Lecture 24 Paediatric Oncology

Question 1

What is the most common childhood cancer

Answer 1

Leukaemias

Question 2

What are red flag symptoms

Answer 2

Unexplained petechiae
Hepatosplenomegaly
Neuro symptoms
Abdo mass
Lymphadenopathy
Rest, back pain

Question 3

What are preschool brain tumour symptoms

Answer 3

• Persistent/recurrent vomiting
• Abnormal balance/walking/co-ordination
• Abnormal eye movements
• Behaviour change; particularly lethargy
• Fits or seizures (not with fever)
• Abnormal head position

Question 4

What are children 5-11 brain tumour symptoms

Answer 4

• Persistent/recurring vomiting
• Persistent/recurring headache
• Abnormal/balance/walking/co-ordination
• Abnormal eye movements
• Blurred or double vision
• Behaviour change
• Fits or seizures
• Abnormal head position

Question 5

What are young people 12-18 brain tumour symptoms

Answer 5

• Persistent/recurring vomiting
• Persistent/recurring headache
• Blurred or double vision
• Abnormal balance/walking/co-ordination
• Behaviour change
• Fits or seizures
• Delayed or arrested puberty

Question 6

What are the 5 key signs of a malignancy

Answer 6

Pain
Lump or swelling
Weight loss
Fatigue
Change in a mole

Question 7

What are oncological emergencies

Answer 7

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

Question 8

What is the early presentation of raised ICP

Answer 8

Early morning headache

Tense fontanelle

Question 9

What is the late presentation of raised intracranial pressure

Answer 9

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

Question 10

What is the best screening tool for raised ICP

Answer 10

MRI

Question 11

What is the treatment for a raised ICP if it is a tumour

Answer 11

Dexamethasone
Reduces oedema
Increases CSF flow

Question 12

What are the surgical treatments for raised ICP

Answer 12

Ventriculostomy

VP shunt

Question 13

Name 2 malignant causes of spinal cord compression

Answer 13

Ewings

Medulloblastoma

Question 14

What are the symptoms of spinal cord compression

Answer 14

Weakness
Pain
Sensory
Sphincter disturbane

Question 15

What is the management of spinal cord compression

Answer 15

Dexamethasone

Chemo

Question 16

What is Superior Vena Cava Syndrome

Answer 16

Happens when the SVC is partially blocked or compressed

Question 17

What are the common causes of SVC Syndrome

Answer 17

Lymphoma
Neuroblastoma
Germ cell tumour
Thrombosis

Question 18

What is the clinical presentation of SVC Syndrome

Answer 18

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

Question 19

What is the clinical presentation of Superior Mediastinal Syndrome

Answer 19

Dyspnoea
Tachypnoea
Cough
Wheeze
Stridor
Orthopnea

Question 20

What is the management of SVC/SMS

Answer 20

Keep upright
Biopsy
Chemo
Radiotherapy

Question 21

What is Tumour Lysis Syndrome

Answer 21

Rapid death of tumour cells

Release of intracellular contents

Question 22

What are the clinical features of tumour lysis syndrome

Answer 22

Elevated potassium
Elevated urate
Elevated phosphate
Decreased calcium

Question 23

What is a complication of tumour lysis syndrome

Answer 23

Acute renal failure

Question 24

What is the treatment for tumour lysis syndrome

Answer 24

Never give potassium
-	Urate Oxidase-uricozyme (rasburicase)
-	Allopurinol
•	Treat Hyperkalaemia
-	Ca Resonium
-	Salbutamol
-	Insulin