Childhood Malignancies

Question 1

What are the common cancers which occur in childhood?

Answer 1

Question 2

At what age does presentation of leukaemia peak?

Answer 2

2-5 years

Question 3

Which type of lymphoma is common in children and which in adolescents?

Answer 3

• Non-Hodgkin’s Lymphoma more common in childhood.
• Hodgkin’s lymphoma more common in adolescence.

Question 4

How does acute lymphoblastic leukaemia present in children?

Answer 4

• In most, it presents insidiously over several weeks, but in some children presents and progresses very rapidly.
• Malaise, anorexia
• Pallor, lethargy
• Infections
• Bruising, petichiae, nose bleeds
• Lymphadenopathy
• Hepatosplenomegaly
• Bone pain

Question 5

How do brain tumours present in children?

Answer 5

• Signs and symptoms often related to raised ICP.
• There may be focal neurological signs depending on site of tumour.
• Spinal tumours (primary or metastatic) can present with back pain, peripheral weakness of arms or legs or bladder/bowel dysfunction, depending on the level of the lesion.
• Persistent back pain in children warrants investigation with MRI scan.

Question 6

How does Hodgkin lymphoma present in children?

Answer 6

• Barndoor presentation = painless lymphadenopathy, most frequently in the head / neck. Can be in abdomen.
• Lymph nodes much larger and firmer than the benign lymphadenopathy commonly seen in young children.
• Nodes may cause airway obstruction.
• Clinical hx often long (months); B symptoms uncommon, even in more advanced disease.

Question 7

How does Non-Hodgkin lymphoma present in children?

Answer 7

• T-cell malignancies may present as acute lymphoblastic leukaemia or non-Hodgkin lymphoma.
  
  • Both characterised by mediastinal mass (which may obstruct SVC) with varying degrees of bone marrow infiltration.
• Abdominal disease presents with pain from intestinal obstruction, a palpable mass or even intussusception in cases with involvement of the ileum.

Question 8

How does neuroblastoma present in children?

Answer 8

• Most children have abdominal mass (commonly adrenal origin) at presentation, but primary tumour can lie anywhere along the sympathetic chain from the neck to the pelvis.
• Tumour mass often large and complex, crossing midline and enveloping major blood vessels and lymph nodes.
• Paravertebral tumours may invade through the adjacent intervertebral foramen and cause spinal cord compression.
• >2 y/o clinical symptoms are mostly from metastatic disease, particularly bone pain, bone marrow suppression causing weight loss and malaise.

Question 9

How does nephroblastoma present in children?

Answer 9

• 80% present <5; rarely seen >10.
• Most present with large abdominal mass (often incidental finding in otherwise well child).
• Occasionally anorexia, abdominal pain and haematuria.

Question 10

How do soft tissue sarcomas present in children?

Answer 10

• Mass at any site.
• Head and neck are most common sites of disease.
• Genitourinary tumours may involve the bladder, paratesticular structures or the female GU tract.
  
  • Symptoms: dysuria and urinary obstruction, scrotal mass or bloodstained vaginal discharge.
• Metastatic disease (lung, liver, bone or bone marrow) - ~15% of patients. Associated with very poor prognosis.

Question 11

How do bone tumours present in children?

Answer 11

• Limbs are most common site.
• Persistent localised bone pain is the characteristic symptom, usually preceding the detection of a mass, and is an indication for early X-ray.
• Most patients otherwise well when diagnosed.

Question 12

How does retinoblastoma most commonly present in children?

Answer 12

• Most common presentation – white pupillary reflex noted to replace the normal red one.
• Can also present with a squint.