Oncology Flashcards
(54 cards)
what is cancer?
group of abnormal cells that can divide in wring way
- gene changes
- stimulates own blood supply
- local invasion
- metastatic spread via blood or lymphatic system
how do we classify childhood cancer?
- International Classification of - Childhood Cancer (ICCC)
Based on tumour morphology and (primary site)
most common childhood cancer?
2nd?
acute lymphoblastic leukaemia
- CNS
age more likely to get caner?
0-4 years
most common cause of childhood cancer? give some examples?
genetic predisposition
- Down - leukaemia
- Fanconi
- BWS -neuroblastoma or nephrpblastoma - US scan every 3 months
- Li-Fraumeni Familial Cancer Syndrome - p53 mutation - family history of cancer
- Neurofibromatosis - chromosome 17 mutation - soft tissue sarcomas, increased risk of brain tumours
child with petechiae or hepatosplenomegaly, new mass or neurological symtoms they should be?
Immediate referral
new mass or neurological symptoms a child should be?
repeat attendance, same problem, no clear diagnosis
urgent referral to paediatrician
when do you refer to a doctor for urgent investigation
rest pain, back pain and unexplained lump
lymphadenopathy - grater than >1cm diameter, growing and firm, not associated symptoms
under 5 years old - head start tumour symptoms
- persistent vomiting abnormal balace/ coordination tion, walking - abnormal eye movement - fits and seizures - abnormal head position
5-11 year old synths include
vision change and behaviour change
teenager head start symptoms
delayed or altered puberty
Oncological Emergencies?
- Sepsis / febrile neutropenia
- Raised ICP
- Spinal cord compression
- Mediastinal mass
- Tumour lysis syndrome
risks of sepsis?
- ANC < 0.5 x 109
- Indwelling catheter
- Mucosal inflammation
- High dose chemo / SCT
(risk if had a catheter/ leukaemia)
organisms causing sepsis? 6)
Pseudomonas aeruginosa Enterobacteriaciae eg E coli, Klebsiella Streptococcus pneumoniae Enterococci Staphylococcus Fungi eg. Candida, Aspergillus
presenting symptoms?
- Fever (or low temp)
- Rigors
- Drowsiness
- Shock
Tachycardia, tachypnoea, hypotension, prolonged capillary refill time, reduced UO, metabolic acidosis
Management of sepsis
IV access
- Blood culture, FBC, coag, UE, LFTs, CRP, lactate
CXR
Management of sepsis - other investigations
Urine microscopy / culture Throat swab Sputum culture / BAL LP - meningitis Viral PCRs - herpes CT / USS - abscesses
management of shock in sepsis
ABC
Oxygen
Fluids
Broad spectrum antibiotics
Inotropes
PICU
presentation of raised ICP - early
early morning - headache/vomiting
- tense fontanelle
- increasing HC
presentation of raised ICP - later
constant headache papilloedema diplopia (VI palsy) Loss of upgaze neck stiffness status epilepticus, reduced GCS Cushings triad (low HR, high BP, falling RR)
diplopia (VI palsy) - means you wouldn’t be able to ?
abduct the eye laterally
features of Cushing’s triad?
(low HR, high BP, falling RR)
investigations for Raised ICP
- best imaging for diagnosis?
Imaging is mandatory (if safe)
CT is good for screening
MRI is best for more accurate diagnosis
Management of raised ICP? - IMMEDIATE?
why?
how much?
Dexamethasone
Reduce oedema and increase CSF flow
250 micro/kg IV STAT then 125 microg/kg BD
