Oncology

Question 1

What types of cancers are seen in children?

Answer 1

33% Leukaemias
25% Brain tumours
40% Extracranial solid tumours

Question 2

When do children get cancer?

Answer 2

Most in 0-4

Question 3

Why do children get cancers?

Answer 3

Genes
Environment
Iatrogenic

Question 4

What symptoms are sent for immediate referal?

Answer 4

Unexplained petechiae

Hepatosplenomegaly

Question 5

What symptoms is sent for urgent referral?

Answer 5

Repeat attendance, with the same problem and no clear diagnosis

Question 6

What symptoms are sent for referral?

Answer 6

Rest pain
Back pain and unexplained lump
Lymphadenopathy

Question 7

How do you find out what it is?

Answer 7

Scans
Biopsy / pathology
Tumour markers

Question 8

How do you find out where it is?

Answer 8

Staging by scans
-CT chest (most common site of spread)
Bone marrow

Question 9

How is children’s cancer treated?

Answer 9

Based on specific disease and extent
MDT approach

Chemotherapy
Surgery
Radiotherapy

Question 10

What are the acute effects of chemo?

Answer 10

Hair loss
Nausea and vomiting
Mucositis
Diarrhoea or constipation
Bone marrow suppression (anaemia, bleeding and infection)

Question 11

What are the chronic effects of chemo?

Answer 11

Organ impairment (kidney, heart, nerve, ears)
Reduced fertility
Secondary cancer

Question 12

What are the acute effects of radiotherapy?

Answer 12

Lethargy
Skin irritation
Swelling
Organ inflammation (bowel and lungs)

Question 13

What are the chronic effects of radiotherapy?

Answer 13

Fibrosis and scarring
Second cancer
Reduced fertility

Question 14

What are oncological emergencies?

Answer 14

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

Question 15

What is sepsis and febrile neutropenia?

Answer 15

Infection is major cause of M+M

R = ANC<0.5x10^9, catheter, mucosal inflammation and high dose chemo

Causes = P. aeruginosa, E. coli, strep, eneterococci, staph and fungi

Presentation = fever, rigors, drowsiness and shock

Management = IV, blood cultures, FBC, coag, UE’s, LFT’s, CRP
CXR, ABC approach and BSAb’s

Question 16

What is the presentation for raised ICP?

Answer 16

Early morning headache
Tense fontanelle
Increasing head circumference

Late = headache, papilloedema, diplopia, stiff neck, reduced GCS and Cushings triad (low HR+RR and high BP)

Question 17

Investigations for increased ICP?

Answer 17

CT for screening

MRI best for accurate diagnosis

Question 18

What is the management of increased ICP?

Answer 18

Dexamethasone if due to tumour

Neurosurgery - urgent CSF diversion

Question 19

What is spinal cord compression?

Answer 19

Complication of nearly all malignancies

• Invasion from para-vertebral disease
• Vertebral body compression
• CSF seeding
• Direct invasion

Question 20

What is the presentation of spinal cord compression?

Answer 20

Weakness
Pain
Sensory loss
Sphincter disturbances

Question 21

What is the management of spinal cord compression

Answer 21

Urgent MRI
Dexamethasone to reduce peri-tumour oedema
Definitive treatment with chemo
-Surgery or radiotherapy are other oprtions

Question 22

What is superior vena cava(SVC) syndrome or superior mediastinal syndrome (SMS)?

Answer 22

Rare
Caused by lymphoma or neuroblastoma

P = facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins, anxious and reduced GCS
SMS = dyspnoea, tachypnoea, cough, wheeze, stridor and orthopnoea 

I = CXR, CT and echo

M = biposy, fbc, aspirate and GCT markers
Steriods, Chemo and radiotherapy

Question 23

What is tumour lysis syndrome?

Answer 23

Metabolic derangement
Rapid death of tumour cells
Release if intracellular contents
Secondary to treatment, and is rarely spontaneous

Question 24

What are the clinical features of tumour lysis syndrome?

Answer 24

Increased K
Increased urate
Increased phosphate
Decreased Ca
Acute renal failure

Question 25

What is the treatment for tumour lysis syndrome?

Answer 25

Avoidance
ECG monitoring
Hydration
Diuresis
Decrease uric acid (allopurinol)
Treat hyperkalaemia (salbutamol and insulin)
Renal replacement therapy

NEVER give K