

Answer 10

MDT appproach
Multimodal therapy

Chemo
Surgery
Radiotherapy

Question 11

What are the acute risks of chemo?

Answer 11

Hair loss
N+V
Muscositis
Diarrhoea/constipation
Bone marrow suppresion- anaemia, bleeding, infection

Question 12

What are the chronic risks of chemo?

Answer 12

Organ impairment (kidney, heart, nerves, ears)
Reduced fertility
Second cancer

Question 13

What are the acute symptoms of radiotherapy?

Answer 13

Lethargy
Skin irritation
Swelling
Organ inflammation (bowel, lungs)

Question 14

What are the chronic symptoms of radiotherpay

Answer 14

Fibrosis
Second cancer
Reduced fertility

Question 15

What are the emergencies of peadiatric oncology?

Answer 15

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

Question 16

Discuss sepsis/febrile neutropenia

Answer 16

Infection is a massive cause of morbidity/mortality
Neutrophils <0.5
In dwelling catheter
Mucosal inflammation
High dose chemo/stem cell

Question 17

How do children with sepsis/febrile neutropenia present?

Answer 17

Fever or low temp
Rotors
Drowsiness
Shock
Tachycardia
Tachypnoea
Hypotension
Prolonged cap refill

Question 18

How do you manage sepsis/febrile neutropenia

Answer 18

IV access
Blood culture
FBC
Coagulation
U&E
CRP 
Lactate

ABC!

Urine microscopy
Throat swab
Sputum culture/BAL
LP
Viral PCR’s
CT/USS

Question 19

How do children with raised ICP present early?

Answer 19

Early morning headache/vomiting
Tense fontanele
Increasing head circumference

Question 20

How does raised ICP present late?

Answer 20

Constant headache
Papilloedema
Diplopia
Loss of upgrade
Neck stiffness
Status epilepticus
Reduced GCS
Cushings triad (low HR, high BP)

Question 21

How do you investigate kids with raised ICP

Answer 21

CT good for screening

MRI good for accurate diagnosis

Question 22

How do you treat increased CSF?

Answer 22

Dexmethasone- reduce oedema and increase CSF flow

Neurosurgery- urgent CSF diversion (shunt, EVD,)