Paediatric Oncology

Question 1

3 Categories of causes of cancer

Answer 1

Genetic
Environment
Iatrogenic

Question 2

Genetic causes of cancer and associations with genetic conditions

Answer 2

Down's Syndrome
Fanconi
Beckwith Wiedemann Syndrome
Li-Fraumeni
Neurofibromatosis

Question 3

Genetic mutation in Li-Fraumeni

Answer 3

p53

Question 4

How is Fanconi monitored?

Answer 4

3 monthly Ultrasound until 7 years old

Question 5

What is fanconi syndrome?

Answer 5

Disorder of proximal tubule. Excess glucose, potassium, bicarb, phosphates, sodium, uric acid excreted in urine

Question 6

Environmental causes of cancer

Answer 6

Infection

Radiation

Question 7

Iatrogenic causes of cancer

Answer 7

Chemotherapy

Radiotherapy

Question 8

Signs and symptoms of cancer

Answer 8

Unexplained petechiae
Hepatosplenomegaly
New neurological symptoms
Abdominal mass
Recurring symptoms
Pain at rest
Back pain
Unexplained lumps
Lymphadenopathy (no preceding viral illness)

Question 9

What two signs and symptoms of cancer indicate an urgent referral

Answer 9

Unexplained petechiae

Hepatosplenomegaly

Question 10

Investigations for cancer

Answer 10

Imaging
Biopsy
Tumour markers
Staging - scans, bone marrow

Question 11

Which tumour markers are measured in suspected cancer?

Answer 11

B-HCG

Testicular

Question 12

3 treatment options for cancer

Answer 12

Chemotherapy
Radiotherapy
Surgery

Question 13

Side effects of chemotherapy

Answer 13

Hair loss
Nausea and vomiting
Mucositis
Diarrhoea/constipation
Bone marrow suppression
Organ impairment
Reduced fertility
Secondary cancer

Question 14

Symptoms of bone marrow suppression (as caused by chemotherapy)

Answer 14

Anaemia
Bleeding
Infection

Question 15

Side effects of radiotherapy

Answer 15

Lethargy
Skin irritation
Swelling
Organ inflammation
Fibrosis
Secondary cancer
Reduced fertility

Question 16

Features of cancer treatment leading to sepsis - febrile neutropenia

Answer 16

Low neutrophils
Indwelling catheter
Mucosal inflammation
SCT/ high dose chemotherapy

Question 17

Symptoms of sepsis

Answer 17

Fever
Rigors
Drowsiness
Shock - tachycardia, tachypnoea
Hypotension
Prolonged capillary refill

Question 18

Management of sepsis

Answer 18

Iv access
Blood cultures
 Lactate
Urine output
IV fluids
IV antibiotics
High flow oxygen

Question 19

What blood tests should be completed if child might be septic?

Answer 19

FBC
U&Es
CRP
LFTs
Lactate
Blood gas

Question 20

What other samples may be taken alongside blod if septic?

Answer 20

Urine and sputum cultures

Throat swabs

Question 21

Symptoms of raised intracranial pressure

Answer 21

Early morning headache
Vomiting
Tense fontanelle

Question 22

Late symptoms of raised intracranial pressure

Answer 22

Headache can become constant
Papilloedema
Diplopia
Loss of upgaze
Neck stiffness
Status epilepticus
Reduced GCS
Cushing's traid - low HR, high BP

Question 23

What is cushing’s triad?

Answer 23

Low heart rate
High blood pressure
Decreased respiration

Question 24

Management of raised intracranial pressure

Answer 24

Imaging - CT, MRI
Dexamethasone
Neurosurgery - rapid CSF diversion

Question 25

Tumours that result in spinal cord compression

Answer 25

Ewing's sarcoma Medulloblastoma Neuroblastoma Germ Cell Tumour

Question 26

Symptoms of spinal cord compression

Answer 26

Weakness Pain Sensoey symptoms Sphincter disturbance

Question 27

Management of spinal cord compression

Answer 27

Imaging - MRI Dexamethasone Surgery

Question 28

Presentation of Superior Vena Cava Syndrome

Answer 28

``` Facial/neck/thoracic plethora Oedema Cyanosis Disteneded veins Very ill Anxious Reduced GCS ```

Question 29

What is Superior Mediastinal Syndrome?

Answer 29

Superior Vena Cava Syndrome in addition to obstruction of trachea

Question 30

Presentation of Superior Mediastinal Syndrome

Answer 30

``` Dyspnoea Wheeze Cough Stridor Orthopnoea ```

Question 31

Investigation for Superior Mediastinal Syndrome

Answer 31

CXR | ECHO

Question 32

Sign of Superior Mediastinal Syndrome on X-ray

Answer 32

Complete whiteout with tracheal deviation

Question 33

Management of SVCS and SMS

Answer 33

Chemotherapy rapidly effective Biopsy Steroids Keep child calm

Question 34

Why would radiotherapy be avoided in SMS/SVCS?

Answer 34

Increases respiratory distress

Question 35

What occurs in Tumour Lysis Syndrome?

Answer 35

Cell dies and releases intracellular contents

Question 36

Example of tumour in Tumour Lysis Syndrome

Answer 36

Burkitt's lymphoma | Increased potassium, urate, phosphate

Question 37

Management of tumour lysis syndrome

Answer 37

Hyperhydrate- no potassium ECG monitoring Diuresis Check electrolytes Decrease uric acid - Urate oxidase, uricozyme, allopurinol Hyperkalaemia - calcium resonium, insulin, salbutamol Renal replacement therapy