Oncology

Question 1

What is leukaemia?

Answer 1

Cancer of a particular line of stem cells in the bone marrow → causing unregulated production of certain types of blood cells

Question 1

How are types of leukaemia classified?

Answer 1

• How rapidly they progress → acute (fast) or chronic (slow)
• Cell line affected → myeloid or lymphoid

Question 2

Types of leukaemia that affect children
(from most to least common)

Answer 2

• Acute lymphoblastic leukaemia (ALL) = the most common in children
• Acute myeloid leukaemia (AML) = the next most common
• Chronic myeloid leukaemia (CML) = rare

Question 3

Most common leukaemia type found in children?

Answer 3

Acute lymphoblastic leukaemia

Question 4

At what age does ALL and AML peak in children?

Answer 4

• ALL peaks aged 2 – 3 years
• AML peaks aged under 2 years

Question 5

What does leukaemia causes to the other blood cell types?

Answer 5

Pancytopenia

• Red blood cells (anaemia),
• White blood cells (leukopenia)
• Platelets (thrombocytopenia)

(The excessive production of a abnormal WBC - due to genetic mutation in preursor cell = can lead to suppression of the other cell lines, causing underproduction of other cell types)

Question 6

What is the main environmental risk factor for childhood leukaemia?

Answer 6

Radiation exposure (e.g. with an abdominal xray during pregnancy)

Question 7

Name a condition that predisposes a child to leaukaemia

Answer 7

• Down’s syndrome
• Kleinfelter syndrome
• Noonan syndrome
• Fanconi’s anaemia

Question 8

Presentation of leukaemia

Answer 8

Typically non-specific:

• Persistent fatigue
• Unexplained fever
• Failure to thrive
• Weight loss
• Night sweats
• Pallor (anaemia)
• Petechiae and abnormal bruising (thrombocytopenia)
• Unexplained bleeding (thrombocytopenia)
• Abdominal pain
• Generalised lymphadenopathy
• Unexplained or persistent bone or joint pain
• Hepatosplenomegaly

Question 9

Investigations for childhood leukaemia

Answer 9

• Unexplained petechiae or hepatomegaly → immediate specialist assessment + urgent FBC (within 48 hours)

Ix to establish diagnosis:
* FBC → anaemia, leukopenia, thrombocytopenia + high numbers of the abnormal WBCs
* Blood film → can show blast cells
* Bone marrow biopsy
* Lymph node biopsy

Further staging tests:
* Chest xray
* CT scan
* Lumbar puncture
* Genetic analysis and immunophenotyping of the abnormal cells

Question 10

Management of childhood leukaemia

Answer 10

Chemotherapy

Others:
* Radiotherapy
* Bone marrow transplant
* Surgery

Question 11

Complications of chemotherapy

Answer 11

• Failure to treat the leukaemia
• Stunted growth and development
• Immunodeficiency and infections
• Neurotoxicity
• Infertility
• Secondary malignancy
• Cardiotoxicity

Question 12

Prognosis for ALL and AML

Answer 12

• ALL → approx. 80% (depends on individual factors)
• AML → less positive

Question 13

Info: Hepatoblastoma

Answer 13

• Malignant tumour of liver - usually occurs in young children
• Hepatoblastoma = different from hepatocellular carcinoma - which usually occurs in adults + occasionally older children
• (The blastomas are the paediatric ones e.g. retinoblastoma, neuroblastoma etc)
• Rare - 10 kids in UK per year

Presentation: Abdominal distension or with mass, pain and jaundice is ually rare
Ix: Elevated alpha-fetoprotein
Management: Chemotherapy, surgery, inoperable cases - liver transplant needed
Prognosis: generally good + children will be cured