oncology

Question 1

cancer classification?

Answer 1

International Classification of Childhood Cancer (ICCC)

Based on tumour morphology and (primary site)

Question 2

Main types of childhood cancer

Answer 2

1. Leukaemia
2. CNS tumours
3. Lymphoma
4. Soft tissue tumour
5. Neuroblastoma

Question 3

most common age for cancer?

Answer 3

0-4

Question 4

genes which are responsible for cancers

Answer 4

Down
Fanconi
BWS
Li-Fraumeni Familial Cancer Syndrome
Neurofibromatosis

Question 5

% of cancer which are cured/

Answer 5

85%

Question 6

example of oncological emergencies?

Answer 6

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

Question 7

rf for infection?

Answer 7

ANC < 0.5 x 109
Indwelling catheter
Mucosal inflammation
High dose chemo / SCT

Question 8

bacteria responsible of sepsis/ febrile neutropenia?

Answer 8

Pseudomonas aeruginosa
Enterobacteriaciae eg E coli, Klebsiella
Streptococcus pneumoniae
Enterococci
Staphylococcus 
Fungi eg. Candida, Aspergillus

Question 9

presentation of infection in child?

Answer 9

Fever (or low temp)
Rigors
Drowsiness
Shock
Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis

Question 10

management of infection in child?

Answer 10

IV access
Blood culture, FBC, coag, UE, LFTs, CRP, lactate
CXR
Other
Urine microscopy / culture
Throat swab
Sputum culture / BAL
LP
Viral PCRs
CT / USS

ABC
Oxygen
Fluids
Broad spectrum antibiotics

Inotropes
PICU

Question 11

what is the early presentation of raised ICP?

Answer 11

early morning headache/vomiting
tense fontanelle
increasing HC

Question 12

late presentation of raised ICP?

Answer 12

constant headache 
papilloedema 
diplopia (VI palsy) 
Loss of upgaze
neck stiffness
status epilepticus, 
reduced GCS 
Cushings triad (low HR, high BP)

Question 13

management for brain tumour- raised ICP

Answer 13

Dexamethasone if due to tumour
Reduce oedema and increase CSF flow
250 micro/kg IV STAT then 125 microg/kg BD

Neurosurgery - urgent CSF diversion
Ventriculostomy – hole in membrane at base of 3rd ventricle with endoscope
EVD (temporary)
VP shunt

Question 14

when is spinal cord compression seen?

Answer 14

Potential complication of nearly all paediatric malignancies
Affects 5 % of all children with cancer
10-20 % Ewing’s or Medulloblastoma
5-10 % Neuroblastoma & Germ cell tumour
Diagnosis (65 %), relapse, progression

Question 15

what is the pathological process of spinal cord compression?

Answer 15

Invasion from paravertebral disease via intervertebral foramina (40 % extradural)
Vertebral body compression (30 %)
CSF seeding (20 % intradural, extraspinal)
Direct invasion (10 % intraspinal)

Question 16

sx of spinal cord compression?

Answer 16

Symptoms vary with level
weakness (90 %) 
pain (55-95 %) 
sensory (10-55%) 
sphincter disturbance (10-35%)

Question 17

mx of spinal cord compression?

Answer 17

Urgent MRI

Start dexamethasone urgently to reduce peri-tumour oedema

Definitive treatment with chemotherapy is appropriate when rapid response is expected

Surgery or radiotherapy are other options

Outcome depends on severity of impairment rather than duration between symptoms and diagnosis
Mild impairment > 90 % recovery
Paraplegic 65 % recovery

Question 18

common cause of SVC and SMS (superior vena cava syndrome, superior medial stink syndrome)

Answer 18

Lymphoma

Other – neuroblastoma, germ cell tumour, thrombosis

Question 19

presentation of SVCS

Answer 19

facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins

Question 20

SMS presentation

Answer 20

dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea

Question 21

ix of SVC/SMS

Answer 21

CXR / CT chest (if able to tolerate)

Echo

Question 22

management?

Answer 22

Keep upright & calm
Urgent biopsy (ideally)

Look to obtain important diagnostic information without GA
FBC, BM, pleural aspirate, GCT markers

Definitive treatment is required urgently

Chemotherapy is usually rapidly effective

Presumptive treatment may be needed in the absence of a definitive histological diagnosis (steroids)

Radiotherapy is effective

May cause initial increased respiratory distress

Rarely surgery if insensitive

CVAD-associated thrombosis should be treated by thrombolytic therapy

Most of underlying malignancies have a good prognosis

Question 23

Tumour Lysis syndrome features?

Answer 23

Metabolic derangement
Rapid death of Tumour Cells
Release of intracellular contents
At or shortly after presentation
Secondary to treatment
(rarely spontaneous)

Question 24

clinical features of tumour lysis syndrome?

Answer 24

Highpotassium
high urate, relatively insoluble
high phosphate
low calcium

Acute renal failure
Urate load
CaPO4 deposition in renal tubules

Question 25

treatment of tumour lysis

Answer 25

Avoidance
ECG Monitoring
Hyperhydrate-2.5l/m2 
QDS electrolytes
Diuresis
1!!!Never give potassium!!!

decrease uric acid:
Urate Oxidase-uricozyme (rasburicase)
Allopurinol

treat hyperkalaemia:
Ca Resonium
Salbutamol
Insulin

renal replacement therapy

Question 26

acute chemo side effects?

Answer 26

Hair loss
Nausea & vomiting
Mucositis
Diarrhoea / constipation
Bone marrow suppression – anaemia, bleeding, infection

Question 27

chronic chemo side effects

Answer 27

Organ impairment – kidneys, heart, nerves, ears
Reduced fertility
Second cancer

Question 28

acute radiotherapy risk factors

Answer 28

Lethargy
Skin irritation
Swelling
Organ inflammation – bowel, lungs

Question 29

chronic radiotherapy side effects

Answer 29

Fibrosis / scarring
Second cancer
Reduced fertility

Question 30

long term effects of cancer on children?

Answer 30

Hearing impairment
Cognitive
Behaviour

Lifestyle advice

affects every aspect pof health essentially

Survivors have increasing cumulative toxicity