PAEDS - haem, oncology, MSK Flashcards
what is the most common form of malignancy in children?
acute lymphoblastic leukaemia
what is the most common of child leukaemias?
ALL
what genetic disorder is associated with childhood leukaemias?
down’s syndrome
define acute lymphoblastic leukaemia (ALL). what are lymphocytes?
a malignant disorder of the bone marrow - malignancy of lymphoblast cells (precursor for lymphocytes)
lymphocytes are WBCs e.g. T cells, B cells
RFs for ALL (5)
- radiation
- genetics
- DS
- previous chemo
- immunodeficiency
brief pathophysiology of ALL
- pause in maturation of lymphocytes (B and T cells)
- uncontrolled proliferation of lymphoblasts within the bone marrow
- other cells in bone marrow are crowded out»_space; cytopenia
B symptoms of ALL
- weight loss
- appetite loss
- night sweats
- fever
signs and symptoms of ALL
a) key
b) other
a) anaemia > fatigue, pallor
neutropenia > frequent infections
thrombocytopenia > easy bruising, bleeding, petechiae
b) lymphadenopathy
hepatosplenomegaly
bone/joint pain
headache
investigations for ALL (5)
- FBC
- blood film
- BM biopsy
- lumbar puncture (check for CNS involvement)
- CXR and CT (check for abdo involvement)
a) what key triad will be found on a FBC in ALL?
b) what will be found on blood film?
c) what will be found on BM biopsy?
a) anaemia (low RBC), thrombocytopenia (low platelets) and neutropenia (low WCC)
b) lymphoid blast cells (lymphoblasts)
c) increased cellularity
management of ALL (3)
- 5 phases of chemotherapy given intravasc/oral/intrathecal (CSF) e.g. methotrexate
- supportive care with blood products e.g. red cells, platelets
- prophylactic anti-fungal therapy e.g. oral triazole
what management option is available for ALL for high risk patients in 1st remission/relapse patients?
haemopoietic stem cell transplantation (HSCT)
poor prognostic factors for children with ALL (5)
- age <2 or >10
- WBC >20 x 10*9
- T or B cell surface markers
- non-Caucasian
- male
what are the 3 types of brain tumours in childhood? where are they commonly found?
- astrocytoma (most common) - tumour of astrocyte cells, commonly near brainstem/optic chiasm
- medulloblastoma - tumour of the primitive neuroectodermal cells
- brainstem/pontine glioma - arising in brainstem, commonly pons or thalamus
what is the most common malignant brain tumour in children?
medulloblastoma
which of the following is usually malignant, and which is usually benign?
a) medulloblastoma
b) astrocytoma
a) normally malignant
b) normally benign
are brain tumours in children nearly always primary or secondary?
primary (unlike adults)
RFs for primary brain tumours in children (5)
- personal/fam hx of brain tumour/leukaemia/sarcoma/BC
- prior CNS irradiation
- neurofibromatosis
- tuberous sclerosis
- other familial genetic syndromes
signs and symptoms of a paediatric brain tumour
may be part of a broader picture of delayed milestones, neurodevelopmental delay etc..
- headache - often worse lying down, coughing, sneezing
- nausea/vomiting - esp early morning
- personality/behaviour change
- polyuria/polydipsia (tumours can stop ADH production)
- seizures
what may be seen on clinical examination of a child with a brain tumour? (visual, motor, growth)
- visual - diplopia, reduced visual acuity/fields, abnormal eye movements
- motor - abnormal gait/coordination, swallowing difficulties, weakness
- delayed growth, delayed/arrest or precocious puberty
signs of a brain tumour in infants (4)
- lethargy
- developmental delay/regression
- increase in head circumference/bulging fontanelles
- seizures
ddx for a brain tumour in children (5)
- migraine
- meningitis/encephalitis
- intracranial haemorrhage
- otitis media
- neurofibromatosis
investigations for childhood brain tumour (2)
- MRI
- lumbar puncture
surgical management options for brain tumours in children (2)
- surgical resection
- CSF shunts if hydrocephalus