Childhood Cancer Flashcards
(20 cards)
When are the peaks of cancer diagnosis with respect to age, between the ages of 0 and 25?
- Initial peak (0-4 years)
- Peak later in teenage years and early 20s (15-25)
What are the more common causes of cancer in young people? After all, they haven’t had time to drink and smoke a whole bunch yet…
- More likely due to genetic factors inherited from parents
- Genetic/epigenetic factors (or altered gene dosing, like in down syndrome) can alter growth regulation, and thus predispose to cancer
What kinds of cancers are more common seen in children vs adults? What are the three most common cancers in children?
- In children, cancers are more commonly due to growth and development changes. In adults, more likely due to damage (particularly of epithelial surfaces)
- In children, leukaemia, brain tumours and lymphoma are most common
Overall vs event-free vs relative vs median cancer survival
- Overall: not dead at a certain time after diagnosis
- Event-free: no relapse at certain time after diagnosis
- Relative survival: survival vs no cancer equivalent
- Median survival: how long the median person lives after diagnosis
Leukaemia vs lymphoma aetiology
- Leukaemia: cancer of blood cells/bone marrow
- Lymphoma: cancer of lymphatic tissue (incl nodes, thymus, and spleen)
Definitive diagnosis of leukaemia vs lymphoma
- Leukaemia: bone marrow biopsy
- Lymphoma: lymph node biopsy
CBE signs of acute leukaemia. How do these relate to clinical features? What are some other clinical signs?
Bone marrow is crowded out:
- Anaemia (pallor, tiredness, exertional dyspnoea)
- Thrombocytopaenia (bruising, bleeding)
- Neutropaenia (fever, infection)
Other signs include:
- Bone pain
- Lymphadenopathy
- Hepatosplenomegaly
Which has better long-term survival rate: ALL or AML
- ALL
- Memory trick: most ALL patients survive
What are the three phases of ALL chemotherapy? Describe them
- Induction: aim to achieve remission
- Consolidation: aim to remove any remaining cancerous cells; consolidate remission
- Maintenance: maintain remission
Explain the concept of risk adapted cancer therapy
- Chemotherapy is riskier
- The riskier the cancer, the higher risk we can justify taking on with treatment options themselves
Risk adjusted treatment of AML
- Standard risk: chemotherapy
- High-risk: chemo then stem cell transplant
Features that make lymphadenopathy suspicious for malignancy
- Size >2cm
- So infective signs
- Painless
- B symptoms
- Persisting
- Supraclavicular
- Abnormal CBE
Risk adjusted therapy for hodgkin’s lymphoma
- Everybody receives chemotherapy
- Radiation therapy in higher risk cases afterward
Hodgkin’s vs Non-hodgkin’s lymphoma
Hodgkin’s contains reed-sternberg cells (multinucleated lymphocytes). Think Reid Hoffman -> Reed-Sternberg; pretending to be kinder, but still cancer
Describe the management approach for a child with suspected solid tumour
- Start w/ history and exam
- Get imaging to see if you’re still suspicious
- If suspicious involve, paed onc: biopsy, special marker tests, multi-D review
Basic treatment options across childhood cancers. What’s the key factor that determines which we choose?
- Treatments include surgery, radiotherapy, chemotherapy, and new targeted therapies
- Determined by risk (type of cancer, metastases etc.)
Signs of brain tumours in infants vs older children
- Infants: vomiting, irritability, lethargy, bulging fontanelles
- Older children: as above, headaches, vision changes, seizures
Supra vs infratentorial brain tumour clinical fx
- Supra: hemiparesis, visual field changes, seizures
- Infra: double vision, eye movement problems (CN 6), and asymmetric smile/facial drop (CN 7); balance problems (cerebellum)
What are the three pillars of paeds brain tumour mgmt?
- Neurosurgery (get it out)
- Chemotherapy
- Radiotherapy
What are some long-term negative post-cancer effects?
- Infertility
- Delayed growth
- Second neoplasms
- Impaired cognitive function
- Financial difficulty
- Difficult social integration
- Increased risk-taking behaviour
