This affects all mucous membrane (oral to anus). Oral mucositis is the most common. Presenta 5-10days following chemotherapy. Mucositis is caused by direct damage of mucosal lining by chemotherapeutic agents or secondary invasion by micro-organisms.

Clinical Presentation(figure 1)

• Burning oral pain.

• Erythema and ulceration.

• Difficulty eating, drinking, talking.

Figure 1 Mucositis. Source: Radiation induced mucositis from Osama et.al.

Diagnosis of mucositis is based on clinical judgement. Oral swab for microscopy, culture and sensitivity should be also taken.

TREATMENT

• Oral debridement eg alcohol help dislodge dried secretion.

• Oral decontamination with antibiotic and antifungal rinsing.

• Pain management.

• Prophylaxis with use of ice chip cryotherapy.

• Low level laser therapy.

This is neutropenic enterocolitis. Ranging from inflammation to necrosis or perforation. It is mostly seen in the ileocaecum. Mortality can be 100% if not noticed early

CLINICAL FEATURES 

• Fever

• Diarrhoea

• Melena

• Abdominal pain

INVESTIGATION

• Abdominal ultrasound

• Abdominal CT-scan

TREATMENT

• Keep child on NPO

• IVF maintenance

• Use of broad-spectrum antibiotics

• Emergency surgical consultation.

INTRODUCTION

This is inflammation of bladder mucosa with oedema and ulceration causing haematuria. Caused by metabolites of cyclophosphamide and Ifosfamide especially acrolein. Acrolein is excreted in urine – it causes oedema, inflammation and necrosis of transitional epithelium with increased contact (Figure 2)

Figure 2: Haemorrhagic CystisImage source: slideshare. Minarcik robbins 2013_ch21-lower_ut

Treatment of Cystitis

• Hyperhydration and continuous bladder irrigation.

• Suprapubic catheterization.

• Platelet transfusion.

• Local instillation of prostaglandin E1, • Alum, Silver nitrate or formalin.

• Bladder resection if intractable.

• Use of Mercapto-ethane sulfonate (mesna) which binds the irritative metabolite, acrolein to produce non-toxic thio-ethers.

Oncological emergencies in children, particularly inflammatory and infection-related, pose a significant risk in sub-Saharan Africa due to limited healthcare resources, late diagnosis, and the high burden of infections. Children with cancer often have weakened immune systems due to the disease or its treatment (like chemotherapy), making them highly vulnerable to severe infections.

Effective management of these emergencies requires early detection, access to antibiotics, fluids, and supportive care, as well as timely referral to specialized centers when needed. Strengthening healthcare infrastructure, improving infection control measures, and increasing awareness in both families and healthcare providers are critical to improving outcomes for pediatric oncology patients in sub-Saharan Africa.