18 - Oncology Flashcards
What are some differentials for bruising in children?
- Non-accidental injury
- Vascular disorders (e.g senile or simple purpura)
- Platelet disorders (e.g ITP, Leukaemia, Liver Disease).
- Coagulation disorders (Haemophilia, vit K deficiency, or von Willebrand disease).
- Drugs (e.g corticosteroids, warfarin, and alcohol)
What questions should you ask in the history about bruising?
- Any nose bleeds or menorraghia, could be platelet disorder
- Ask about possible underlying medical causes.
- Ask about alcohol and drugs
- Family history of a bleeding disorder, or a tendency to bruise or bleed easily
- Assessing the location and pattern of bruising in the context of the person’s age, mobility and developmental status, and the explanation for injury
What investigations need to be done for children with unexplained bruising (not suspected to be NAI)?
- Urgent FBC including platelet count (within 48 hours) to assess for leukaemia
- Blood film
- Clotting screen
What are some differentials for lymphadenopathy in children?
- Simple reactive to infection e.g tonsillitis
- Leukaemia
- Lymphoma
- Cervical lymphadenitis
- Glandular Fever
- Kawasaki Disease
- Drugs
- SLE
What are some drugs that can cause lymphadenopathy?
- Allopurinol
- Carbamazepine
- Lamotrigine
- Penicillin
- Phenytoin
- Sulfonamides
What questions should you ask in the history when a child has unexplained lymphadenopathy?
ALWAYS ASK ABOUT B SYMPTOMS
- Patient’s age
- Duration of mass
- Associated symptoms e.g fever, night sweats, weight loss
- Recent illness
- Drug history
- Exposure to animals, insects, anyone with TB
- Recent travel history
- Immunisation status
What examination should you do when a child has unexplained lymphadenopathy?
- Check child’s growth and development
- Size and quality of lesion
- Check all cervical lymph nodes, supraclavicular. axillary, inguinal to see if localised or generalised
- Look at eyes, ears, nose, mouth, throat as common causes of reactive lymphadenopathy
- Assess for rashes
- Assess for hepatosplenomegaly or other abdominal masses
What are some red flags for lymphadenopathy in children?
• >2cm
- Severe pallor
- Weight loss
- Loss of appetite
- Loss of energy
- Hard fixed non-tender mass
- Unexplained bruising or bleeding
• Unexplained fever or night sweats, unexplained weight loss, chest pain)
What are the most common malignancies associated with lymphadenopathy in children?
Worrying features: firm, indurated, fixed and matted lymph nodes that are usually not tender
<6: Acute leukaemia, Neuroblastoma, Rhabdomyosarcoma, Non-Hodgkin’s Lymphoma
>6: Non-Hodgkin’s Lymphoma and Rhabdomyosarcoma
If a child has reactive lymphadenopathy, what information should you give to the parent?
Reassure that this is a normal response to infection
Likely to slowly decrease over time, though this may take 2-4 weeks
It is normal for the lymph nodes to get bigger and smaller in future with intercurrent infections.
How does cervical lymphadenitis present and how is it treated?
- Enlarged tender lymph node with erythema
- Needs oral co-amoxiclav
- If >5cm or not improving send to hospital for IV antibiotics
When does lymphadenopathy need to be urgently referred in children?
Referral to rapid access clinic
•B symptoms
- Cervical lymphadenopathy >2cm and increasing in size or present for more than 2 weeks
- Unexplained inguinal lymphadenopathy >1.5cm
- Unexplained axillary, epitrochlear or supraclavicular lymph nodes > 1cm diameter
What investigations are done for suspected leukaemia/lymphoma because of the sign lymphadenopathy?
Bloods
- FBC
- Peripheral blood film
- C-reactive protein/ESR
- LFTs: for multisystem involvement
Imaging
- CT scan
- Biopsy of lymph node: via excision if FBC suggests malignancy
If blood malignancy is ruled out with lymphadenopathy what are some other blood tests you can do for a cause?
- EBV serology
- CMV serology
- ASOT
What are some differentials for pallor in children?
- Anaemia
- Haemotological malignancy
- Shock e.g sepsis
What are causes of pancytopenia in children? (image important)
- Acute leukaemia
- Aplastic anaemia
- Infections e.g parvovirus B19, malaria
- Megaloblastic anaemia
- ITP
What are some clinical features of pancytopenia?
Think low RBC, WBC, platelets and the effects of that are pallor, infection and bleeding
What are the commonest childhood cancers?
- Leukaemia (ALL most common)
- CNS
- Lymphoma
What are the two main types of leukaemia in children and what age group are they most common in?
- Acute Lymphoblastic Leukaemia (ALL): 70-80% (B or T cell)
- Acute Myeloid Leukaemia (AML): 20%
What is the epidemiology and risk factors for ALL?
Epidemiology
- 800 cases a year
- Peak aged 2-5
- M>F
Risk Factors
- Radiation exposure e.g AXR during pregnancy
- Down’s syndrome
- Kleinfelter syndrome
- Noonan syndrome
- Fanconi’s anaemia