Oncology / Haematology Flashcards
What is the most common cancers in children
Leukaemia - 33%
Brain tumour - 25% but higher mortality (posterior common)
Extra-cranial
What are extra cranial
Lymphoma - Hodgkin's / non-Hodgkin's Neuroblastoma Soft tissue Nephroblastoma Retinoblastoma Malignant Bone Germ cell Hepatic
What causes cancer in childhood
Sporadic
Genetics
Environment - Radiation / infection - HPV
Iatrogenic - RT / chemo
What is the prognosis of childhood cancer
> 80% 5 year survival
How do you classify childhood cancer
International Classification of Childhood Cancer (ICCC)
Based on tumour morphology and primary site
What genes are involved
Downs syndrome Fanconi Beckwith Weidemanne syndrome (BWS) Li-Fraumeni p53 Neurofibromatosis
What age group is most likely to get cancer
Peak at 0-4 = highest rate
Another peak at 18-22
What are people with Down’s likely to get
Leukaemia
What is Li-Fraumeni syndrome
Autosomal dominant
p53 gene
50% chance of cancer by 30
90% chance of cancer by 70
What suggests immediate referral to hospital (same day)
Unexplained petechiae
HSM
What suggests urgent referral (48 hour)
Repeated attendance with same problem
New neuro symptoms
Abdominal mass
What suggests a referral (2 week) + FBC in 24 hours
Rest pain Back pain Unexplained lump Lymphadenopathy Unexplained and persistent symptoms Extreme fatigue Extreme weight loss Changes in mole
Symptoms of brain tumour
Commonly posterior Persistent vomiting - morning Persistent headache Signs of raised ICP Cerebellar signs - DANISHP Behaviour change Lethargy Fits / seizures Abnormal head position Blurred / double vision Delayed puberty CN palsies
Signs of cancer to be aware off
UNEXPLAINED PERSISTENT Lump / bump / swelling Extreme tiredness Excessive Sweating Significant weight loss Changes in a mole / bruising
How do you Dx what the tumour is and where it is
Tumour markers of germ cell / liver
Scans - USS for screen / MRI Biopsy - pathology Tumour marker on bloods / pregnancy test on man for bHCG ALP = live / baby / bone Stage - scans / bone marrow
How do you Rx cancer
MDT Chemo Surgery RT CAR-T cells revolutionise leukaemia
What are acute risks of chemo
Hair loss N+V Mucositis Diarrhoea Constipation Bone marrow suppression
What are chronic risks of chemo
Organ impairment - ECHO / bone density etc.
Reduced fertility
Second cancer
What are acute risks of RT
Lethargy Skin irritation Swelling GORD Cytsitis Dermatitis Organ inflammation
What are chronic risks of RT
Fibrosis
Reduced fertility
Second cancer
What are oncological emergencies due to treatment
Sepsis Febrile neutropenia Raised ICP Spinal cord compression Mediastinal mass / SVC obstruction Tumour lysis syndrome
What do people who have had childhood cancer have a higher risk of
Chronic disease in adult life
What can be used to provide chemotherapy
Central line or port
What do child with splenectomy get
Pneumococcal vaccine
When can you not give NSAID
Chemo
DDAVP
What is the mot common malignancy in childhood
ALL
- SEE HAEMATOLOGY
When are you caution if going chemo
AVN
What is a neuroblastoma
Most common solid tumour formed from neural crest cells in ANS
Common at adrenal gland and abdomen
What are the symptoms
Mass
How do you Dx
AXR
USS
IV urogram
Increased catecholamines in urine
What does a nephroblastoma present
Abdominal mass = most common Abdominal pain / flank - unilateral Haematuria Lethargy Anorexia Weight loss Fever HYpertension Lung mets Associated with Beckwith Weidman
How do you Dx and treat a nephroblastoma
USS IV urogram CT / MRI to stage Biopsy for definite Dx Chemo Surgery - nephrectomy Post-op RT
What causes a retinoblastoma
Autosomal dominant
What are features of retinoblastoma
Squint
Decreased vision
Proptosis
No red light reflex
How do you treat retinoblastoma
Surgery not the only option depending on how advanced - enucleation RT Cyrotherapy Photocoagulation Screen parents and siblings as AD
What is most common cause of anaemia in children
Iron deficiency
- Blood loss e.g. menstruation
- Diet - lots of milk
- Malabsorption e.g. coeliac
What are other causes
Thalassaemia Sickle cell Sideoblastic Haemolytic Bone marrow failure
What causes normochromic
Chronic disease - renal / hypothyroid / infections
ALL / bone marrow failure
What causes bone marrow failure
Leukaemia
Lymphoma
Storage disorders
Aplastic
What causes haemolytic
Autoimmune
Hereditary spherocytosis
G6PD
Haemoglobinopathy - sickle cell / thalassemia
What are symptoms of anaemia
Lethargy Pallor SOB Koilonychia Atrophic tongue / mouth Tachycardia Flow murmur
What is important not to miss
HSM - more severe
Petechiae
Jaundice
Height and weight
What are important questions
Diet / feeding Milk = high risk Weight loss Bleeding or bruising Jaundice Bone pain Fever Hx illness FH of disorders
How do you investigate
FBC + MCV Film Bone marrow aspirate if abnormal Reticulocyte / DAT to see if haemolytic Ferritin Anti TTG Hb electrophoresis - haemoglobinopahy Blood / urine culture - chronic infection
When do you do aspirate
If film abnormal
Shows blasts
What does FBC show
Severity and type of anaemia
What is less worrying
Single cytopenia over pancytopenia
What is Ddx of lethargy
Iron defieincy Coeliac Malabsorption Blood disorder that cause anaemia ALL
What blood disorder
Haemolytic anaemia - jaundice?
Thalassemia
Sickle cell
Hereditary spherocytosis / G6PD
What is reticulocyte high in
Haemolysis as RBC need to be made as destroyed
What is reticulocyte low in
Decreased production due to bone marrow failure
Lack of Fe
Lack of folate
Wha causes bleeding / bruising in neonate
Haemorrhagic disease of newborn Maternal thrombocytopenia Trauma Infection Haemophilia
What causes bleeding or bruising in infant / children
Injury Haemophilia vWF ITP Congenital infection / sepsis Liver disease ALL
Main causes of bleeding
Trauma
Bleeding disorder - vWF / ITP
Malignancy - ALL
What is important to ask
FH bleeding disorder or heavy period What is bruises like How long to go Any joint pain / limp / bleeding Any bleeding during dental surgery / vaccination Any spontaneous bleeding Nose bleed Signs of anaemia
What is normal length of nose bleed
<15 minutes
What is important to look in examination
ALL - HSM / LN enlargement
What investigations
FBC, ferritin + clotting vWF Factor 8 (A) Factor 9 (B) Blood group O as causes low vWF
What causes epistaxis
Nose picking
Foreign body
Allergic rhinitis / URTI
When do you refer
<2
FH
>15 minutes
If <2 what is it due to
Trauma
Bleeding disorder
What can you prescribe if >2 and no evidence of abnormality
Topical neomycin
Discourage nose picking
