Paediatric - Oncology Flashcards
How might Acute Leukaemia present in a child and name 2 investigations other than blood tests
a. ) Fever/Fatigue/Anaemia/Bruising/Bone pain/Infections
b. ) Chest x-ray; Bone marrow aspirate; Lumbar puncture
Detection of which cell indicates a Hodgkin’s lymphoma?
Reed-Sternberg cell
A 4-year-old male presents to the emergency department after his mother brings him in with anaemia, neutropenia, thrombocytopenia, easy bruising, pale, lethargic. What is the most likely diagnosis?
ALL
Where does a Wilms’ tumour affect?
Kidney
Wilms’ tumour is most common in children of what age?
Under 5 years
Name some features of a patient with Wilm’s tumour
- Abdominal mass
- Abdominal pain
- Haematuria
- Lethargy
- Fever
- Hypertension
- Weight loss
What is the initial investigation of a Wilms’ Tumour?
What else to stage the tumour and identify histology?
Renal ultrasound (A CT or MRI scan can be used to stage the tumour) (Biopsy to identify the histology is required to make a definitive diagnosis)
What is first treatment of Wilm’s Tumour and what is the adjuvant therapy given?
Surgical excision of the tumour along with the affected kidney (nephrectomy).
The main options for adjuvant treatment are:
- Adjuvant chemotherapy
- Adjuvant radiotherapy
Neuroblastoma is a solid tumour that affects what?
The sympathetic nervous system
most commonly in the adrenal or paraspinal sites
What is the most established genetic marker of risk in neuroblastoma?
oncogene MYCN
What are some features of a patient with a Neuroblastoma?
- Loss of appetite.
- Occasionally watery diarrhoea due to vaso-active intestinal polypeptide (VIP) secretion.
- Vomiting.
- Weight loss.
- Fatigue.
- Bruising due to pancytopenia as a result of marrow infiltration.
- Periorbital bruising - ‘racoon eyes’ (due to metastatic disease in the orbits).
- Weakness, limping, paralysis and bladder and bowel dysfunction due to spinal cord compression from paraspinal sympathetic tumours.
- Bone pain (due to bone metastases).
- Permanent cognitive deficits - rare.
Name a complication of Neuroblastoma at presentation, during chemotherapy and a surgical complication
At presentation
- Cord compression from paraspinal tumour.
- Severe hypertension.
- Renal insufficiency.
During or after chemotherapy
- Myelosuppression and immunosuppression.
- Impaired renal function.
- Hearing loss.
- Tumour lysis syndrome - hyperkalaemia, hyperuricaemia, hyperphosphataemia.
Surgical complications
- Haemorrhage.
- Intussusception.
- Injury to major vessels or nerves.
Around 40% of retinoblastoma cases are caused by a hereditary mutation on which chromosome?
13 (retinoblastoma 1 (Rb1) gene)
Name some features in a patient with a retinoblastoma
The most common and obvious sign is abnormal appearance of the pupil, leukocoria.
Second most common sign is Strabismus
Other less common and less specific signs and symptoms are:
- deterioration of vision
- a red and irritated eye
- faltering growth or delayed development.
- Some children with retinoblastoma develop a squint.
- Affected children are likely to be systemically well.
Name a treatment for Retinoblastoma
- Photocoagulation
- Cryotherapy
- Transpupillary thermotherapy
- Transpupillary thermotherapy
- Chemotherapy
- Enucleation
- External beam radiotherapy