Haem + onco Flashcards
1
Q
Which type of leukaemia is the one which most commonly and almost only affects children?
A
Acute lymphoblastic leukaemia (peaks between ages 2-5)
2
Q
What investigations should be conducted in someone with suspected ALL
A
- FBC: shows pancytopenia or anaemia and thrombocyotpenia
- blood film- blast cells present
- chest xray- to check for mediastinal mass
- bone marrow aspirate: to see extent of infiltration
- lumbar puncture for CNS involvement
3
Q
How does ALL present?
A
- anaemia
- thrombocyopenia - easy bruising and bleeding
- leukopenia: fevers/ infections
- bone pain: increased pressure from hyperplastic marrow
- weight loss and malaise
- CNS involvement: headaches, seizures
- high WBC may lead to lymphadenopathy
- hepatosplenomegaly
4
Q
Give 1 major risk factor for ALL
A
- trisomy 21
5
Q
How is ALL managed?
A
- resus and stabilisation (may need hyperhydration if hyperviscosity due to high WBC)
- Aggressive IV, oral and intrathecal chemo
- supportive blood products and prophylactic anti- fungal
- maintenance therapy for 2 yrs for girls and 3 yrs for boys
- some need allogenic BMT
- 90% survive
6
Q
How may lymphoma present?
A
- non tender lymphadenopathy- may be intraabdominal or mediastinal so not always palpable
- weight loss
- night sweats
- fevers
- lethargy, anorexia
- may have cough/ wheeze/ SVCO if mediastinal mass
7
Q
How should suspected lymphoma be investigated?
A
- FBC- infection differential
- U&E- tumour lysis syndrome
- LDH levels are usually elevated
- USS- identify other nodes and assist biopsy
- Chest X- ray- mediastinal node involvement
- Full body CT- determine the extent of the disease
- Lymph node biopsy
8
Q
give 2 riskfactors for lymphoma
A
- EBV
- immunosurpressed
- pts on cancer treatment
9
Q
Describe the staging of lymphoma
A
- STAGE 1: single group of lymph nodes/ single organ
- STAGE 2: 2 or more groups of lymph nodes/ organs same side of the diaphragm
- STAGE 3: lymph nodes or organs on both sides of the diaphragm
- STAGE 4: diffuse involvement of lymph nodes and organs, e.g. liver and bones
10
Q
how is lymphoma managed?
A
- Mediastinal mass with potential airway compromise- high dose steroids and airway support
- Superior vena cava obstruction (SVCO)- stenting of veins to keep patent
- Tumour lysis syndrome (causes release of large amounts of phosphorus, potassium and calcium- potential kidney damage) - hyperhydration + allopurinol
- Long term treatment is with chemotherapy and radiotherapy
11
Q
How does a nephroblastoma/ wilms tumour present?
A
- median age is 3.5
- incidental abdo mass finding (usually unilateral but may be bilateral)
- abdominal swelling
- abdo pain
- fever
- haematuria
- HTN
- may present late with signs of compression of other intra- abdominal structures
12
Q
Describe the staging of wilms tumours?
A
- 1: tumour confined to the kidney + can be completely removed in surgery
- 2: tumour has begun to spread beyond the kidney, but can be removed in surgery
- 3: tumour cannot be completely surgically resected because spread to lymph nodes
- 4: Distant metastases- commonly the lungs
- 5: Bilateral tumours
13
Q
How are wilms tumours managed?
A
- supportive: treat infections, ensure optimum nutrition and hydration
- surgery: to preserve renal function and remove malignant tumour
- chemo: to reduce malignant tissue before surgery
- 85% are cured
- long term need to take steps to protect remaining good kidney: good BP control, avoid contact sports
14
Q
What is immune thrombocytopenia (ITP)
A
- autoimmune disorder where platelet count is reduced
- primary is where platelets are destroyed in isolation
- secondary is due to other causes/ where other things also go wrong
- most occur in children following viral infection or immunisation, is self limiting and they recover within 6-8 weeks
15
Q
Give 5 secondary causes of ITP
A
- autoimmune disorders: SLE, antiphospholipid antibody syndrome
- infection: hep C, HIV, varicella zoster, h. pylori
- meds
- lymphoproliferative disorders
