Malignancy

Question 1

How common are childhood cancers? Which are the common types?

Answer 1

1/500 
Leukemia
Brain tumours 
Lymphoma
Wilm's tumour
Bone tumours

Question 2

When do the common childhood cancers present?

Answer 2

Infants/young children: leukemia, Wilm’s, neuroblastoma

Teens: Hodgkin’s, bone tumours

Question 3

Fever and neutropenia in a child undergoing chemo may indicate ___. What is the management?

Answer 3

Neutropenic sepsis- emergency

• Admission
• Sepsis 6
• IV antibiotics after septic screen eg. urine dip, blood cultures, CXR

Question 4

What are the signs and symptoms of leukemia?

Answer 4

General: fatigue, low appetite, weight loss, sweats, fever
Anaemia: pallor, SOB, dizziness, palpitations
Thrombocytopenia: bleeding, bruising
Neutropenia: recurrent infections
Infiltration:
-ALL: thymic, testicular enlargement, hepatosplenomegaly

Question 5

What investigations would you do if you were considering leukemia?

Answer 5

• FBC and differential
• Blood film
• Clotting
• BM biopsy
• LP
• CXR

Question 6

Describe the treatment of acute leukemia

Answer 6

MDT with oncology, haem, GP, specialist nurses, etc

• Chemo: induction, consolidation, continuation. Usually for abotu 3 years. Pegaspargase is mainstay
• Intrathecal chemo
• Prophylactic antibiotics, allopurinol, transfusions

Question 7

What are some signs and symptoms of brain tumours in children?

Answer 7

Headache, waking from sleep
Vomiting in the morning
Visual disturbance, eye movements eg nystagmus, squint
Ataxic gait, poor balance 
Neuro signs 
Developmental delay, change in behaviour

Question 8

What is the best imaging modality for brain tumours?

Answer 8

MRI

Question 9

A mediastinal mass may indicate ___

Answer 9

ALL or NHL

Question 10

What is a neuroblastoma?

Answer 10

Malignant proliferation of neural crest cells in the adrenal medulla

Question 11

What are the features of neuroblastoma?

Answer 11

Weight loss
Abdominal mass
Hepatomegaly (mets)
Bone pain (mets)
Cord compression (mets)

Question 12

How would you investigate suspected neuroblastoma?

Answer 12

Urinary catecholamines and metabolites (VMA)
CT/MRI
MIBG scan

Question 13

If a child has an abdominal mass, what is your first investigation? If that is positive, what is your second?

Answer 13

USS -> MRI

Question 14

What is the other name for nephroblastoma?

Answer 14

Wilm’s tumour

Question 15

How does nephroblastoma present?

Answer 15

-Abdominal mass
-Haematuria
-Usually well, can have:
Poor feeding, weight loss
Irritability, pain

Question 16

What is the most common soft tissue malignancy in children?

Answer 16

Rhabdomyosarcoma

Question 17

What are the most common bone malignancies in children? How do they present?

Answer 17

Osteosarcoma > Ewing’s sarcoma in teens. E>O in kids

-Bone pain, swelling, limp, fractures

Question 18

How does retinoblastoma present?

Answer 18

Visual impairment
Loss of the red reflex
Squint

Question 19

What is the prognosis for paediatric leukemia?

Answer 19

Quite good. 90% 5 year survival.

Question 20

Abdominal mass in a well child should make you suspect ___.

Abdominal mass in a child with systemic symptoms should make you suspect ___

Answer 20

Wilm’s tumour.

Neuroblastoma, splenomegaly due to leukemia etc