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Paediatrics > Paediatric oncology > Flashcards

Paediatric oncology Flashcards

Cancer // Sepsis // Raised ICP // SCV/SMS // Tumour lysis syndrome

1
Q

What is the brief epidemiology of childhood cancer in UK?

A

It is very RARE

  • 1/500 pre age 14
  • GP sees 1 in career
  • 10-15 per DGH catchment/year
  • <1% all cancers
  • Boys more than girls
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2
Q

What are the various types of paediatric malignancy and which of these are more common?

A
  • 33% Leukaemias (require systemic treatment)
  • 25% brain tumours
  • 40% are extracranial solid tumours
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3
Q

Why do children get cancer?

A
  • Genes
    • Down
    • Fanconi
    • BWS
  • Environment
    • Radiation
    • Infection
  • Iatrogenic
    • Chemotherapy
    • Radiotherapy
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4
Q

Who should we be worried about….

Immediate referral?

Urgent referral?

Refer?

A
  • Immediate referral
    • unexplained petechia, hepatosplenomegaly
  • Urgent referral
    • repeat attendance, same problem, no clear diagnosis
    • new neuro symptoms, abdo mass
  • Standard referral
    • rest pain, back pain, unexplained lump
    • lymphadenopathy
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5
Q

Explain the rough guidelines of the headsmart campaign:

A
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6
Q

How can we detect what sort of cancer it is?

How can we detect where the cancer is?

A
  • Scans
  • Biopsy / pathology
  • Tumour markers
  • Staging eg scans, bone marrow
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7
Q

What are some of our Rx options for cancer?

A
  • Multimodal therapy based on specific disease and extent (plus patient factors)
  • MDT approach
  • Chemotherapy
  • Surgery
  • Radiotherapy
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8
Q

Side effects/Risks of chemo?

A

Acute

  • hair loss
  • nausea vomiting
  • mucositis
  • diarrhoea
  • bone marrow suppression

Chronic

  • organ impairment
  • reduced fertility
  • second cancer
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9
Q

Side effects/Risks of radiotherapy?

A

Acute

  • Lethargy
  • Skin irritation
  • Swelling

Chronic

  • Fibrosis
  • Second cancer
  • Reduced fertility
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10
Q

What are the oncological emergencies?

A
  • Sepsis / febrile neutropenia
  • Raised ICP
  • Spinal cord compression
  • Mediastinal mass
  • Tumour lysis syndrome
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11
Q

Risks of sepsis/febrile neutropenia?

Which organisms can cause this?

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

Organisms:

  • Pseudonomas aeroginosa
  • E coli
  • strep pneumonia
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12
Q

SSx of childhood sepsis?

A
  • Fever (or low temp)
  • Rigors
  • Drowsiness
  • Shock
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13
Q

Rx for childhood sepsis?

A
  • —IV access
  • —Blood culture, FBC, coag, UE, LFTs, CRP, lactate
  • Urine culture
  • Throat swab
  • Sputum culture / BAL
  • CXR
  • —ABC
    • Oxygen
    • Fluids
  • Broad spectrum antibiotics
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14
Q

SSx of raised ICP?

A

Early

  • early morning headache/vomiting
  • tense fontanelle
  • increasing HC

Late

  • constant headache
  • papilloedema
  • diplopia (VI palsy)
  • Loss of upgaze
  • neck stiffness
  • status epilepticus,
  • reduced GCS
  • Cushings triad (low HR, high BP)
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15
Q

How do we Ix raised ICP?

A
  • Imaging is mandatory (if safe)
    • CT is good for screening
    • MRI is best for more accurate diagnosis
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16
Q

Rx for raised ICP?

A
  • Dexamethasone if due to tumour
  • Neurosurgery - urgent CSF diversion
17
Q

Which cancers are likely to cause spinal cord compression?

A

•10-20 % Ewing’s or Medulloblastoma

5-10 % Neuroblastoma & Germ cell tumour

18
Q

SSx for spinal cord compression?

A
  • weakness (90 %)
  • pain (55-95 %)
  • sensory (10-55%)
  • sphincter disturbance (10-35%)
19
Q

Rx for spinal cord compression?

Outcomes?

A
  • 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
  • Mild impairment = 90% recovery
  • Paraplegic = 65% recovery
20
Q

What is SVC syndrome? What is SMS?

SSx?

A

Superior vena cava syndrome // Superior mediastinal syndrome

  • SVCS: facial, neck and upper thoracic plethora, oedema, cyanosis, distended veins, ill, anxious, reduced GCS
  • SMS: dyspnoea, tachypnoea, cough, wheeze, stridor, orthopnoea

CXR/CT chest

Echo

21
Q

Rx for SVC syndrome/SMS?

A
  • 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
22
Q

What is tumour lysis syndrome?

A
  • Metabolic derangement
  • Rapid death of Tumour Cells
  • Release of intracellular contents
  • At or shortly after presentation
  • Secondary to treatment
23
Q

SSx of tumour lysis syndrome?

A
  • increased potassium
  • increased urate, relatively insoluble
  • increased ­phosphate
  • reduced calcium
  • Acute renal failure
    • Urate load
    • CaPO4 deposition in renal tubules
24
Q

Rx for tumour lysis syndrome?

A
  • Avoidance
  • ECG Monitoring
  • Hyperhydrate-2.5l/m2
  • QDS electrolytes
  • Diuresis
  • Never give potassiuma

Paediatrics (32 decks)

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