Oncology Flashcards
What is ALL?
Acute lymphoblastic leukaemia
Most common in children
Affects B or T lymphocytes
What syndrome increases risk of ALL?
Downs - by 30 times!
What are the symptoms of ALL?
Lymphadenopathy
Anaemia
Infection
Bleeding
Headaches
Hepatosplenomegaly
Night sweats, failure to thrive, weight loss, petechiae
What is the diagnosis for ALL?
Blast cells on bone marrow aspirate
PAS = positive
Positive nuclear staining for TdT
What is the treatment for ALL?
Methotrexate chemotherapy
Steroids
What is AML?
Neoplastic proliferation of immature blast cells unable to differentiate to mature neutrophils resulting in bone marrow failure
What does AML lead to?
Crowding out of other cells causing loss of RBC (anaemia), platelets (bleeding) and neutrophils (infection)
What are the symptoms of AML?
Only leukaemia with gum infiltration
General anaemia
Infections
Splenomegaly
Night sweats, fever, failure to thrive, petechiae
What are the investigations for AML?
Auer rods on bone marrow biopsy
Blast cells on bone marrow aspirate
What is the treatment for AML?
Blood and platelet transfusions
Chemotherapy
Allopurinol to prevent tumour lysis
What is CML?
- Uncontrolled proliferation of myeloid cells
- Most cases are due to a reciprocal translocation of 9;22 of the Philadelphia chromosome which increases tyrosine kinase
What is the treatment for CML?
Oral imatinib - tyrosine kinase inhibitor
Chemotherapy
Stem cell/ bone marrow transplant
What is a complication of CML?
Can progress to AML
What is wilms tumour?
Nephroblastoma - specific tumour affecting the kidney in children typically under 5
What are the symptoms of wilms tumour?
Abdominal pain and mass
Haematuria
Lethargy
Fever
Hypertension
Weight loss
What are some investigations for wilms tumour?
USS abdomen
CT scan of abdomen - claw sign
Biopsy
What is the management for wilms tumour?
Nephrectomy
Chemotherapy/ radiotherapy
Regular USS and CXR
What is a neuroblastoma?
A malignant embryonal tumour derived from neural crest tissue.
What is the most common site of a neuroblastoma?
Adrenal glands followed by the abdominal sympathetic chain
What rash can a neuroblastoma cause?
Blueberry muffin
What is a urine test for neuroblastoma?
Urine catecholamine to creatinine ratio
What is the gold standard investigation for neuroblastoma?
MIBG scan
What is retinoblastoma?
A rare eye cancer affecting the retina which can be heritable or non-heritable.
Nearly all are caused by a heritable abnormality in the retinoblastoma gene (RB1).
What are some symptoms of retinoblastoma?
Absent or abnormal light reflex
Squint
Visual deterioration
White glow/ reflection in pupil
Uncontrolled eye movements and pain
What are the investigations for retinoblastoma?
Red reflex test
USS of eye
Blood tests
MRI
Vision test
What are the majority of bone tumours?
Osteosarcoma and Ewing’s sarcoma
The majority of bone cancers spread from where
PBKTL - prostate, breast, kidney, thyroid, lung
What is the presentation of osteosarcoma and where does it affect?
Localise pain and swelling
Pathological fracture
Mostly long bones around knee and humerus
Metaphysis is more common than mid-shaft
What are the investigations and gold standard for osteosarcoma?
Biopsy is gold
X-ray
Lactate dehydrogenase and alkaline phosphatase
MRI of primary site
Chest CT
Isotope bone scan
What is a Ewing’s Sarcoma?
Arises from primitive poorly differentiated neuroectodermal cells
Diaphysis of long bones most common
Axial skeleton more than OS
Pelvis most common
What are the investigations for Ewings sarcoma?
Plain x-ray shows lytic lesion with periosteal reactions and ‘onion skin’ appearance
Biopsy is gold
What is an osteoid osteoma?
Benign tumour arising from osteoblasts
Small tumours around metaphysis of long bones
What is the presentation of osteoid osteoma?
Localised progressive pain
Worse at night
Improves with NSAIDs
Localised swelling, tenderness and limping
what is a hepatoblastoma?
Very rare cancer starting in the liver which usually doesn’t metastasise
What are some symptoms of hepatoblastoma?
Lump in abdomen
Pain and swelling
Loss of appetiite
Weight loss
Fatigue
N+V
Fever
Itchy skin
Jaundice
What are the most common sites of low grade gliomas?
cerebellum and optic pathway
What are some symptoms of brain tumours?
Headaches - worse in mornings
N+V
Seizures
Irritable
Losing interest in activities
Eye problems
Fatigue
What are some investigations for brain tumours?
FBC
CT
MRI
Biopsy
