Lukemia

Question 1

Ri sk Factors

Acute lukemia

Answer 1

Ri sk Factors
•  RadiaEon or chemical exposure
•  Certain viral exposures ( EBV )
•  Certain geneEc syndromes ( Down syndrome,
Ataxia-telangiectasia, Bloom syndrome and
Fanconi anemia )

Question 2

In volvement of luk

Answer 2

In volvement
•  Spleen, liver and Lymph nodes are the most
commonly affected
•  Extra-medullary disease ( CNS, Kidneys and
testes.
•  CNS: headache, nausea and Cranial nerves.

Question 3

Lukemia

Answer 3

The “4 Ps” Pallor, Pyrexia, purpura and Pain.
•  Clinical Signs.
•  Easy bruising •  Swollen lymph nodes ( 50 % of paEent are asymptomaEc ) •  loss of appeEte •  Unintended weight loss •  Skin rash •  Bleeding gums •  Nosebleeds

Question 4

Wo rk up

Of leukemia

Answer 4

CBC		(	2	lines	abnormality	)					WBC		25%	blast		 •  LDH		 •  Uric	acid	and	renal	dysfuncEon	 •  Bone	marrow		 •  CXR		
Wo rk	up	
•  Lumbar	puncture		
•  Neuro-imaging		
•  Chromosomal	analysis

Question 5

Man agement luke

Chemotherapy

Answer 5

Man agement		
Chemotherapy		
•  InducEon	therapy	 •  ConsolidaEon	therapy		 •  Maintenance	therapy		 •  CNS	prevenEve	therapy		
Man agement		
•  Bone	marrow	transplant		
•  RadiaEon	therapy		(	mainly	for	CNS	
involvement	)	
.

Question 6

Pro gnosis of lukemia

Answer 6

Pro gnosis
•  poor prognosis: < 1 year or > 10 years Philadelphia chrormosome t(9,22) WBC > 50,000 at presentaEon T cell leukemia Ethinicity
- Good prognosis Female sex
Pro gnosis
•  > 70 % of Children with ALL have event free
survival
•  4 years survival is 85%
•  Risk of Relapse is 25% mainly in bone marrow

Question 7

Ho dgkin Lymphoma

Answer 7

lymphoma is the 3rd most common childhood
cancer.
•  3 types ( childhood type < 14 years)
•  Mainly seen in low socioeconomic people
Ho dgkin Lymphoma
•  Boys < 10 years
•  EBV and geneEc factors
•  Classic histological hallmark is Reed-Sternberg
cell ( look like owl’s eyes)

Question 8

Clinical ManifestaEons

Answer 8

Clinical ManifestaEons
•  AsymptomaEc cervical and supraclvicular
lymphadeopathy.
•  MediasEnal lymph node involvement
•  1/3 has “B” Symptoms ( fever, night sweats,
weight loss ) Pel-Ebtein fever
Ho dgkin Lymphoma

Question 9

Wo rk up

Ho dgkin Lymphoma

Answer 9

CBC				 •  LDH		 •  Uric	acid	and	renal	dysfuncEon	 •  Bone	marrow		 •  CXR		
•  By	excisional	biopsy		
•  PET	scan	for	staging		
•  Bone	marrow		
•  CT	abdomen	and	chest

Question 10

Non-Hodgkin Lymphoma

Answer 10

The most common type of lymphoma in
Children •  High risk group: Ataxia-Telangiectasia Wiskoi-Aldrich syndrome HIV Immunosuppression disease

Question 11

Bu rkii lymphoma

Answer 11

Bu rkii lymphoma
•  90 % orginated from the GI tract
•  Abdominal mass
•  Jaw involvement ( African type)