Ch 21 - Malignant Disease Flashcards
ALL: features (7)
Presentation peaks at 2-5 yrs. Features are a sign of disseminated disease & infiltration of BM. BM infiltration: anaemia - pallor + lethargy; thrombocytopenia - bruising + petechiae + nose bleeds, Neutropenia - infection Bone pain Hepatosplenomegaly LN pathy
ALL: Ix (2)
FBC Blood film
ALL: management - induction (3), maintenance (5), relapse (2)
Induction - Vincristine + dexamethasone + intrathecal methotrexate Maintenance - Vincristine + dexamethasone + 6 Mercaptopurine + methotrexate + co-trimoxazole Relapse - total body irradiation + BM transplant
Brain tumours general features: (6)
In children almost always primary & 60% infratentorial Clinical features are result of either raised ICP: vomiting, headache, personality change, papilloedema, tense fontanelle or from spinal tumours/mets - back pain, limb paresis, bowel bladder dysfunction
Give 4 types of brain tumours:
Astrocytomas - benign to highly malignant - gliobastoma multiforme Medulloblastoma - arises from midline of posterior fossa > Raised ICP - vomitting morning headache > ataxia, CN 6 & 7 signs Ependymoma - mostly in post. fossa - behaves like medulloblastoma Craniopharyngioma - a developmental tumour arising from remnant of Rathke pouch. Not truly malignant, but locally invasive & grows in suprasellar region.
Ix (1) & management (2) of brain tumours
MRI M - treat hydrocephalus, attempt resection
Give 3 features that the tumours would elicit depending on site of tumour: Supratentorial cortex, Midline, Cerebellar + 4th ventricle, Brainstem
Supratentorial cortex - seizures + hemiplegia + focal neuro
Midline - bitemp hemianopia, pituitary failure e.g. DI, growth failure Cerebellar + 4th vent - Truncal ataxia + coordination difficulties + abnormal eye movements
Brainstem - CN defects, pyramidal tract signs, cerebellar signs
Hodgkins Lymphoma: features (4), Ix (2), managemnet (3)
Adolsence > childhood
F - assymetrical painless LNpathy (neck), B symptoms - night sweats, weight loss, fever
Ix - LN biopsy, BM biopsy,
M - comination chemo - ABVD; adreomycin, Bleomycin, Vinblastine, Dacarbazine, +/- radio 80% cure rate
Non Hodgkins lymphoma: Features - T cell (3), B cell (2), Ix (3), management (1)
F - T cell; mediastinal mass, SVC obstruction, BM infiltration
B cell; localised LN disease - pain from obstruction
Ix - Radiology, biopsy, BM + CSF examination
M - multi-agent chemo e.g. B cell give rituximab
Neuroblastoma: definition, features (8), Ix (3), management (2)
D - tumour arising from neural crest of adrenal medulla + SNS, disease spectrum from Benign (ganglioneuroma) > v. malignant (neuroblastoma)
F - pallor, weight loss, abdo mass, hepatomegaly, bone pain, limp, paraplegia, proptosis, skin nodules
Ix - raised urinary catecholamine + BM biopsy + MIBG scan (radioisotope uptake scan)
M - Surgery for primaries, chemo for metastatic
Nephroblastoma (Wilm’s tumour): D, features (4), Ix (1), Management (3)
D - tumour of embryonal renal cells
F - most often it will jst be an abdo mass, but sometimes can also have abdo pain + HTN + haematuria
Ix - CT/MRI
Rx: Chemo > delayed nephrectomy > staged to guide radiotherapy
Good prog
Soft tissue sarcomas: features - head/neck (3), genitourinary (4), Ix (2), management (3)
Rhabomyosarcoma is most common
head/neck - proptosis, blood stained nasal discharge, nasal obstruction
Genitourinary - bloody vaginal discharge, scrotal mass, dysuria, urinary obstruction0
Ix - Biopsy + imaging
M - chemo, radio, surgery
Bone tumours: osteogenic sarcoma & Ewing sarcoma most common, features (1), Ix (2), management (3)
F - usually jst persistent bone pain
Ix - MRI, bone scan (Ewing sarcoma shows substantial soft tissue mass)
M - chemo, radio, surgery
Retinoblastoma: Definition, features (3), Ix (2), Management (2)
D - malignant tumour of retinal cells; dominant inhertiance - Cr 13 (if bilat is defo hereditary)
F - White pupillary reflex instead of red + squint
Rx - chemo to shrink > then laser therapy
