paediatric oncology Flashcards
(50 cards)
what is cancer
abnormal cells dividing in an uncontrolled way
gene changes
stimulates own blood supply
local invasion
metastatic spread via blood or lymphatic systems
how common is childhood cancer
rare - 1821 cases <15 in UK p/a (130 scotland)
1/500 pre age 14
<1% all cancers
M>F
classification of childhood cancer
based on tumour morphology (and primary site) - cell of origin
standard classification is essential for comparing incidence and survival across regions and over time periods
what cancers do children get
31% leukaemia - mainly acute lymphoblastic leukaemia
26% CNS tumours - increases in teenage yrs
10% lymphoma
7% soft tissue tumours
6% neuroblastoma
5% renal tumours
4% malignant bone tumours
4% other
3% germ cell tumours
3% retinoblastomas
1% hepatic tumours
when do children get cancer
more likely at a younger age (0-4)
decreases between 5-14
2nd peak at 15-24 - increased risk of lymphomas and germ cell tumours
why do children get cancer
genetic - down (leukaemia), fanconi, BWS (neuro and nephroblastoma, hepatoblastoma), Li-Fraumeni familial cancer syndrome (strong FHx of cancer), neurofibromatosis (soft tissue tumours and nerve sheath tumours, brain tumours)
environment - radiation, infection (EBV - burkitt’s lymphoma)
iatrogenic - chemo and radiotherapy
diagnostic journey of cancer
- biological onset of disease
- symptom onset
- seek medical attention
- doctor recognises cancer as a possibility
- investigation, diagnosis, treatment
why are there delays in cancer diagnosis
patient doesn’t seek medical attention
doctor doesn’t recognise cancer as a possibility
what children should you be worried about - when to refer
-
immediate referral
- unexplained petechiae,
- hepatosplenomegaly
-
urgent referral
- repeat attendance, same problem, no clear diagnosis
- new neuro symptoms, abdo mass
-
refer (to doctor for urgent investigations)
- rest pain, back pain and unexplained lump
- lymphadenopathy (>1cm, growing continuously, firm, rubbery, not mobile, not associated w/ infective symptoms )
symptoms to see a doctor about
how often are they cancer
3/1000 - not able to wee, blood in wee, unexplained lump/firmness anywhere on the body
1/1000 - lymphadenopathy, frequent bruising, persistent back pain, persistent unexplained tiredness, persistent headaches, unexplained seizures or changes in vision or behaviour
persistent abdo swelling, unexplained vomiting, unexplained sweating/fever, unexplained weight loss/low appetite, changes in appearance of eyes or unusual reflections in photos, frequent infections or flu like symptoms
symptoms of brain tumours in pre-school children
persistent/recurrent vomiting
abnormal balance/walking/coordination
abnormal eye movements
behaviour change esp lethargy
fits/seizures (w/o fever)
abnormal head position - wry neck, head tilt, stiff neck
symptoms of brain tumours in 5-11y/o
persistent/recurrent vomiting
persistent/recurrent headache
abnormal balance/walking/coordination
abnormal eye movements
blurred/double vision
behaviour change
fits/seizures
abnormal head position - wry neck, head tilt, stiff neck
symptoms of brain tumours in 12-18y/o
persistent/recurrent vomiting
persistent/recurrent headache
abnormal balance/walking/coordination
abnormal eye movements
blurred/double vision
behaviour change
fits/seizures
delayed/arrested puberty
what are some oncological emergencies
- can be at diagnosis or a consequence of treatment:
sepsis/febrile neutropenia
raised ICP
spinal cord compression
mediastinal mass
tumour lysis syndrome
sepsis/febrile neutropenia - why is it important
- infection is a major cause of morbidity/mortality
sepsis/febrile neutropenia - risk factors
- ANC <0.5 x109
- indwelling catheter
- mucosal inflammation
- high dose chemo/SCT
sepsis/febrile neutropenia - causative organisms
- pseudomonas aeruginosa
- enterobacteriae e.g. e. coli, klebsiella
- streptococcus pnuemoniae
- enterococci
- staphylococcus
- fungi e.g. candida, aspergillus
sepsis/febrile neutropenia - presentation
- fever/low temp
- rigors
- drowsiness
- shock - tachycardia, tachypnoea, hypotension, prolonged CRT, reduced UO, metabolic acidosis
sepsis/febrile neutropenia - management
- IV access
- bloods: culture, FBC, coag, U+E, LFTs, CRP, lactate
- CXR - evidence of pneumonia/fungal infection
- other - urine microscopy/culture, throat swab, sputum culture/BAL, LP, viral PCR, CT/USS (abscesses, deep seated infection)
- ABC - oxygen, fluids
- broad spectrum abx
- inotropes
- PICU
early presentation of raised ICP
early morning headache/vomiting
tense fontanelle
increasing head circumferece
late presentation of raised ICP
constant headache
papilloedema
diplopia (VI palsy)
loss of upgaze
neck stiffness
status epilepticus
reduced GCS
cushing’s triad (low HR, high BP, falling RR)
investigation of raised ICP
imaging is mandatory (if safe)
- CT good for screening
- MRI best for more accurate diagnosis
management of raised ICP
dexamethasone if due to tumour
- reduce oedema and increased CSF flow
- 250mcg/kg iV stat and then 125mcg/kg BD
NEUROSURGERY - urgent CSF diversion
- ventriculostomy - hole in membrane at base of 3rd ventricle w/ endoscope
- EVD (temporary)
- VP shunt
how common is spinal cord compression
- potential complication w/ nearly all paeds malignancies
- 5% of all children w/ cancer
- 10-20% ewing’s or medulloblastoma
- 5-10% neuroblastoma and germ cell tumour
