malignancy Flashcards
MOST Common paediatric malignancy
how do we dx between AML and ALL in staining
ALL
AML - sudan black + and mPO+, pas + diffusion
ALL: none , pas + granules
Most common age for all
2-6
Treatment for ALL
chemotherapy and intrathecal chemotherapy as normal drugs don’t cross the cns + CS
FOLLOW THE INDUCTION
CONSOLIDATION
MAINTENCE
Most common symptoms and other symptoms for ALL
BONE PAIN especially at night LETHARGY LYMPHADENOPATHY PALLOR EASY BRUSING FEVER recurrent infections - neutropenia
hepatospelenomegaly
diagnosis of ALL
def: BM biopsy (>20% blast cells)and sent off for cytology
FLOW CYMETRY :CD19 B CD 7 T CELLS
CBC: can have pancytopenia but usually its 2 cell lines down like platelets + abc and in rare cases just 1 cell line
blood smear - blast cells
tumour lysis syndrome - high k+ etc
Chest x ray - mediastinal mass
LP - check cNS involvement
abdominal us - check for Organ infiltration
what’s the level of leukocytes in ALL
can be all 3 , but usually increased !
poor prognosis associated with ALL
Philladeplphia chromosome 9, 22
<1and >10
males
Cns involvement
which type of lymphoma Is more common in childhood
NHL
Reed stenberg
seen in Hodgkin ‘owl eye’
which type of lymphoma is more common in general
NHL
Staging system for LYMPHOMAS
x ray for osteosacroma and defintive diagnosos
Ann harbour
new bony growths and periosteal reaction BONE BIPSY
- rf for Hodgkin lymphoma
- child with racoon eyes DX
EBV + HIV
neuroblastoma, child abuse and skull base fracture
Which maliganies can present with mediastinal masses
leukemia and lymphomas but more common in lymphomas which are the most common cause of an anterior mediastinal mass in children and second in adults
what kind of transplant in leukemias and lymphomas and tx for osteosarcoma
leukemias-allogenic
all 3inc limb salvage surgery
lymphomas- autologous
types of Hodgkin in detal
NS- fibrotic + cellular types and lacunar cells are charcteristic
mixed cellularity
lymphocyte rich
lymphocyte depleted
who has 2 classifications the CLASSIC(above)
NLP- nodular lymphocytic predominant subtype
treatment for Hodgkin
what bones ar einvlved in osteosacroma
Ln in hodgkin
ABVD OR BEAUCOPP +/- RT
long bones esp the metaphysis
most common is cervical, supraclavicular and sometimes mediasinal
Which lymphoma has more extra nodal sites and where can it spread too
labs for hodgkin
NHL
waldeyers ring, gut (maltoma) , skin sezary syndrome
eosiniohilia
monocytosis
lymphopenia
neutrophila
Burkits lymphoma
sighns of ewings
NHL - B cell lymphoma
night time pain
feeling a soft tissue mass
decreased ROM
PAIN
Burkits lymphoma
types of staging hodgkin
NHL - B cell lymphoma
3 types
- endemic variant - commonly involves jaw and face
- sporadic variant
- immunodeficinecy- hIV
clinical staging and pathological staging and patholoigcal reuqires. laportomy and splenectomy
nephroblastoma age
definfitve diagnosis for neuroblastoma
peak age 3-4 years old
bone marrow bipsy
most common place of metastasis of wiilms tumour
lungs
signs of films
hypertension abdominal mass - distention hematuria UTI fever
common site of metatsitis for neuroblastoma
WHICH IS MORE COMMONE OS OR EWINGS
boes affected
bones
osteosarcoma
OS: bones that form the knee and upper limb (proximal humerus)
EW: pelvis, ribs and tends to be more the diaphysis of bones but can be metaphysis
origin of neuroblastoma
prognostic factors
adrenal glands, ut can start from other areas of body like sympathetic ganglia near the spine or abdomen
AGE IS VERY IMPORTANT, the younger the child the better <18 months old
signs of neuroblastoma
key word for diagnosis of ewings
swollen abdomen brushing around the eyes+dancing eyes horners syndrome bluish skin nodules (infants) bone pain diarrhoea! SYMPATHETIC: SWEATING, HYPERTENSION!
onion skin or ‘hair on end’ pattern on x ray, and small blue cell tumours
what type of anmeia associated with NH L
types of benign bone tumours
NORMOCYTIC
osteoblastoma
osteochondroma
osteiod osteoma
osetoma
chrondroma
giant cell tumour
IMPORTANT LABS FOR NHL (MCQS)
most common symptom of bone cancer
HIGH LDH
URIC ACID CAN BE HIGH
NOROMOCYTIC ANEMIA
bone pain
what could cause raised copper levels, bone canceres coomonly metastisised too?
LYMPHOMAS
leukemias, RA , hemachromatosis
lUNGS, then bone
colon cancer marker
tx for neuroblastoma
CEA
surgery if it hasnt spread anywhere and chemo if spread or even before surgery to shrink the tumours
RT too
diagnosis of neurobkastima
dx of osteosacroma
NSE
ewings sarcoma - more likely to hvae raised ESR, LDH , fver anemia
chrondrosarcoma (more in adults)
osteomyelits , pain, systemic signs
Vanillylmandelic acid IN URINE
TYPE OF SPECIAL SCAN FOR NERUOBLASTOMA
MIBG SCAN
(USED FOR PHEOCROMOCYTOMA AND NEUROBLASTMONA - cancers of nervous tissue)
opsclonus myoclonus
what could labs for bone cancers show
seen in neuorblastoma
dancing eyes and muscle jerks in arms and legs
increased LDH+ ALP
which tumour does not cross the midline usually and talk about heridatary retinoblastoma and the risks
WILMS
AD domiannt, these kids get the disease at an earlier age and its usuallay bilateral , risk of other cancers such as pineoblastoma
WHAT GENETIC SYNDROMES ARE ASSOCIATED WITH WILMS
beckwith wiedemann- macrosglossaia, omphalocele
WAGR syndrome
(wilms, aniridia, genitounrinary problems and mental retardation)
in order of occurence of philidepliphia chromosom
- CML - mandatory
- ALL
- AML - least common
WHEN DO WE SAY REMISSION HAS OCCURED FOR ALL
key words for diagnoses of OS
when less than 5% blast in the BM
codman triange, ‘sunburst appearance’
which type of hodgkin lyphoma has the best prognosis and risk factors for osteosarcoma
lymphocyte rich
- heridarty retinoblastoma
- rothmand thomspon syndrome
- -
most common NHL IN KIDS and symptoms of osteosarcoma
BURKITS LYMPHOMA
prolonged bone pain (mistaken for sports injury or growing pains )
- pahtolgocial frcatures
- decreased ROM
- swelling!!! especially in the region of metaphyiss
are nephro and neuroblastoma benign ?
most coomon bone cancer in kids
NO - maliganant
osteosarcoma
*
which bone cancer is asociated with transloaction
ewings 11,22
ewings sarcoma- boys
