Childhood Cancer

Question 1

You are a 4th year medical student and a 26 year old mother who is currently 20 weeks into her second pregnancy wants to talk to you about childhood cancer as her first child unfortunately passed away from leukaemia. She asks what are the chances that’s when a baby is born it might end up having some form of cancer as well

Answer 1

Generally cancer in children is uncommon with it occurring 11.5 times for every 100000 children which in total comprises less than 1% of all cancer cases.

Question 2

The medical student is doing some revision of Childhood cancers and asks you the doctor.
What is the most common type of cancer in children

Answer 2

Leukaemia

Question 3

Hi Dr a medical student comes to you and asks about the general rankings of the most common cancers that occur in children he already knows that leukaemia is the most common but was wondering about the top three

Answer 3

So the most common cancer is leukaemia second are the brain and spinal tumors and third are the lymphomas

Question 4

Hi Dr I am one of the fourth year medical students I have been doing some research into acute lymphoblastic leukaemia and discovered that its peak incidence is between ages 3 and 5. I was wondering what the most common embryonal tumor is.

Answer 4

So all be embryonal tumours end in the suffix blastoma and of the blastomas the most common is neuroblastoma

Question 5

Hi Dr I am one of the second year medical students I was doing some research into the 4 embryonal tumors: neuroblastoma, retinoblastoma, wilms tumour, hepatoblastoma. I need to know about for exams and have discovered that all apart from one embryonal tumor have a peek incidence around birth which one of the 4 does not

Answer 5

Wells has a peak incidence between one and two years of age where is a neuroblastoma retinoblastoma and passive last game at all have a peak incidence of less than one month old

Question 6

Hi Dr I know that in terms of the cancers most commonly affecting children that leukaemia is right at the top and lymphoma is third. When we look specifically at the lymphomas what age is Hodgkin’s disease more prominent

Answer 6

The incidence of Hodgkin’s disease spikes after age 11

Question 7

Hi Dr I was looking at the third most common cancer in children lymphoma and I was looking specifically at non-Hodgkin’s lymphoma what is the Peak incidence age for non-Hodgkin’s lymphoma

Answer 7

Same age 2 and a 1/2 onwards the incidence rate levels off at about seven million

Question 8

Hi Dr in my lecture I was learning that brain and spinal tumours are the second most common type of cancer affecting children after leukaemia I was wanting to do some more research into specific brain and spinal tumors and was wondering if you could tell me some of them

Answer 8

So the three main brain and spinal tumours are an astrocytoma ependymoma, primitive neuroectodermal tumors

Question 9

Hi Dr
I was recently told that my 5 year old daughter has an astrocytoma. The consultant was speaking to told me that between 5 and 6 years is the age you typically expect to see this type of tumour I was wondering what the outcomes were for treatment of this type of this type of cancer what do you need to tell her?

Answer 9

Unfortunately astrocytoma out which is one of the embryonal tumours has a poor prognosis

Question 10

You are the medical students doing newborn checks. Hi Dr I have gone to do the doctor to check of the newborn that you asked me to. I was checking his eyes specifically the red reflex and noticed that it was absent in his right eye in fact his right eye looked yellow when I was looking through the fundoscope. What is the significance of this type of Clinical presentation.

Answer 10

In the worst case scenario retinoblastoma present with an absence of the red reflex. The lens may look yellow and you may also get strabismus

Question 11

Hi Dr I was just counselling a mother who recently found out that her 1 year old son has been diagnosed with retinoblastoma she is extremely concerned because all she knows is this is a type of Childhood cancer. She asks you what is the prognosis for this type of cancer

Answer 11

Retinoblastoma has typically a good prognosis

Question 12

A medical student asks you
hi Dr I was doing some research into retinoblastoma and discovered that there is another peak after childhood in the age group that it can typically affect but I can’t remember which age group can you tell me

Answer 12

Fifty Plus

Question 13

Hi Dr
I am one of the 4th year medical students doing some research into conditions that may predispose to certain types of cancer

I came across a p53 germline mutation that can do exactly that I remember that it was given a specific name
most likely the guy who discovered it but I can’t remember what his name was can you tell me

Answer 13

Li-fraumeni syndrome

Question 14

Hi Dr I am one of the fourth year medical students I have seen a child who’s presented with multiple lumps across the whole body which I suspect maybe case of neurofibromatosis
Which pathway is involved in terms of the cellular level

Answer 14

NF1 Gene the RAS pathway

Question 15

Hi Dr I was doing some reading into wilms tumour I know that children who have this condition may present with an abdominal mass and I was wondering in terms of the cellular mechanisms what is the Gene associated with wilms tumour

Answer 15

Wt1

Question 16

Hi Dr a one month old neonate has recently been diagnosed with wagr syndrome I remember that this syndrome increases the neonatal risk of developing a particular type of embryonal tumor that I can’t remember which one can you tell me

Answer 16

Sophie embryonal tumors are neuroblastoma retinoblastoma wilms tumor and hepatoblastoma
Wagr syndrome stands for wilms associated

Question 17

Hi Dr a one month old neonate has recently been diagnosed with wagr syndrome I remember that this syndrome increases the neonatal risk of developing a particular type of embryonal tumor that I can’t remember which one can you tell me

Answer 17

Sophie embryonal tumors are neuroblastoma retinoblastoma wilms tumor and hepatoblastoma
Wagr syndrome stands for wilms associated

Question 18

Hi Dr a one month old neonate has recently been diagnosed with wagr syndrome I remember that this syndrome increases the neonatal risk of developing a particular type of embryonal tumor that I can’t remember which one can you tell me

Answer 18

Sophie embryonal tumors are neuroblastoma retinoblastoma wilms tumor and hepatoblastoma
WAGR syndrome stands for wilms tumour aniridia syndrome IN WHICH THE ASSOCIATED BLASTOMA IS SELF-EXPLANATORY

Question 19

Hi Dr I was doing some research into the childhood blastomas so that’s retinoblastoma neuroblastoma wilms tumour and hepatoblastoma in specific regards to hepatoblastoma which Gene is affected

Answer 19

Fap1

Question 20

Hi Dr
A mother of a 3 year old has brought him in because he’s not feeding properly, he has a temperature and is not walking.
The child was seen by the GP 2 weeks ago with swollen glands which was diagnosed as tonsillitis and so the child was given amoxicillin.
When I was doing the full examination on inspection I noticed that the child had bruises. On palpation there was cervical lymphadenopathy. His temperature is 38 degrees Celsius.
Based on the key clues of lymphadenopathy bruising bone pain and abdominal mass what is the most likely differential in a child of this age.

Answer 20

Acute leukaemia either myeloid or lymphoblastic

Question 21

Hi Dr just to double check with acute lymphoblastic leukaemia is that the one that affects the B and T cells

Answer 21

Yes

Question 22

Hi Dr
I have just seen a child that was diagnosed with acute lymphoblastic leukaemia at age 9 months and his mum was asking me what the prognosis is in terms of the survival what should I tell her

Answer 22

You can tell her that the prognosis is very good treatment normally takes between 2 and 3 years but the overall 5 Year survival is around 90%

Question 23

Hi Dr
I have just seen a 6 month old boy that was diagnosed with acute myeloid leukaemia. He has currently had one month of intensive treatment. His Mum is worried because she is wondering how much longer the treatment will go on for what should I tell her?

Answer 23

Treatments for acute childhood leukaemia usually last for 4-6 months

Question 24

Hi Dr
I am a second year medical student revising my cancers of Childhood
I know that the most common cancer of childhood is leukemia which can be divided into the acute lymphoblastic leukaemia and acute myeloid leukaemia second are the brain and spinal tumors such as astrocytoma and then third are the lymphomas I was wondering what the two main categories of lymphoma are

Answer 24

Hodgkin’s lymphoma and non-Hodgkin’s lymphoma

Question 25

Hi Dr which type of lymphoma affects t-cells and b-cells I know that acute lymphoblastic leukaemia can affect t cells and B cells

Answer 25

non-Hodgkin’s lymphoma

Question 26

Hi Dr
I am examining a 4 month old boy who has been diagnosed with lymphoma but we are not sure which specific type on examination he has a mediastinal mass which specific type of non-Hodgkin’s lymphoma is this more likely to be

Answer 26

T cell

Question 27

Hi Dr I have just finished examining a 3 year old boy who presented with a head and neck and abdominal mass the diagnosis currently is lymphoma and we were wondering which specific type of lymphoma may present in children of this age with a head and neck

Answer 27

non-Hodgkin’s lymphoma specifically b-cell

Question 28

You are the F1 doctor on the paediatric ward doing clerkings of the children there. The mum of a 3 year old boy tells you that she has noticed her son has had a temperature during the night he will get very sweaty and he has been itchy. You have just done an examination on this three year old boy who on palpation you notice has lymphadenopathy an enlarged liver and an enlarged spleen. What is your top differential in this case

Answer 28

Lymphoma leaning towards hodgkin’s lymphoma as you don’t have a mass in the head neck abdomen or mediastinum which would point you towards non-Hodgkin’s. But you have the classic symptoms of fever weight loss and night sweats

Question 29

You have just seen a three year old boy who was diagnosed with hodgkin’s lymphoma in the history mum told you that the boy had been having a temperature had been losing weight and has been very sweaty during the night you did your examination and confirmed that there was enlarged liver and an enlarged spleen you decide to do bloods as well what abnormal blood result in haemoglobin would you expect to find

Answer 29

Anaemia - reduced haemoglobin count

Question 30

You are the F2 doctor in the paediatric ward in Bath. A 12 year old boy has recently been admitted as his mum has noticed a prolonged history of cough and wheeze which can’t be explained by a respiratory infection or asthma. More worrying is the fact that the boy is having difficulty breathing when he’s lying flat. His face is swollen he has a reduced appetite and is losing weight. Due to his respiratory problems you decide to do a chest x-ray as one of your first line investigations and notice a widening of the mediastinum. Considering what you know about the presentation of a t cell non-Hodgkin’s lymphoma what do you suspect is the underlying cause

Answer 30

Superior vena cava obstruction

Question 31

Hi Dr I am one of the fourth year medical students I was asked by one of the consultants to do a clerking of a 12 year old boy who was recently admitted to the paediatric ward presenting with cough and wheeze fever night sweats and unexplained weight loss. because of the respiratory nature of his symptoms I have decided to do a respiratory examination first I have gone through your basic inspection palpation percussion auscultation and want to make sure I haven’t missed anything important on palpation I only did the typical chest expansion is that adequate

Answer 31

No the main concern here is that the child may have a childhood cancer specifically lymphoma which may present with the symptoms of fever weight loss and night sweats classic of Hodgkin’s disease you would also expect to see lymphadenopathy and so you must do a palpation of their neck and groin lymph nodes to make sure there is no enlargement

Question 32

Hi Dr I have just finished seeing a 15 year old boy who has come in complaining of abnormal weight gain cold intolerance dry skin. I was pretty confident of the most likely diagnosis at this point but then when I Delve deeper into his past medical history I found out that a year ago he had started experiencing fever weight loss night sweats and noticed some lumps in his neck. I was wondering is his current presentation related to a possible diagnosis of lymphoma which may explain the B symptoms of Hodgkin’s disease he was experiencing before

Answer 32

Yes so basically hypo and hyperthyroidism are late effects of untreated lymphoma

Question 33

Hi Dr
A Mum of a 8 year-old boy has come in today because she has noticed that her child has been more poorly than normal her child has been constantly complaining of headaches and feeling dizzy and has vomited as well all over the last couple of months. Due to the headaches and the vomiting I thought it best to do a neurological examination. When I was doing cranial Nerve examination I used the fundoscope to look into the back of his eye and noticed that there was papilloedema. What is the worst case differential?

Answer 33

Headache vomiting and the presence of papilloedema all point to increased intracranial pressure which tells us that there’s something abnormal going on in this child’s brain therefore we would want to do a scan of his head to make sure there’s nothing like a tumour and abscess or any recent trauma that may have caused a bleed.

Question 34

Hi Dr
I was doing some reading behind the cancers that may affect children I have read that one particular type is the most common malignant central nervous system tumors. But I can’t remember what it was called can you tell me

Answer 34

Medulloblastoma is a type of central nervous system tomour that typically affects kids age 7 to 10 years old

Question 35

Hi Dr
I was doing some more detailed reading into medulloblastomas and the different age ranges that this type of central nervous system cancer typically affects. I know that there are four types of medulloblastoma specifically wnt shh group C and group d. What is the age range typically affected by group c medulloblastoma

Answer 35

3 to 5

Question 36

Hi Dr I have just finished taking a history from a child who was diagnosed with a medulloblastoma at roughly 1 to 2 years old.
Which type of medulloblastoma typically affects children at this particular age shh

Answer 36

Shh

Question 37

Hi Dr I am doing a follow-up of a child who was diagnosed with medulloblastoma at age 6 to 11. Which type of medulloblastoma has a peak incidence at this age range

Answer 37

Wnt

Question 38

Hi Dr I was doing a follow-up of a child aged between 11 and 15 years old for a specific type of central nervous system cancer known as a medulloblastoma I can’t remember which specific type of medulloblastoma typically affects teenagers within this range can you tell me which one

Answer 38

Group d

Question 39

Hi Dr I have seen a child who was diagnosed with a specific type of central nervous system tumour known as SHH medulloblastoma I recognise that this specific type of medulloblastoma may present again when the child is older I was wondering when a later presentation of SHH medulloblastoma may present again

Answer 39

16 +

Question 40

Hi Dr I have just seen a 10 year old child who was diagnosed with a medulloblastoma his mum is asking me what the prognosis for this particular type of medulloblastoma WNT as she is aware that the other types can have a poor prognosis

Answer 40

There are four different types of medulloblastoma wnt shh group D and group C which have a worsening prognosis in this order the worst prognosis of medulloblastoma is associated with the WNT

Question 41

Hi Dr
I am one of the fourth year medical students I have just finished seeing the two year old child that you asked me to go and see he came in with his mum mum told me that she has noticed that the two year old doesn’t have as many wet nappies has a temperature and screams whenever she tries to change his nappy I did an examination of the child and noticed that his basic OBS were abnormal specifically he was tachycardic when I did an inspection of his stomach there was a visible distension which on palpated felt quite firm
Inspection of his face he has bruises around his eyes I am worried that a particular type of cancer specifically neuroblastoma presents in this way. Make up a question

Answer 41

Is it true that a neuroblastoma may present in this way with the key sign being the abdominal mass for a child of his age

Question 42

Hi Dr I am with the mum of a 2 year old who was recently diagnosed with a neuroblastoma she is worried about her child and asks what the treatment for this type of cancer is. She was doing some reading and came across something called induction rapid c o j e c can you tell her what this is

Answer 42

Induction rapid COJEC is a specific type of chemotherapy administered to children who have a neuroblastoma

Question 43

Hi Dr I have just finished explaining the chemotherapy treatment for the 2 year old who was diagnosed with a neuroblastoma. The mum wants to know if treatment ends after the chemo

Answer 43

No after going through rapid COJEC chemotherapy then the child will need surgery followed by another high dose of chemo, stem cell rescue followed by radiotherapy differentiation therapy and finally immunotherapy

Question 44

Hi Dr we have just seen a child with an abdominal mass on the oncology ward and we were told to do some investigations but we weren’t sure which were the most relevant to do for oncology discuss

Answer 44

Since the main concern is the abdominal mass an ultrasound scan or MRI scan gives more information about what the mass actually is checking uric acid levels urine catecholamines alpha-fetoprotein beta hCG will tell you whether the mass is the type of tumour that may be releasing hormones into the system and blood pressure which would be done as part of the OBS in your full examination if abnormally high may direct towards a renal pathology

Question 45

Hi Dr I have just finished examining a 4 year old who has a distended abdomen. When I was checking her background history and mum mentioned that she had also noticed some blood in her daughter’s urine. When I try to palpate the mass the girl winced. Which type of embryonal tumor are you concerned about in this age group with this presentation

Answer 45

Wilms tumour

Question 46

Hi Dr I have come here with my 14 year old son today because he has been complaining of knee pain and pain around his chin that is preventing him from playing football and he is finding it difficult to sleep as well. Ok I will do an examination of his legs first seen since that seems to be the problem. On inspection I noticed that there is some swelling around the problem leg. On palpation I noticed that his shin is particularly tender around the tibia. When I try to do passive and active movements I noticed that there is restricted knee flexion. If you were worried about a differential of an osteosarcoma or a Ewing sarcoma what would you expect the examination findings to be

Answer 46

On inspection you would expect to see if swelling around the affected area but you would not expect to see redness on palpation you would expect the area to be tender particularly around the tibia on active and passive movements you would expect reduced flexion at the knee

Question 47

Ok so I’ve just finished examining your 14 year old child and I think based on the findings so I can see that the area is obviously quite swollen and that it’s quite tender to touch and I’m worried that he’s not able to flex his knee as far as he should be able to I’m going to do some first line investigations typically we would start with bloods we would do urine dip but that’s not relevant in this case I’ll do an x-ray. The mum asks you ok if the x-ray results are abnormal are there any further scans investigations you would need to do

Answer 47

Yes we would go on to do an MRI scan and a bone scan just to rule out the possibility of two particular types of bone cancer osteosarcoma and ewing’s sarcoma