Curriculum standards
Curriculum standards
Completion requirements
View
Advanced Training in Medical Oncology (Paediatrics & Child Health)
Knowledge guide
LG14: Oncological conditions
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Abdominal mass
- Abnormal movement issues, such as:
- limp
- Asymptomatic finding on surveillance investigations
- Bowel / Bladder dysfunction
- Cytopaenias, such as:
- anaemia
- pancytopenia
- thrombocytopenia
- Hyperleukocytosis
- Lymphadenopathy
- Pain, such as:
- bone
- joint
- Raised intracranial pressure
- Significant family history
- Skin lesions, such as:
- atypical rashes
- nodules
- petechiae
- Spinal cord compression
- Systemic symptoms:
- anorexia
- fever
- weight loss
- Thoracic mass, such as:
- mediastinal
- Tumour lysis syndrome
Conditions
- Central nervous system tumours:
- atypical teratoid rhabdoid tumour
- choroid plexus carcinoma
- craniopharyngioma
- embryonal tumours of the central nervous system
- ependymoma
- high-grade glioma, including diffuse midline glioma
- intracranial germ cell tumour
- low grade glioma
- medulloblastoma
- Leukaemia:
- acute lymphoblastic leukaemia
- acute myeloid leukemia and subtypes
- juvenile myelomonocytic leukaemia
- other rare leukaemia, such as:
- acute undifferentiated leukaemia
- chronic myeloid leukaemia
- Lymphoma:
- Hodgkin
- non-Hodgkin
- Non-central nervous system solid tumours:
- endocrine tumours:
- adrenocortical
- phaeochromocytoma
- thyroid cancers
- germ cell tumours
- hepatoblastoma
- hepatocellular carcinoma
- histiocytic disorders, such as Langerhans cell histiocytosis
- metastasis
- nephroblastoma
- neuroblastoma and other peripheral nerve cell tumours
- neuroendocrine tumours of childhood
- renal cell carcinoma
- retinoblastoma
- sarcomas:
- Ewing sarcoma / primitive neuroectodermal tumours
- osteosarcoma
- rhabdomyosarcoma
- soft tissue sarcoma
- undifferentiated sarcoma
- endocrine tumours:
- Non-malignant haematological conditions:
- anaemia and polycythaemia
- bone marrow failure / dysfunction, such as aplastic anaemia
- haematologic and thrombotic emergency conditions
- haemolytic disorders, such as:
- hemolytic uremic syndrome
- thrombotic thrombocytopenic purpura
- haemophilia
- histiocytic disorders, such as hemophagocytic lymphohistiocytosis
- lymphopenia and lymphocyte subsets
- myelodysplasia and myeloproliferation
- neutropoenia and neutrophilia
- other common bleeding disorders, such as von Willebrand disease
- Stem cell transplant and cellular therapies:
- complications, such as:
- graft-versus-host disease (GvHD)
- sinusoidal obstruction syndrome (SOS)
- veno-occlusive disease (VOD)
- conditioning regimens
- donor lymphocyte infusion
- donor selection
- GvHD prophylaxis
- indications
- Thrombocytopaenia and thrombocytosis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Adult cancers presenting in childhood, such as:
- gastrointestinal tumours
- nasopharyngeal carcinomas
- All paediatric cancers can present with non-specific and undifferentiated symptoms, and in atypical locations
- Lymphoproliferative diseases and malignancies related to immunodeficiency and infection, such as post-transplant lymphoproliferative disorders
- Non-malignant conditions that are treated by oncologists as may benefit from similar pathways, such as neurofibromatosis lesions
- Other leukaemia, such as:
- chronic subtypes, such as chronic myeloid leukaemia
- other variants
- Other rare solid tumours, such as rhabdoid
- Premalignant haematological conditions, such as:
- myelodysplasia
- myeloproliferative disorders
- Skin cancers, such as:
- Kaposi sarcoma
- melanoma
Presentations
- Horner syndrome
- Malignant bone fractures
- Paraneoplastic syndromes, such as opsoclonus-myoclonus-ataxia syndrome
- Pruritis
- Skin nodules
- Undifferentiated symptoms
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Anatomical biochemistry, cellular and molecular biology, genomics, immunology, pathology, and pharmacology of cancer, such as cancer immunology, including biologics and immunotherapy
- Epidemiology, including (but not limited to) age, geographic, and sex distribution, incidence, and prevalence of cancers, along with predisposing factors, if known
- Genetic disorders, genetics of malignancy, malignancy associations, and underlying syndromes
- Pathophysiology of premalignant and malignant diseases, and non-malignant haematological diseases, including genetics and neoplasia development, and role of chronic inflammation and tumour microenvironment
Investigations
- Appropriate aspirates, biopsies, and tissue samples:
- fine needle versus trucut versus excisional biopsies (image guided or open)
- importance of biobanking
- research or clinical trials samples
- role of second opinions and central review
- samples for anatomic pathology / morphology
- tissue samples (fresh / frozen) and their role in diagnosis / prognosis:
- cytospin
- fluorescence in situ hybridization / polymerase chain reaction
- immunohistochemistry
- molecular pathology and cytogenetics:
- karyotyping and gene panel analysis
- next-generation sequencing or whole exome sequencing
- precision medicine programs
- Cancer staging and risk stratification by tumour type in paediatrics
- Complete history and examination
- Establishing the diagnosis
- Imaging and its relevance depending on cancer type:
- anatomical:
- CT scan
- MRI
- plain film
- ultrasound
- functional / nuclear medicine scans:
- bone scans
- metaiodobenzylguanidine
- PET
- anatomical:
- Intent to cure and principles of management according to tumour risk, stage, and type, such as:
- local control measures, which may include surgery
- radiation
- systemic therapy
- Other investigations:
- audiology assessment
- ECG
- electrocardiographic
- endoscopy
- fertility assessment and preservation
- formal renal function, such as:
- diethylenetriaminepentaacetic acid
- glomerular filtration rate
- lung function
- Presentation of case at appropriate specialised multidisciplinary meetings
- Relevant blood investigations
- Special tests:
- alpha-fetoprotein
- beta human chorionic gonadotropin
- chromogranin A
- inflammatory markers, such as:
- C-reactive protein (CRP)
- erythrocyte sedimentation rate
- plasma metanephrines
- tumour burden markers, such as lactate dehydrogenase
- urine catecholamines
Procedures
- Baseline height, nutritional assessment, physical activity level, and weight
- Bone marrow aspiration and biopsy
- Central line access
- Fertility preservation
- Lumber puncture and intrathecal chemotherapy administration
- Omaya access
General management considerations
- Advance care planning, such as referral to palliative care for patients with advanced stage disease, recurrent / relapsed disease, and known poorer outcomes
- Consideration of stresses related to body changes and subsequent altered social and peer interactions due to cancer and treatment, such as amputation, hair loss, and weight changes
- Goals of therapy
- Multidisciplinary care in management and treatment
- Shared care with local practitioners for patients not living close to main treatment centres
- Special considerations and communication related to patients’ age, developmental stage, and psychosocial circumstances
- Other considerations, such as:
- drug levels and toxicity monitoring
- drug sensitivity testing, such as thiopurine methyltransferase genotype for thiopurine
- enrolment in appropriate clinical trials if appropriate, such as precision medicine programs
- genetic testing, including for predisposition syndromes as appropriate
- multidisciplinary team discussions of all new diagnoses
- pharmacogenomics testing
- precision medicine assessment techniques, and multidisciplinary curation of results
- prophylactic treatment as indicated, such as immunoglobulin
- quality of life and patient-reported symptom measures
- rehabilitation
- tumour surveillance post-treatment and in at-risk populations, such as:
- genetic susceptibility
- immunodeficiency
- post-infectious
- syndromes
- Unique requirements of adolescent and young adult population