Malignant Disease Flashcards
Name 3 embryonal tumours.
- Wilm’s tumour.
- Neuroblastoma.
- Rhabdomyosarcoma.
Give examples of children who are at increased risk of cancer.
- Down’s syndrome children are at increased risk of leukaemia.
- Immunocompromised children are at increased risk of lymphoma.
An abnormal red reflex in a child may be a sign of what paediatric malignancy?
Retinoblastoma.
Give 5 signs of CNS malignancy in children.
- Early morning headache.
- Headache that is worse on lying down.
- Vomiting - especially in the morning.
- Papilloedema.
- Squint.
- Nystagmus.
- Ataxia.
- Personality or behavioural change.
Describe the general treatment for CNS malignancies.
- Surgical resection + VP shunt (reduces the risk of coning).
- Chemotherapy.
- Radiotherapy.
Why are there fewer chemotherapy options available for children with CNS malignancies?
Because there are fewer chemotherapy drugs able to penetrate the BBB.
Give 5 signs that lymphadenopathy may be due to malignancy rather than a benign cause e.g. infection.
- Enlarging node without infective cause.
- Persistently enlarged.
- Unusual site e.g. supra-clavicular.
- B symptoms e.g. fever, weight loss, night sweats.
- Abnormal CXR.
Give 5 differential’s for abdominal mass in children.
- Hepatoblastoma.
- Wilm’s tumour.
- Neuroblastoma.
- Lymphoma/leukaemia.
- Constipation/bowel obstruction.
- Enlarged kidneys - polycystic.
What investigations might you do on a child with an abdominal mass?
- USS.
- CT.
- Biopsy.
What are neuroblastoma tumours?
Tumours arising from neural crest tissue in the adrenal medulla and sympathetic nervous system.
Give 2 signs of a neuroblastoma tumour.
- Abdominal mass - often crosses the midline and envelopes major vessels and lymph nodes.
- Symptoms of metastases e.g. bone pain, weight loss, pallor, limp, hepatomegaly.
Describe the treatment for a neuroblastoma malignancy.
- Surgery - localised primaries can often be cured with surgery alone.
- Chemotherapy - can be given before and/or after surgery to control disease.
- Radiotherapy for high risk groups.
What is Wilm’s tumour?
Nephroblastoma, malignancy arising from embryonal renal tissue.
Give 5 signs of Wilm’s tumour.
- Abdominal mass (most common presenting feature)
- Painless haematuria
- Flank pain
- Anorexia
- Fever
unilateral in 95% of cases
metastases are found in 20% of patients (most commonly lung)
Describe the treatment for Wilm’s tumour.
- Chemotherapy
- Nephrectomy.
- Radiotherapy
Describe the aetiology of retinoblastoma.
- Mutations in RB1 (tumour suppressor gene) located on chromosome 13.
- Familial (AD).
- Sporadic.
Give 3 signs of retinoblastoma.
- absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
- strabismus
- visual problems
Describe the treatment for retinoblastoma.
- enucleation is not the only option
- depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation
Give 3 late effects of cancer treatment in children.
- Endocrine related e.g. growth and development problems.
- Intellectual.
- Fertility problems.
- Psychological issues.
- Cardiac and renal toxicity
Give 3 differentials for head and neck lumps in children.
- Lymphadenopathy.
- Thyroglossal cyst.
- Goitre.
- Malignancy.
- Branchial arch remnants.
- Dermoid cysts.
What are the red flag signs for head/neck lumps in children?
> 2cm for >2w and enlarging.
List 3 ix done in neuroblastoma.
- Urinary catecholamine levels (raised)
- Biopsy
- Metastasis- bone marrow sampling, MIBG scan with/without bone scan
