Cancer Flashcards
Are carcinomas seen in adults or children more?
In adults more
Are embryonal tumours seen more in adults or children?
Children
List 3 common embryonal tumours.
Wilms tumour
Neuroblastoma
Rhabdomyosarcoma
Adolescence and young adulthood sees a high incidence of which cancers?
Bone tumours
Lymphomas
What causes childhood cancers?
Often unknown
Small amount due to genetic abnormality, mutations
Down’s syndrome and immune-compromised children at higher risk
If a cancer has infiltrated the bone marrow, what symptoms will you see?
- Anaemia: pallor, SOB, poor feeding
- More infections, unresolving infections
- Thrombocytopenia: bleeding, bruising, petechiae
- Bone pain, grumpy, not doing much
What does it mean if a child has an abnormal red reflex?
Also, what is the red reflex?
They could have retinoblastoma
When an ophthalmoscope is shined into eyes about 30cm away, the eye should appear red.
What could proptosis in a child signify?
Proptosis is when the eye sticks out
Infection
Neuroblastoma
Rhabdomyosarcoma
You’re a GP and see a 5 year old child 6 times in one year for ear discharge. What should you be concerned about?
Recurrent ear discharge could be a sign of rhabdomyosarcoma
As a rule, what cases should you consider malignancy?
In any child whose condition does not resolve or respond to treatment normally.
Which type of leukaemia is most common in children?
ALL: acute lymphoblastic leukaemia
Clinical features of ALL?
Fever Fatigue Frequent infections Lymphadenopathy Hepatomegaly, splenomegaly Anaemia Bruising, petechiae Bone, joint pain
Investigations of ALL?
Blood film Serum chemistry CXR Bone marrow aspirate LP
Treatment of ALL? When are they indicated?
Chemotherapy: 5 phases
First line
Haemopoietic stem cell transplant
In high risk patients in remission or if a patient has relapsed.
How do tumours of the CNS present?
Headache (worse when lying down)
Vomiting (in the morning)
Papilloedema
Squint
Nystagmus
Ataxia
Personality/behaviour change
When should you arrange a head scan of children presenting with headache?
If there’s papilloedema
If they have neuro signs
If headache recurrent, or is early morning
If there’s vomiting
If they have growth/developmental delay
If they’re younger than 3
What’s the treatment for CNS tumours?
Surgery
Chemotherapy
Radiotherapy
Differential diagnosis of lymphadenopathy?
Self-limiting infection
HIV
Auto-immune disorders
Malignancy
When should you become concerned about lymphadenopathy?
What should you do to investigate?
No clear infective cause
Persistently enlarged
Unusual site (supraclavicular)
If there’s fever, weight loss, hepato + splenomegaly
If the CXR is abnormal
You’d do a biopsy of the node.
Management of lymphoma in children?
Chemotherapy
Radiotherapy (only in Hodgkins)
Radiotherapy (for relapses)
What’s the difference between Hodgkin’s and Non-Hodgkin’s lymphoma?
Which has the worse prognosis?
In Hodgkin’s lymphoma Reed-Sternberg cells are seen under the microscope.
Non-Hodgkin’s has the worse prognosis
How do children with abdominal tumours present?
With an abdominal mass
With associated symptoms (dependent on the type of cancer) - weight loss, pain, haematuria, hypertension, constipation.
How would you investigate a child with an abdominal mass?
USS
CT
Biopsy
Differential diagnosis of child with abdominal mass?
Hepatoblastoma Wilm's tumour Adrenal Neuroblastoma Lymphoma / leukaemia Constipation Polycystic Kidneys
Where in the body are neuroblastomas often found?
Adrenal gland
Spinal cord
Chest
How can you differentiate between a Wilm’s tumour and an adrenal neuroblastoma on a CT image?
In adrenal neuroblastoma, the tumour crosses the midline and encases the aorta and IVC
A Wilm’s tumour usually stays in one hemisphere, and it appears that the kidney is ‘grabbing’ the tumour
Treatment of Wilm’s tumour?
Chemotherapy
Surgery: nephrectomy (total or partial)
Radiotherapy
What are the late effects of cancer treatment?
Endocrine (growth and developmental delay)
Intellectual difficulties
Cardiac and renal toxicity
Fertility problems
Psychological problems
Where are osteosarcomas and Ewing’s sarcomas commonly found?
Ewing’s: lower body: pelvis, femur, tibia
Osteo: large bones of upper and lower limb so humerus and femur
