5.3 Childhood Malignancy Flashcards
% of new cancers paediatric?
1%
1 in 600
Difference in paediatric cancers?
- Not associated with lifestyle (except radiation exposure)
- rarely inherited (down’s leukaemia
Most common paediatric cancers?
CNS
bone marrow
Current cancer treatments
Chemo
Radiation
Surgery
Biologics
How many % usually children with cancer can be cured?
Over 75%
Cardinal symptoms of cancer
- Recurrent fever unknown cause
- persistent pain - bone pain
- lymphadenopathy
- uprpura
- pallor
- Strabismus
- change in coordination/behaviour
Most common paediatric cancer?
Acute lymphoblastic leukaemia
Do kids get CML and CLL?
Rarely
ALL comes form which cell?
Lymphoid progenitor cell
Symptoms of ALL?
Anaemia, bruising, fever, bone pain Myphadenopathy, hepatosplenomegaly -malaise -Anorexia
ALL what do you see in blood tests?
Hb 5-60
Thombocytopaenia (platelets 10-20,000)
White cells: lost of blasts
Neutropaenia
ALL DDX?
- Idiopathic thrombocytopaenia prupura
- neutropaenias
- anaemia
- CBV
- infection with lymphadenopathy
- arthritis
- child abuse
- solid tumour with bone metastasis
Prognosis for ALL is better?
- Age 2-10 better
- lower WCC (<50 000)
- pred response
- no CNS disease
- hyperdiploidy
ALL treatment lasts how long?
Around 2 years
ALL treatment regimen?
- 5 weeks induction (98% remission)
- 6-10 months heavy chemo
- 1.5 years of gentle oral maintenance chemo
- bone marrow transplant sometimes
How to treat CNS ALL?
Sometimes cranial RT
Intensive Chemo
How does treatment of AML differ from ALL?
- 20% of childhood leukaemia
- more serious than ALL
- 60% cure
- more intensive chemo
- looks different on bone marrow
Childhood brain tumours usually where?
More posterior fossa
Paeds brain tumour presentation?
Headache Vomiting Increased head circumference FTT Seizures Altered gait/balance -diplopia -focal neuro signs
Most common Paeds brain tumour?
Medulloblastoma
Radiation therapy to brain side effects in which 4 main domains
- neuro-cognitive (worse if younger)
- neuroendocrine (pituitary, thyroid, sex hormones)
- carcinogenic
- hearing
What is neuroblastoma?
Adrenal gland/sympathetic nerve trunks
What is the most common extracranial paediatric tumour?
Neuroblastoma
Where are most Neuroblastoma located?
Abdominal
Prognosis of Neuroblastoma?
Poor usually
Neuroblastoma with favourable prognosis?
Below 18 months
What is Wilm’s Tumour?
Kidney tumour in paeds
Difference between children with wilm’s and neuroblastoma?
Wilm’s children are generally well, with large Abdo mass, flank pain, incidental
-outlook is generally good
Who gets Hodgkin’s lymphoma?
Typically older kids (teenagers)
Hodgkin’s lymphoma presentation?
Neck mass
Mediastinal mass
B symptoms
Hodgkin’s lymphoma outcomes?
- Generally good with chemo and radiotherapy
- majority are cured
Non-Hodgkin’s lymphoma types in paeds?
- T-cell lymphoblastic lymphoma
- Burkitt’s Lymphoma (B-Cell)
- Anaplastic large cell
Lymphomas in general prognosis?
Generally good, curable with chemo only in most cases
Ewing Sarcomas occur where?
- Diaphyseal long bones
- axial skeleton
- extra-osseous
- 70% survival if non-metastatic
Osteosarcoma happen where?
- Growing ends of long bones
- distal femur, Prox tibia, Prox humerus most common
- 70% survival if non meta
Two kinds of retinoblastoma?
Non germinal - 29/30months diagnosis
-unilateral
Germinal - 14-16 months diagnosis
-bilateral
What are the bad paediatric cancers?
- Metastatic sarcomas
- Stage IV neuroblastoma over age 1
- high grade glioma/pontine glioma
- ALL with bad chromosomes
- recurrent anything…
Paeds oncology transfusion support?
Platelets if <10 000
Red Cells if Hb <70
Paeds oncology blood products special status:
Irradiated
CMV neg
Hi <70
Platelets <10
Febrile neutropaenia in kids approach
Admit
Bloods/cultures
Antibiotics
THEN call oncologists
If fever persists in febrile neutropaenia then what?
Anti fun gals Looks for source: Blood Chest Urine Perinatal
Additional supportive measures in paeds chemo patients?
- Always central venous lines
- VZ V infection: prophylaxis
- Bactrim for pneumocystis jirovecii
- acyclovir for herpes simplex
Immunisations on chemo?
No live vaccines ever!
Flu Vac is ok
Live for siblings are ok
Late effects of cancer treatment, 5 broad categories:
Organ function Growth+development Psychosocial Carcinogenesis Fertility+reproduction
When start giving vaccines in paeds onc kids? Generally?
Non-live - 6 months after treatment
Live - 12 months after treatment
