Oncology 2 Flashcards
What are lymphomas
Malignancies of the cells of the immune system
Hodgkin and NHL
NHL more common in childhood
Hodgkin is seen more in adolescence
Presentation of Hodgkin lymphoma
painless lymphadenopathy - most frequently in the neck
LN are very large and firm. May cause airway obstruction
Clinical history can be several months. Systemic symptoms uncommon..
B symptoms:
Sweating, pruritus, weight loss and fever
Investigations and management of Hodgkin’s lymphoma
LN biopsy
Radiological assessment of all nodal sites
Bone marrow biopsy
-Stage disease and determine treatment
combination chemotherapy with or without radiotherapy
PET scan to monitor treatment response
80% can be curedm 60% of disseminated disease
What is NHL
T-cell malignancy
B-cell malignancy
Presentation of NHL (T-cell malignancy)
Mediastinal mass with varying degress of bone marrow infiltration
May cause SVC obstruction
Presentation of NHL (B-cell malignancy - more commonly)
Localised LN disease, usually head and neck or abdomen
Abdo disease presents as pain from intestinal obstruction , a palpable mass or even intussusception in cases with involvement of the ileum
investigation and management in NHL
Biopsy, radiological assessment of all nodal sites (CT or MRI)
Examine bone marrow and CSF
Multi-agent chemo
80% survival rate for both T and B cell disease
Main differences between Hodgkins and NHL
Hodgkin’s lymphoma:
has Reed-Sternberg cells
Often starts in the upper body
Spreads very slowly and is very receptive to chemo and radiotherapy
When is chemo used.
Long-term complications of chemotherapy
Curative in ALL
Controls primary/metastatic disease in sarcoma/neuroblastoma
adjuvant treatment to deal with residual disease and to eliminate presumed micrometastases
Delayed puberty Reduced fertility Reduced growth Neurotoxicity Hepatotoxicity Renal toxicity Cardiotoxicity Pulmonary toxicity Secondary cancer Psychological effects
Side effects of chemo
Hair loss Anaemia Infection Bruising Sore mouth Nausea Vomiting Mood changes Irritability Weight gain
Long-term consequences of radiotherapy
Used for some tumours, but generally the risk of damage to growth and function of normal tissue is greater in a child
Also, babies are hard to immobilize
What are the forms of bone marrow transplant?
Allogeneic - from a compatible donor
Autologous - from patient, harvested beforehand while the bone marrow is uninvolved or in remission
Allogeneic usually in high-risk or relapsed leukaemia
Autologous usually used in solid tumours that have poor prognosis with conventional chemo (eg. advanced neuroblastoma)
What is a neuroblastoma
Arise from neural crest tissue in the adrenal medulla and sympathetic NS
Spontaneous regression sometimes occurs in very young infants
Spectrum from benign (ganglioneuroma) to highly malignant (neuroblastoma)
Most common before age of 5
Clinical features of neuroblastoma
Most children have an abdominal mass
Primary tumour can lie anywhere along the sympathetic chain from neck to pelvis.
Classically, adrenal primary.
At presentation, the tumour mass is often large and complex and can cross the midline and envelope major blood vessels and LN
paravertebral tumours may invade through the adjacent intervertebral foramen and cause spinal cord compression..
> 2 years, symptoms mostly from metastatic disease, particularly bone pain, bone marrow suppression causing weight loss and malaise.
Pallor Weight loss Abdominal mass Hepatomegaly Bone pain Limp
Rarer clinical features of neuroblastoma
Paraplegia Cervical lymphadenopathy Proptosis Periorbital bruising Skin nodules
