Cancer in children

Question 1

What are the most common cancers in people aged 15-24?

Answer 1

females = carcinomas, lymphomas, melanoma, brain tumour
males = germ cell tumours, lymphomas, brain tumour, leukaemia

Question 2

What are the known risk factors of cancer in children?

Answer 2

• medical conditions and genetics (trisomy 21, mutation in RB1 gene)
• problems with development in the womb
• exposure to infections (EBV)
• exposure to radiation (radiotherapy)
• previous cancer treatments

Question 3

Describe acute lymphoblastic leukaemia (ALL)

Answer 3

• commonest cancer of childhood, 420 patients aged <24 years each year
• 75% of leukaemia are ALL
• cancer of immature lymphocytes (lymphoblasts or blasts)
• B-cell and T-cell leukaemia
• symptoms and signs = tiredness, lethargy, pallor, bruises, bleeding, recurrent infections, fever
• diagnosis : bone marrow tests, lumbar puncture
• treatment : chemotherapy (oral, IV)
• long term side effects are rare
• outcome = 5 year event free survival = 87%
• 10% relapse and 50% survival after relapse

Question 4

Describe acute myeloid leukaemia (AML)?

Answer 4

• 25% of leukaemia cases are AML
• 70 children <16 years are diagnosed each year
• cancer of immature myeloid WBC
• symptoms and signs = tiredness, lethargy, pallor, bruises, bleeding
• diagnosis = bone marrow tests, lumbar puncture
• treatment: chemotherapy, monoclonal ab, bone marrow transplant
• outcome : 5 year EFS of 50-60%

Question 5

Describe brain tumours

Answer 5

• 2nd most common cancer
• 400 children in the UK develop brain tumours each year
• boys are affected more
• symptoms - headaches, nausea & vomiting, one-sided weakness, clumsiness, balance problems, ,seizures, behavioural changes
• diagnosis - MRI scan, blood test, biopsy
• benign - low grade astrocytoma, craniopharyngioma
• malignant = medulloblastoma (15%), ependynoma (5-10%)
• treatment = surgery, chemotherapy, radiotherapy, steroids
• late effects = learning difficulties, sight problems, impact on growth

Question 6

Describe lymphoma

Answer 6

• 3rd most common cancer

- 2 types = non-hodgkins and hodgkins lymphoma

Question 7

Describe non-hodgkin lymphoma

Answer 7

• 80 children in the UK each year
• more common in boys
• B cell NHL
• T cell NHL
• symptoms = swollen lymph nodes, fever, tiredness, weight loss, loss of appetite
• diagnosis = CT/MRI scan, biopsy, bone marrow aspirate and biopsy
• treatment = T cell NHL about 2-3 years (ALL type treatment )
  B cell NHL about 4-8 courses of intensive chemotherapy
• outcome - 80% cured

Question 8

Describe Hodgkins lymphoma

Answer 8

• more common in older teenagers and young adults
• each year 70 patients aged 0-14 years, 120 patients 15-19 years, 180 patients aged 20-24
• classical hodgkin lymphoma (95%)
• lymphocyte predominant hodgkin lymphoma (5%)
• no cause/EBV driven/poor immunity
• symptoms - swollen glands, cough, breathlessness, fever, night sweats, weight loss
• diagnosis = biopsy, imaging, blood tests
• treatment = chemotherapy
• outcome = about 90% of children will be cured

Question 9

Describe rhabdomyosarcoma

Answer 9

• most common soft tissue sarcoma - develops from muscle or fibrous tissue
• <60 children each year in the UK
• most patients <10 years old - more common in boys
• around the head and neck, bladder, testes, womb and vagina
• embryonal (80%) alveolar (15-20%)
• children with Li-fraumeni syndrome have a higher risk of developing
• symptoms and signs = lump or swelling, obstruction nasal or discharge, abdominal pain
• diagnosis = imaging, biopsy
• treatment = chemotherapy, surgery and radiotherapy
• outcome 5 year EFS 65%

Question 10

Describe neuroblastoma

Answer 10

• <100 children in the UK each year
• most patients <5 years old
• most common solid tumour in children that occurs outside of brain/spinal tumours
• site or origin : adrenal glands or nerve tissue
• symptoms and signs = abdominal distension, constipation, breathlessness, difficulties in swallowing, lumps
• diagnosis = CT, MRI & MIBG scans, blood and bone marrow tests
• treatment = chemotherapy, surgery, high dose chemotherapy with autologous stem cell transplant, radiotherapy
• outcome = lowest survival rates of all childhood cancers

Question 11

Describe Wilms tumour

Answer 11

• renal cancer
• 80-85 children in the UK each year
• more common <7 years
• could be seen with congenital malformations, aniridia, abnormalities of the genitals
• symptoms and signs: abdominal distension/lump, haematuria, hypertensions
• diagnosis = USS, CT, MRI scans
• treatment = chemotherapy, surgery, radiotherapy
• outcome = >85% cured

Question 12

Describe osteosarcoma (bone tumours)

Answer 12

• 30 children in the UK each year
• more commonly in older children and teenagers
• most common sites in the arms and legs = around the knee and shoulder joints
• inc risk in children with hereditary retinoblastoma
• symptoms and signs = pain, swelling, fracture, limp
• diagnosis = imaging, biopsy
• treatment = chemotherapy, surgery, mifamurtide
• outcome = 5 years EFS 54%

Question 13

Describe Ewing sarcoma (bone tumour)

Answer 13

• <30 children in the UK each year
• most commonly occurs in the long bones, ribs, pelvis and spine
• more common in teenagers, more common in boys
• symptoms and signs = pain, swelling, limp, fracture
• diagnosis = imaging, biopsy
• treatment = chemotherapy, surgery, radiotherapy
• outcome = 4 year EFS for local-regional disease = 82^, distant metastases = 12%