Could this Child have Cancer

Question 1

Risk to having a childhood cancer

Answer 1

neurofibromastosis, immune defs, chromosomal instability (Fanconi anemia, ataxia
telangiectasia) genetic syndromes (Down syndrome, Turner’s Syndrome, overgrowth
syndrome)

Question 2

Epi: most common (40% of all childhood cancers)

Answer 2

acute lymphoblastic leukemia

Question 3

what symptoms of ALL are due to mass effect in the bone marrow?

Answer 3

Mass effect in bone marrow: ¯RBC (pallor, fatigue), ¯plt (bleeding, petechia, ecchymoses), ¯WBC
(fever, infection)

• Mass effect elsewhere: hepatosplenomegaly, lymphadenopathy, bone pain

Question 4

investigations when a kid comes in with pallor, fatigue, petechiae, and lymphpenia

Answer 4

• CBC: WBC may or may not be elevated, anemia, thrombocytopenia
• Smear: atypical lymphocyte, leukemic blast cells
• Lymph Node Biopsy: indicated when continues to enlarge after 2-3wk or with Abx, symptoms,
supraclavicular LN

• Bone Marrow Aspiration: homogenous population, fewer normal populations, ­cellularity

Question 5

Lymphoma

Epi: 3rd most common

Subtypes: Hodgkin’s (typically __); Non-Hodgkin’s Lymphoma (__more frequently, __ + __ defs common)

Symptoms: painless __, __ mass, pleural effusions, abdo mass, B symptoms (fever, __ __, wt loss)

Answer 5

Epi: 3rd most common

Subtypes: Hodgkin’s (typically teens); Non-Hodgkin’s Lymphoma (males more frequently, celiac + immune defs common)

Symptoms: painless lymphadenopathy, mediastinal mass, pleural effusions, abdo mass, B symptoms (fever, night sweats, wt loss)

Question 6

most common brain tumour

Answer 6

medulloblastoma

Question 7

headache features that are worrisome

Answer 7

• diminishes over the course of the day
• worse when lying down/recumbent
• worsen over time
• worsen with valsalva
• not laterallized (often front or back)
• focal neuro findings

Question 8

when to image an aching head

Answer 8

1. Presence or onset of neurologic abnormality
2. Ocular findings, such as papilledema, decrease in vision
3. Vomiting that is persistent, increasing in frequency, or preceded by headache
4. Change in character of a headache
5. Recurrent morning headaches or headaches that repeatedly wake a child
6. Short stature or deceleration of linear growth
7. Diabetes insipidus
8. Age of three years of less
9. Neurofibromatosis
10. Macrocephaly in infants/toddlers

Question 9

osteo vs ewing sarcoma

Answer 9

Bo ne Tumours Subtypes: osteosarcoma (long bones, older teens), Ewing Sarcoma (more prone to diaphysis of long bones or axial skeleton) Investigations: X-ray (low threshold) Management: refer to ortho/onco

Question 10

Wilms’ tumours are located in the ___<

Answer 10

kidney

Question 12

When to Biopsy a Lymph Node

With no laboratory or radiographic data to explain the large nodes:

Nodes that remain enlarged or continue to enlarge after ____weeks, particularly after a course of ___

Nodes that have not diminished in size after ___weeks or have not returned to normal by ___ weeks

Answer 12

When to Biopsy a Lymph Node

With no laboratory or radiographic data to explain the large nodes:

Nodes that remain enlarged or continue to enlarge after 2-3 weeks, particularly after a course of antibiotics

Nodes that have not diminished in size after 5-6 weeks or have not returned to normal by 10-12 weeks