Childhood Cancers

Question 1

Most common cancers in children

Answer 1

• Leukaemia
• Brain tumours
• Lymphoma

Question 2

Clinical red flags

Answer 2

• Fever
• Lymphadenopathy
• Vomiting
• Pallor

NB - these symptoms are also present in self-limiting illnesses so it is important to onterpret in combination with detailed Hx and examination

Persistence of symptoms is a key factor!

Question 3

Presentation of leukaemia

Answer 3

• Hepatomegaly
• Splenomegaly
• Pallor
• Fever
• Bruising
• Bony pain/limp
• Abdominal symptoms (pain, anorexia, weight loss)
• Unusual bleeding
• Lymphadenopathy

Question 4

Red flags of lymphadenopathy

Answer 4

• Lymph node size >2cm
• Node increasing in size over 2 weeks
• No decrease in node size after 4-6 weeks
• Node not returned to baseline after 8-12 weeks
• Abnormal chest X-ray
• Presence of supraclavicular node
• Presence of systemic signs and symptoms (fever, weight loss, night sweats, hepatosplenomegaly)

Question 5

Back pain

Answer 5

• Not to be ignored
• Very unusual for children to get back pain
• Alwaysbe mindful
  
  • Spinal tumours (including mets)
  • Abdominal tumours
  • Spinal cord compression

Question 6

Case 1

• 11 year old boy
• Fit and well
• Attended GP for worsening cough - commenced on steroids and salbutamol for probably asthma
• 2 months later attended with worsening cough and SOB - give more steroids
• Following month family holiday abandoned due to dyspnoeic and too tired to walk
• Referred to A&E
• Facial swelling, marked cough, tachypnoeic, tachycardic, asymmetrical air movement, markedly reduced air entry at left base, hypoxia requiring 2l O₂

Answer 6

• Dx - SVC obstruction
• Mediastinal mass
• Bx - T cell lymphoblastic lymphoma
• Rx - dexamethasone, chemptherapy

Question 7

Case 2

• 12 year old boy
• Previously well
• 1 week Hx lumbar pain acute onset following 60m sprint
• Suddenly unable to pass urine
• 12 hours later unable to walk
• Attended ED and transferred to RHSC
• On examination petrified, flacid lower limb paralysis, multiple 1x1cm lumps over trunk and limbs
• Catheterised and neurology referral
• Commenced on dexamethasons and admitted for observation
• MRI spine next day

Answer 7

• Refer to oncology
• Urgent abdominal USS - multiple intrarenal nodules
• Attempted renal biopsy but inconclusive as poor sample
• Bone marrow aspirates/CSF nil
• Starting to move toes
• Able to walk with assistance
• Biopsy confirmed Burkitt’s lymphoma
• Commenced on chemotherapy

Question 8

Solid malignancy

Answer 8

• Consider referral for repeated attendances
• Acknowledge parental anxiety
• Don’t forget to examine the abdomen
• Recognition of tumour specific signs (Racoon eyes)
• Observations important - HTN

Question 9

Brain tumours in infants

Answer 9

• Increasing OFC
• Vomiting, lethargy, irritablity
• Examination showed convergent squint, bulging fontanelle, irritable, macrocephaly, delayed milestones
• Urgent MRI head and spine
• Initial management - craniotomy, tumour resection
• Biopsy
• Rx - high dose chemotherapy and stem cell rescue

Question 10

Brain tumour in a child

Answer 10

• Mood changes, temper tantrums and visual disturbance
• Progressive symptoms over months (i.e. dysarthric speech, abnormal gait and limb weakness)
• Early morning headaches, vomiting and progressive limb weakness
• Increasing parental anxiety
• Initially manage with 3rd ventriculostomy
• Diffuse intrinsic pontine glioma (DIPG)
• Manage with radiotherapy

Question 11

Brain tumour in a teenager

Answer 11

• Long history of progressive vomiting (i.e. 1 year)
• Headaches, weight loss and secondary amenorrhoea
• Bilateral papilloedema
• Pure germinoma
• Manage with cranio-spinal radiotherapy

Question 12

Brain tumours

Answer 12