Oncology Flashcards
Leukaemia
Cancer of the stem cells in the bone marrow
Name some types of Leukaemia
acute lymphoblastic leukemia (ALL) acute myeloid leukemia (AML) chronic lymphocytic leukemia (CLL) chronic myeloid leukaemia (CML)
What type of Leukaemia is the most common in children?
ALL
In which age group does ALL have peak incidence?
2-3 years
What is the second most common type of Leukaemia in children?
AML
In which age group does AML have peak incidence?
<2 years
Incidence of CML
very rare
Risk Factors for Leukaemia
- Down’s syndrome - Kleinfelters syndrome - Radiation exposure during pregnancy - Noonan syndrome
Symptoms of Leukaemia
- Persistent fatigue - Unexplained fever - Faltering growth - Weight loss - Night sweats - Anaemia - Petechiae and abnormal bruising - Unexplained bleeding - Abdominal pain - Generalised lymphadenopathy - Hepatosplenomegaly
Ix for Leukaemia
- NICE recommend any child with unexplained petechiae or hepatomegaly require specialist assessment. FBC + Blood Film + Bone Marrow Biopsy
When should a FBC be done if you suspect Leukaemia?
should be done within 48 hours
What may FBC show for someone with Leukaemia ?
anaemia, leukopenia, thrombocytopenia
What may a blood film show for someone with Leukaemia ?
can show blast cells
What is the definitive Ix for Leukaemia ?
Bone marrow biopsy
Managment of Leukaemia
- Chemotherapy
- Potential radiotherapy and bone marrow transplant
Brain Tumours - are they likely to be primary or secondary children?
These are almost always primary in children
What is the leading cause of childhood cancer deaths in the UK?
Brain Tumours
Name some types of Brain Tumours
Astrocytoma, Medulloblastoma, Ependyoma, Brainstem glioma, Craniopharyngioma
Brain Tumours : Astrocytoma severity ?
- varies from benign to highly malignant
Brain Tumours : Medulloblastoma - distribution ?
arises in the midline of the posterior fossa and may seed through the CNS via the CSF giving spinal metastases
Brain Tumours : Ependymoma - location ?
- mostly in the posterior fossa where it behaves like medulloblastoma
Brain Tumours : Craniopharyngioma - origin?
developmental tumour arising from an embryological remnant
Symptoms of Brain Tumours are often related to raised ____
ICP
Symptoms of Brain Tumours
Headache worse on waking, coughing, straining or bending forward along with papilloedema - Focal neurological signs may be detected - Back pain, Peripheral weakness of arms/legs or Bladder/bowel dysfunction can also be present depending upon the level of the lesion.
Ix for Brain Tumours
MRI scan
Managment of Brain Tumours
Surgery is usually the first treatment and aimed at treating hydrocephalus
- Chemo and radio depends upon the tumour type and age of the patient.
Wilms Tumour origin
Originating from embryonal renal tissue
What is the most common renal tumour of children?
Wilms Tumour
When does Wilms Tumour often present?
most often presents before 5 years of age
Symptoms of Wilms Tumour
Abdominal pain
- Anorexia
- Haematuria
Signs of Wilms Tumour
Large abdominal mass, often incidentally found in an otherwise well child - HTN
Ix for Wilms Tumour
CT/MRI are often characteristic and show the intrinsic renal mass
Management of Wilms Tumour
Initial chemotherapy followed by delayed nephrectomy
Neuroblastoma
Tumour arising from the neural crest tissue in the adrenal medulla and sympathetic nervous system. - It is a biologically unusual tumour
When does Neuroblastoma usually occur ?
usually occurs before 5 years of age
What is the general prognosis of Neuroblastoma ?
Generally, prognosis is very good with more than 80% of patients being cured
Symptoms of Neuroblastoma
- Abdominal mass - Pallor - Weight loss - Hepatomegaly
- Bone pain
- Limp
- Cervical lymphadenopathy
- Periorbital bruising
- Skin nodules
Ix for Neuroblastoma
Raised urinary catecholamine levels
Biopsy
Bone marrow sampling
Management of Neuroblastoma
- Surgery can often be curative when there is no metastatic disease - Metastatic disease will need chemotherapy, surgery and radiotherapy
Retinoblastoma
Malignant tumour of retinal cells
Retinoblastoma accounts for __% of visual impairement in children
5
Retinoblastoma can be either ____ or _____
unilateral or bilateral.
Causes of bilateral Retinoblastoma
Hereditary
Which Chromosome is involved with inheritance of Retinoblastoma
Retinoblastoma susceptibility is on chromosome 13 with dominant inheritance
Most cases of Retinoblastoma present in the first ___ years of life
3
Symptoms of Retinoblastoma
White pupillary reflex replaces the red one - Squint
Ix for Retinoblastoma
MRI and examination under anaesthetic
Management of Retinoblastoma
Aim is to cure but still preserve vision - Treatment is based around ophthalmological findings - Chemotherapy
Why is Chemotherapy used in Retinoblastoma tx?
Chemotherapy is used to shrink the tumour, particularly in bilateral disease and then followed by local laser treatment.
Prognosis of Retinoblastoma
Most patients are cured but many can be visually impaired but there is a significant risk of secondary malignancy
What type of Sarcome is seen more often in younger children?
Ewing’s sarcoma is seen more often in younger children
What type of Sarcoma is more common than Ewings?
Osteogenic sarcoma is more common than Ewings.
Symptoms of Bone Tumours
- Limbs are the most common site - Persistent, localised bone pain is the most common symptom otherwise patients are generally well.
First Line Ix for Bone Tumours
Plain X-ray is often first line and then followed by MRI and bone scan
Other Ix for Bone Tumours
Bone x rays + CT scan
What does bone X-ray show in Bone Tumours?
Bone x-ray shows destruction and variable periosteal new bone formation
What is a characteristic feature of Ewing’s Sarcoma on X ray?
there is often a substantial soft tissue mass (onion skin appearance)
What is a CT scan used for in Bone Tumours investigation?
used to assess for lung metastasis
Managment of Bone Tumours
Combination chemotherapy is given before surgery
Management of Ewing’s Sarcoma
Combination chemotherapy is given before surgery - In Ewings, radiotherapy is also used, especially if surgical resection is impossible.
Hepatoblastoma
- Primary malignancy liver tumour
Symptoms of Hepatoblastoma
Usually presents with abdominal distension or with a mass, pain and jaundice is usually rare
Ix of Hepatoblastoma
Elevated a-fetoprotein is detected in nearly all cases of hepatoblastoma.
Managment of Hepatoblastoma
Management includes chemotherapy, surgery and in inoperable cases, liver transplantation is needed
Prognosis of Hepatoblastoma
Prognosis is generally good and children will be cured
