Malignancy Flashcards
Where are brain tumours usually in children and what’s their origin?
They are more often primary (unlike adults)
And they are usually infratentorial meaning they are in the cerebellum or below
Brain tumours are the most common solid tumour in children
What are some common types of brain tumours
Astrocytoma (40%) - benign or malignant
Medullablastoma (20%)
Ependymyoma (8%)
Craniopharyngoma
What are some symptoms of brain tumours in children?
Either general signs of raised ICP or specific focal neurological signs
How should brain tumours be investigated?
Bets visualised on MRI scan
How should brain tumours be managed?
Surgery if possible with the main incentive be to alleviate any hydrocephalus
Sometimes anatomical position means excision is not safe - for this reason even tumours that are histologically benign can cause death
Prognosis is not good
What is a Wilm’s tumour?
Tumour arising from the embryonic renal tissue - this means it will be present from birth but might not be found until later as children won’t develop symptoms straight away
How does Wilm’s tumour present?
Most usually with large abdominal masses that are found incidentally - ASYMPTOMATIC
Symptoms may include abdominal pain, anorexia, anaemia, haemturia and hypertension
How should a Wilm’s tumour be investigated?
MRI, USS and CT are all useful
LOOK IN LUNG FOR METS
How are Wilm’s tumours managed?
There is usually initial chemotherapy and then later nephrectomy
Radiotherpay is sometimes offered to patients with very advanced disease
What is the prognosis for Wilm’s tumour?
GOOD - approx 80%
What are the most common forms of malignancies in children? And what is the most common specific malignancy?
HAEMATOLOGICAL MALIGNANCY
Specifically LEUKAEMIA IS THE MOST COMMON
What is the most common form of leukaemia in kids?
Acute lymphoblastic leukaemia
a fairly large chunk also AMLs
What is the peak of incidence of leukaemia?
Why do symptoms occur and how quickly do they occur?
Peak inc: 2-5 years
Symptoms occur due to disseminated disease and the infiltration of malignant cells into tissues
Usually they come on over a course of a few weeks but can be much more rapid
What are some symptoms of ALL in children?
GENERAL: malaise and anorexia
BONE MARROW: Neutropenia (infection), Anaemia (pallor and lethargy) and thrombocytopenia (nose bleeds, bruising)
RETICULO-ENDOTHELIAL: Hepatosplenomegaly and lymphadenopathy
OTHER: CNS (headaches, vomiting and nerve palsies), TESTES (testicular enlargement)
What investigations should be done for ALL?
FBC - might show anaemia and thrombocytopenia and circulating leukaemia cells
BONE MARROW
CXR
When would changes be seen on CXR?
Mediastinal involvement in CXR would be suggestive of T cell disease
T cell disease occurs in 15%
B cell disease occurs in 75% (rest are mixed)
How is ALL managed initially?
Correct anaemia (possibly with transfusion)
Give hydration therapy
Give allopurinol as a renal protectant against rapid cell lysis
Then after 4 weeks of this start chemotherapy
What is the chemotherapy treatment schema for ALL?
INDUCTION with vincristine and steroid (dex)
CNS PROTECTANT AND CONSOLIDATION (IT methotrexate, vincristine, steroid, thiopurine)
INTERIM - weekly vincristine, 5 daily steroid and daily 6-mercaptopurine
DELAYED INTENSIFICATION - Vincristine, dex, doxirubicin, L-Asparginase, IT methotrexate
What are some poor prognostic factors for ALL?
If child aged under 1 or above 10
If WCC is >5x10^( (high tumour load)
If there are cytogenic abnormalities t(4;11)
If there is slow initial response to therapy
Minimal residual disease assessment
Is Hodgkin’s or Non-Hodgkin’s lymphoma more common in children?
NHL - no Reed-Sternberg Cells
How does lymphoma usually present?
Large, non-tender cervical lymphadenopathy
Sometimes there are B symptoms
(night sweating, weight loss, pruritus, fever)
How can you tell between benign lymphadenopathy and lymphoma?
Lymphadenopathy in lymphoma is larger and a lot firmer
If a child presents with extensive lymphadenopathy how should they be treated?
Lymph node biopsy and radiological assessment of all lymph node sites
