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Year 4 Paeds > Oncology Paeds > Flashcards

Oncology Paeds Flashcards

1
Q

most common solid tumour in children

A

brain tumour

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2
Q

top 2 most common cancers in children

A
  1. leukaemia
  2. brain tumour
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3
Q

common location of brain tumours

A

50% posterior fossa
50% glioma

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4
Q

3 main paeds CNS tumours

A

astrocytoma
ependymoma
medulloblastoma

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5
Q

2 main branches of CNS tumours

A

glial - astrocytoma and ependymoma
neuroectodermal

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6
Q

astrocytoma grading

A

1 - 4
1 = pilocytic (essentially benign)
4 = glioblastoma

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7
Q

definition: ependymoma

A

glial but originate from ependymal lining of vernticles (lateral or 4th)

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8
Q

defintion: medulloblastomas

A

primitive neuroectodermal tumour
found in medulla oblongata usually

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9
Q

most common brain tumour

A

medulloblastoma

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10
Q

type of tumour in cerebellum (3)

A

astrocytoma, ependymoma, PNET

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11
Q

type of tumour in brainstem (1)

A

astrocytoma

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12
Q

type of tumour in hypothalamus/pineal

A

astrocytoma, PNEY, NGGCT< teratoma, dysgerminoma

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13
Q

type of supratentorial tumour

A

astrocytoma, PNET, ependymoma

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14
Q

syndromes increasing risk of brain tumour

A

neurofiromatosis type 1
tuberous sclerosis
von-hippel lindau
Li Fraumeni syndrome
Turcot syndrome

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15
Q

tumour associated with neurofibromatosis type 1

A

optic nerve glioma

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16
Q

tumour associated with tuberous sclerosis

A

subependymal giant cell astrocytoma

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17
Q

associations with brain tumours

A

ionising radiation
HIV, ataxic telangectasia

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18
Q

clinical presentation of brain tumours (8)

A

vomiting
headache
changes in personality
squint
reduced school performance
growth failure
seizures
developmental delay

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19
Q

aetiology: PNT tumours

A

arise from primitive neuroepithelial cells

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20
Q

Metastasis PNT

A

invade locally
metastasise in subarachnoid space

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21
Q

PNT treatment (3)

A

surgery
post-op craniospinal radiothetrapy
post-radio chemotherapy

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22
Q

Radiotherapy side effects in <4y/o

A

severe hearing loss
visual problems
ambulatory problems

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23
Q

tx: ependymoma

A

surgery
radiotherapy
(no chemo if >3y/o)

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24
Q

grading of glial tumours

A

pilocytic (low)
low grade (low)
anaplastic (intermediate)
glioblastoma multiforme (high)

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25
Q

sites of glial tumours

A

optic nerve
hypothalamic
thalamic
cerebellar
brain stem

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26
Q

tx: low grade glioma

A

watch adn wnd
surgery
watch and wait
if not able to operate - ?chemo and radio

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27
Q

tx: high grade glioma

A

palliative
temozolamide to reduce progression

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28
Q

effects of cancer therapy in children

A

endocrine - growth, puberty, thyroid, fertility
cognitive - learning and psychosocial
neurological
hearing - radiotherpy and cisplatin
2ary melignant neoplasms
cardiac

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29
Q

leukaemia

most common leukaemia in children

A

acute lymphoblastic leukaemia (ALL)

leukaemia

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30
Q

other types of leukaemia common in children

A

AML - acute myeloid leukaemia
ANLL - acute non-lymphocytic leukaemia

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31
Q

peak ages of leukaemia in children

A

ALL - peaks 2-5 y/o
AML - <2 y/o

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32
Q

pathyphysiology of leukaemia

A

bone marrow cancer
genetic mutation in one of precursor cells in bone marrow causes excessive production of single type of abnormal WBC
excessive production of one causes suppression of other lines - PANCYTOPENIA (low RBC, WBS and platelets - anaemia, luekopenia and thrombocytopenia)

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33
Q

investigations: leukaemia

A

FBC
bone marrow biopsy
coagulation screen (DIC - disseminated intravascular coagulation)
lumbar puncture (disease in CSF)
CXR (mediastinal mass - characteristic of T-cell sdisease)

34
Q

risk factors: leukaemia

A

radiation exposure (AXR in prepgnancy)
Down’s syndrome
Kleinfelter’s
Noonan
Fanconi’s anaemia

35
Q

Presentation: leukaemia (12)

A

persistent fatigue
unexplained fever
failure to thrive
weight loss
night sweates
petechiae and abnormal brusing
unexplained bleeding
lymphadenopathy
bone or joint pain (unexplained and persistent)
hepatosplenomegaly
abdominal pain
pallor

36
Q

diagnosis: leukaemia

A

immediate referral to specialist
FBC within 48 hours
blood film - can show blast cells
bone marrow biopsy
lymph node biopsy

37
Q

staging investigations: leukaemia

A

CXR
CT scan
lumbar puncture
genetics analysis and immunophenotypung

38
Q

management: leukaemia

A

chemotherapy mainstay
radio, bone marrow transplant or sugery are other options)

39
Q

complications of chemotherapy

A

endocrine - failure to thrive, puberty, growth, fertility
immunodeficiency
secondary malignancy
cadiotoxicity
neurotoxicity
infections and immunodeficiency

40
Q

3 core symptoms ALL

A

recurrent inffections (neutropenia)
anaemia (pallor and fatigue)
thrombocytopena (purpuric/bruising)

41
Q

supratentorial tumour

A

astrocytoma

42
Q

midline brain tumour

A

cranipharygioma

43
Q

cerebellar brain tumour

A

medulloblastoma, astrocytoma or ependymoma

44
Q

brainstem brain tumour

A

brainstem glioms

45
Q

spinal cord tumour

A

astrocytoma, ependymoma

46
Q

clinical features with cupratentorial (cortex tumours) (3)

A

seizures
hemiplegia
focal neurological signs

47
Q

clinical features of midline tumours

A

visual field loss (bitemporal hemianopia)
pituitary failure (growth failure, diabetes insipud, weight gain)

48
Q

clinical features with cerebellar and IVth ventricle tumour

A

truncal ataxia
co-oordination difficulties
abnormal eye movements

49
Q

clinical features of brainstem tumours

A

cranial nerve defects
pyramidal tract signs
cerebellar signs (ataxia)
no raised ICP

50
Q

4 year old refusing to walk, unable to climb stairs, qsquint and facial asymmetry with drooling

A

brainstem glioma

51
Q

10 y/o headaches, vomiting, poor groth, struggling to see board at school

A

craniopharygioma

52
Q

3 year old vomiting in mornings, unsteady on feet and new onset convergent squint

A

medulloblastoma

53
Q

14 y/o aggressive behavious, headaches, seizures

A

astrocytoma - glioblastoma multiforme

54
Q

investigations for brain tumours

A

MRI scan

55
Q

management of brain tumours

A

surgery usually 1st lune

56
Q

aetiology: neuroblastoma

A

neural crest tissue in adrenal medulla and aympathetic nervous system

57
Q

common age of neuroblastoma

A

<5y/o

58
Q

clinical features: neuroblastoma

A

abdominal mass
primary tumour usually in sympathetic chain between neck and pelvis
tumour mass often large and croses midline - affecting major blood vessels and lymph nodes
spinal cord compression

59
Q

clinical features metatstatic neuroblastoma

A

bone pain
bone morrow suppression
weight loss
malaise

60
Q

symptoms of neuroblastoma

A

palloe
weight loss
abdominal mass
hepatomegaly
bone painlimp

61
Q

investigations: neuroblastoma

A

raised urinary catecholamine metabolite levels
confirmatory biopsy

62
Q

oncogene predictive of neuroblastoma prognosis

A

MYCN

63
Q

management: neuroblastoma

A

surgery alone if no mets
chemotherapy if metastatic, stem cell, surgery and rasiotherapy

64
Q

def: Wilm’s tumour

A

nephroblastoma
originates from embryonal renal tissue and is most common renal cancer of childhood

65
Q

age of presentation with Wilm’s

A

<5y/o
(v rare after 10 y/o)

66
Q

clinical feat: Wilm’s tumour

A

large abdominal mass
haematuria
otherwise well

67
Q

RF: nephroblastoma/Wilm’s tumour

A

Beckwith-Wiedemann syndrome

68
Q

investigations: Wilm’s

A

USS
and/or CT/MRI - intrinsic renal mass

69
Q

management: wilm’s tumour

A

chemotherapu and delayed nephrectomy

70
Q

def: retinoblastoma

A

malignant tumour of retinal cells

71
Q

aetiology of retinoblastoma

A

bilateral = all hereditary (chromosome 13)
dominant pattern of inheritance but incomplete penetrance

72
Q

common age of presentation retinoblastoma

A

<3 y/o

73
Q

clinical features: retinoblastoma

A

white puilary reflex
squint

74
Q

investigations: retinoblastoma

A

MRI and examination under anaesthetic

75
Q

treatment: retinoblastoma

A

chemotherapy (esp bilateral) to shrink tumour
laser

76
Q

2 main types of bone cancer

A

osteosarcoma
Ewing sarcoma

77
Q

clinical features: bone cancer

A

limbs most common site
persistent localised bone pain
mass on limbs
mainly otherwise well

78
Q

investigation: bonce cancer

A

plain X-ray - destruction and variable periosteal new bone formation
MRI
bone scan
CT chest for lung mets
bone marrow sampling

79
Q

what is often seen on imaging of Ewing sarcoma

A

substantial soft tissue mass

80
Q

management: bone tumour

A

chemotherapy before surgery
radiotherapy in Eqing sarcoma

Year 4 Paeds (6 decks)

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