Oncology Paeds Flashcards
What are the commonest forms of cancer and what are some risk factors?
2nd most common cause of death in children after 1 Y after injuries.
⬆️ risk: w/ chromosomal abnormalities- trisomy 21, prior malignancy, neurocutaneous syndromes, immunodeficiency syndromes, fhx, exposure ro radiation, chemicals, biological agents.
-Leukemia! Commonest (40%)
Brain tumours (20%)
Lymphomas (15%)
Malignancies to certain age groups:
🔹Newborns- neuroblastoma, Wilms tumor, retinoblastoma.
🔹Infancy + childhood- leukemia, neuroblastoma, Wilms tumor (Kidney) , retinoblastoma
🔹Adolescents: lympoma (prp na perasei jeros na sinaxei pramata) , gonadal tumors (tora ginunte developed- rapid cell division- chance of mutation) , bone tumors.
Unique tx- radiation, chemo + surgery can affect growth, development, endocrine fx, infertility.
Good prognosis ✔️
What happens in lymphadenopathies?
CF- firm, discrete, non-tender, enlarging, immobile +/- suscpicious mass/ imaging findings, +- constitutional sx.
Fluctuance, warmth or temderness are more suggestive of benign nodes( infection)
DiffDiagnosis (DD)
Infection:
Viral: URTI, EBV (causes mononucleosis) (also called human herpes virus 4- HHV-4) , CMV, adenovirus, HIV.
Bacterial: S. Aureus, GAS, anaerobes, TB, cat scratch disease( Bartonella)
Other: fungal, protozoan, Rickettsia,
Autoimmune: RA, SLE, serum sickness
Malignancy: lympona, leukemia, metastatic solid tumors.
Other: sarcoidosis, Kawasaki D, histiocytosis.
How would you investigate a lympoma?
Generalised lymphadenopathy: CBC, blood culture Uric acid, LDH, ANA, RF, ESR EBV/CMV/HIV serology Toxoplasma tilter Fungal serology CXR TB tests Biopsy
Regional lymphadenopathy: Period of onservation if asymptomatic Trial of oral antibiotics USS Biopsy - esp if persistent >6w and / or constitutional sx.
Whats leukemia?
Malignant progressive disease in which the bone marrow + other blood forming organs form increased number of immature or abnormal leucocytes. These supress the production of normal blood cells leading to anaemia + other sx.
Epidimiology:
Mean age of diagnosis: 2-5Y but at any age
Heterogenous group of disease - ALL(80%), AML (15%), CML(
Whats the clinical presentation of leukemia?
Bone pain- bone marrow failure(anaemia, neutropenia, thrombocytopenia) and infiltration of leukemic cells into bone marrow
- infiltration into tissues results in lymphadenomapthy, hepatosplenomegaly, CNS manifestations, testicular disease.
- fever, malaise, wt loss, bruising, easy bleeding.
-
‼️Hyperleucocytosis- (total WBC >10.0x10.9/dL) is a medical emergency ! 100000000.
What happens in Hyperleukocytosis?
- presents clinically- resp or neurological distress caused by hyper viscosity of blood and leukostasis.
Risk of : ICH, pulmonary leukostasis syndrome, tumor lysis syndrome.
Mx- fluids, allopurinol, FFP/ platelets- to correct thrombocytopenia, imduction chemo, avoid transfusinh RBCs unless symptomatic (then use very small volumes)
Whats the management and prognosis of leukemia?
COMBO- chemo (non- cross resistant chemo agents) , allogeneic stemm cell transplantation for high grade or reccurent disease.
Bone marrow transplant?
Supportive care + treat complications. (Febrile neutropenia, tumor lysis syndrome)
Prognosis: 80-90%- 5 Y survival for ALL, 50-60% 5Y for AML.
Prognotic fx- testicular disease/ CNS, immunophenotype.
Whats febrile neutropenia?
Development of fever, often with signs of infx,
⬇️⬇️ numbers of neutrophil granuloscytes .
Neutropenic sepsis- when pts are less well. 50% infx detectable, Bacteraemia-20% of them (B in bloodstream).
Infectious diseases guidelines:
Empirical antibiotics- until neutrophil count recovers- >500/mm3 and fever abdated.
Oral co-amoxiclav + ciprofloxacin.
More severe: cephalosporins- against pseudomonas aeruginosa- Cefepime + carbapenems.
Whats tumor lysis synrome?
TLS- group of metabolic complications that can occur after tx of cancer, usually lympomas, leukemia and smts w/o tx.
Caused by breakdown products of dying cells and include:
⬆️ blood K+
⬆️ Phosporus in blood, ⬆️ blood uric acid, ⬆️ urine uric acid,
⬇️ serum Ca+ , –> Acute uric acid nephropathy–> ARF (AKI)
↪️ lactic acidosis
Tx AKI.
Whats a lymphoma?
Any group of blood cell tumors that develop from lyphatic cells.
Sx- enlarged lymph nodes, FEVER, drenching sweats, wt loss, itching, feeling tired.
2 main subtypes:
Hodgkin lymphomas(HL) and non -Hodgkin lymphomas (NHL), (90%)
WHO- multiple myeloma+ immunoproliferative diseases.
RFs for Hodgkin lymphoma- EBV +FHX of EBV.
NHL- autoimmune, HIV/AIDs, Infx by human T- lymphotropic viruses, eating large amounts of meat and fat, immunosupressive meds, pesticides.
What is the clinical presentation of lymphomas? Whats the epidimiology?
Epidimiology: Hodgkin: 15-34Y, >50Y.
Non hodgkin- incidence peaks at 7-11Y. (Younger)
Clinical F
Hodgkin- commonest: persistent, painless, firm, cervical or supraclavicular lymphadenopathy,
Persistent Cough / dyspnea, (2o to mediastinal mass,
Less commonly- splenomegaly, axillary, or inguinal lymphadenopathy.
Non- Hodgkin- catwgorised to- lymphoblastic, large cell, and Birkitt’s lymphoma.
Rapidly growing tumor, distant metastasis (unlike adult non- Hodgkin)
SS- related ro disease site: most commonly- abdo, chest, mediastinal mass, head and neck.
How do you manage lymphomas?
Hodgkin-
Comb of Chemo+ radiothetapy
Aimed at limiting cumulative doses of anthracyclines- toxic to heart- and alkylators (risk of second malignancy, infertility) and limiting dose and field of radiation.
PET SCAN before tx to asses early disease and plan therapy.
NHL- combination chemo, no added benefit in paediatric protocols.
Prognosis-
Hodgkin- >90% 5Y survival.
NHL- 75-90% 5 Y survival.
Whats the epidimiology and CF of paediatric brain tumors?
20% of all paediatric cancers (second to leukemia)
60% of paediatric tunors are infratentorial
Paediatric tumors arise from cellular lineages:
Glia- low grade astrocytoma (supra- infratentorial), anaplastic asteocytoma, glioblastoma multiforme( largely supratentorial)
Primitive nerve cells: supratentorial (PNET)
↪️ 90% of neonatal brain tumors.
CF
Vomiting, seizures, macrocrania, hydrocephalus (megalonei)
Developmental delay (Jacob) , poor feeding, failure ro thrive.
Neural spasticity- might escape diagnosis.
Whats Wilm’s tumor?
Neohroblastoma- 2-5Y M=F
Most common 1o renal neoplasm of childhood
5-10% both kidneys simultaneously or in sequence affected.
DD
Hydronephrosis, Polycystic kidney disease, renal cell carcinoma, neuroblastoma.
CF- 80% asymptomatic, unilaterla abdo mass, HTN,
Gross haematuria, abdo pain, vomoting, may have Pulmonary metastaisis at time of diasgnosis- resp symptoms.
Asssc cognenital abnormalities:
WAGR syndrome, Beckwith Wiedemann syndrome…
Mx- staging +/- nephrectomy
Chemo, radiation for higher stages.
Whats neuroblastoma?
Rare cancer- mostly affects kids. Of sympathetic nerves,
Can affect sympathetic chain as well.
