Oncology Flashcards
At what age do you expect to see childhood cancers peak. And what kind?
0-4yrs
Most to least:
- Leukaemia
- Brain tumours
- Lymphoma
- Other
What cancer is ass with the following syndromes?
- Down’s
- Fanconi
- Neurofibromatosis
Downs = Leukaemia
Fanconi = Adult type cancers incl mouth, anal, vulval & leukaemia
Neurofibromatosis = Neurofibromas, sarcoma & leukaemia
How do we classify childhood cancers?
The International Classification of Childhood Cancers
It’s based on morphology unlike adult systems which use location
Childhood cancers can present with lot’s of non-specific symptoms e.g. weight loss, lumps, tiredness, seizures, headache, vomiting, fever etc.
When would you refer and how quickly?
Same Day:
- Unexplained Petechiae
- Hepatosplenomegaly
48hrs:
- Repeat attenders with same problem but no diagnosis
- New neuro symptoms
- Abdo mass
2wks:
- Rest pain, back pain or unexplained lump
- Lymphadenopathy
In general what are the tests, staging methods and treatment for childhood cancers?
Imaging e.g. US, MRI, CT, X-ray
Tumour Markers
Biopsy
Staging with scans and bone marrow biopsy
Name 5 emergency presentations of a childhood cancer?
1) Sepsis or febrile neutropenia
2) Raised ICP
3) Spinal Cord Compression
4) Mediastinal syndromes
5) Tumour Lysis Syndrome
Known cancer patient comes in with:
- Fever
- Rigors
- Drowsy
- Tachycardia & Tachypnoea
- Hypotensive
Sepsis
septic symptoms e.g. fever, rigors & drowsiness
+ shock symptoms e.g. tachy, hypotension, long cap refill, low UO & Metabolic acidosis
First off what are the risk factors for sepsis in a cancer kid?
Neutropenia
Mucosal inflammation
Catheter
Chemo
What organisms are likely to cause sepsis in a cancer kid?
Pseudomonas E.coli Pneumococcus Enterococci Staph Fungi
How do you handle sepsis in these kids?
Inititate sepsis 6:
- Fluids
- Abx
- O2
- UO
- Culture
- Inotropes
Transfer to PICU
Kid with early morning headache & vomiting comes in, you notice a tense fontanelle and big head circumference?
Raised ICP (in this case from cancer)
Later they can get:
- Constant headaches
- Papillodema
- Diplopia
- Loss of upgaze
- Neck stiffness
- fits
- Low GCS
- Cushing’s Triad
If you see a kid with raised ICP how would you handle it?
Get an emergency CT (screen) & MRI (to confirm)
Give Dexamethasone (reduces cerebral oedema & raises CSF flow)
Neurosurgery e.g. Ventriculostomy or EVD
What tumours are likely to cause spinal cord compression in a kid and how would that present?
Ewing’s Sarcoma or MEdulloblastoma
Causes:
Weakness > Pain > Sensory impairment > sphincter disturbance
What do you do if you suspect spinal cord compression?
Urgent MRI
Followed by dexamethasone (then normal cancer treatment)
Outcome is related to degree of impairment rather than rapidity of treatment but still urgent!
What is SVS or SMS?
Superior Vena Cava/Mediastinal Syndrome
SVS is when a mediastinal mass (mostly lymphoma) compresses important structures:
- Facial/neck/upper thoracic swelling
- Cyanosis
- Distended Veins
- Generally unwell
- Anxious
- Low GCS
If it also affects the airways causing SOB, tachypnoea, cough, wheeze, stridor or orthopnoea it becomes SMS
