A child with malignancy Flashcards
What are the most common cancers found in children?
- Types of cancers are different from adults
- Leukaemia – commonest
- Brain & spinal tumours – second commonest
How does cancer present in children?
Clinical presentation
• Mass with mass effect
• Disseminated disease – bone marrow infiltration
• Consequence of pressure from a mass – airway obstruction due to enlarged lymph node in mediastinum
How does treatment differ to that in an adult?
• Pneuomcystis carinii • Measles and chicken pox can be life threatening Other Supportive issues • Fertility preservation • Psychosocial support • Early return to school • Effect on parents and other siblings
What is the commonest form of leukaemia in children? How does it present?
- Acute lymphoblastic leukaemia – 80% • Peak age – 2-5 yrs
- Presentation due to disseminated disease
- General – tiredness
- Bone marrow infiltration
- Anaemia - pallor
- Neutropenia
- Thrombocytopaenia bruising • bone pain
- Reticuloendothelial system – hepatosplenomegaly, lymphadenopathy • CNS – headaches, vomiting, nerve palsies
- Testes – testicular enlargement
How is leukemia investigated?
- leucocytosis/leucopenia, anaemia, thrombocytopenia, blast cells
- Abnormal clotting
- Bone marrow aspiration – immunological and cytogenetic characteristics
- CSF – cerebral disease
- Chest X-ray – mediastinal mass for T-cell disease
How is leukaemia treated?
• Based on risk stratification • First treat anaemia, infections and thrombocytopaenia • Additional hydration and allopurinol • Remission induction (4 weeks) • Eradicationofleukaemicblastsandrestorationof normal marrow function • Combinationchemotherapywithsteroids • Intensification • Intensive chemotherapy to consolidate remission • Improvescureratesbutincreasestoxicity • CNS • Intrathecaltherapy • Continuingtherapy • Modestintensityoverl
What are the Clinicalfeatures of brain cancer in children?
• Generally primary, mostly infratentorial
• Astrocytoma (commonest) – benign/malignant
• Medulloblastoma – midline of posterior fossa
• Clinicalfeatures
• Vomiting, headaches, balance incoordination, behaviour changes, abnormal
eye movements, seizures, abnormal head position
• Bulging fontanelle, lethargy, double vision
• Examination – neurological abnormalities, papilloedema, signs and symptoms of raised intracranial pressure
How is brain cancer investigated and managed in children?
- MRI – imaging of choice
- LP for metastasis (beware of raised ICP)
- Management • Surgery
- Radiotherapy / Chemotherapy
- Complications of surgery, therapy and disease
What are the clinical features of Hodgkin’s Lymphoma? How is it managed?
• Adolescence • Clinicalfeatures Hodgkin's Lymphoma • Painlesspersistentlymphadenopathy • Maycauseairwayobstruction • Systemic symptoms – sweating, pruritus, weight loss, fever – B-symptoms are uncommon • Investigations • lymph node biopsy, imaging of nodal sites (PET scan), bone marrow biopsy • Management • Combinationchemotherapy • Radiotherapy • Prognosis • 80%survival rate
What are the clinical features of Non-Hodgkins lymphoma? how is it managed?
- Non-Hodgkin’s (T-cell or B-cell)
- Childhood
- Clinicalfeatures
- Mediastinal mass – SVC obstruction
- B- cell – localised lymph node ds in head, neck or abdomen
- Investigations
- Biopsy, imaging of nodal sites (CT/MRI) • Bonemarrow&CSF
- Management
- Multi-agentchemotherapy
- Prognosis
- 80% survival rate
Investigations and management of neuroblastoma
Neuroblastoma
• Investigations
• Raised urinary catecholamines (VMA/HVA)
• MRI, Biopsy, Bone marrow sampling, MIBG scan
• Management
• Surgery, chemotherapy
What is the prognosis for neuroblastoma?
- Prognosis
- Age and stage of disease influence prognosis
- Children over 1 year with advanced disease poor prognosis • High relapse rate, cure rate ~40%
What are the clinical features of Nephroblastoma (Wilm’s tumour)
- Embryonal renal tissue tumour
- Before 5 yrs of age
- Clinical features
- Abdominal mass, haemturia, abdo pain, anaemia, hypertension
- Investigations • USS, CT/MRI • Staging
how is Nephroblastoma (Wilm’s tumour) managed?
• Chemotherapy with delayed nephrectomy • >80 % cure rate
What are the signs/symtoms of Retinoblastoma?
- Can affect one or both eyes
- All bilateral tumours are hereditary
- Susceptibilty gene is on chromosome 13 • White pupillary reflex or a squint
- Chemotherapy, laser treatment
- Significant risk of second malignany
