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Paediatrics > Paeds Malignancy > Flashcards

Paeds Malignancy Flashcards

1
Q

what is the most common childhood cancer?

A

acute lympoblastic leukaemia

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2
Q

what is are the top three most common childhood cancers?

A

leukaemia
brain tumours
lymphoma

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3
Q

The presentation of paediatric malignancy can be from 3 aspects.

A
  1. mass
  2. mass pressure local effects
  3. disseminated disease
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4
Q

A girl is on chemo. She has fever with neutropenia. This needs to be investigated and treated urgently. What 4 opportunistic infections are common?

A

pneumocystis jiroveccii
aspergillus
candida
coagulase -ve staph from cath

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5
Q

Staph aureus is coagulase positive. Coagulase negative staph often cause nosocomial infections. Give me 2 examples of coagulase …

A

staph epidermidis

staph saprophyticus

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6
Q

What is a PICC line?

A

peripherally inserted central catheter

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7
Q

What things might be involved in supportive care for child with cancer?

A

fertility preservation
central venous catheter
psychosocial support

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8
Q

Give me some side effects of chemo.

A 
bone marrow suppression
gut mucosal damage
nausea + vomiting
anorexia
alopecia
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9
Q

Side effect of vincristine?

A

neuropathy

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10
Q

Side effect of cisplatin?

A

deafness

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11
Q

Side effect of cyclophosphamide?

A

haemorrhagic cystitis

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12
Q

What is the most common leukaemia for kids?

A

acute lymphoblastic leukaemia (80%)

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13
Q

80% of kids’ leukaemia is acute lymphoblastic leukaemia. Remainder are…

A

acute myeloid leukaemia

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14
Q

What are the myeloid cells?

A

granulocytes
megakaryocytes
RBCs
monocytes

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15
Q

What are the lymphoid cells?

A

T cells

B cells

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16
Q

What makes a leukaemia ‘acute’?

A

> 20% blasts in bone marrow

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17
Q

Crowding of blasts in acute leukaemia leads to marrow failure and infilitration. What are the consequences of marrow failure for the patient?

A

anaemia
bleeding
infection
BONE PAIN!

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18
Q

Crowding of blasts in acute leukaemia leads to marrow failure and infiltration. What are the consequences of infiltration for the patient?

A

CNS - headaches, vom, CN palsies
lymphadenopathy
hepato spleno megaly

(testes enlargement)

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19
Q

In acute leukaemis blasts build up because they’re not differentiating. They crowd and spill over into bloodstream and other parts of body, which is called?

A

infiltration

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20
Q

Give me two GENERAL symptoms of acute leukaemia.

A

malaise

anorexia

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21
Q

What would show up on the blood film in acute leukaemia?

A

blast cells

FBC sometimes abnormal

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22
Q

Give me two risk factors for acute leukaemia.

A

Down’s

Radiation

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23
Q

What is the key investigation for classifying acute leukaemia?

A

BONE MARROW ASPIRATE

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24
Q

What other investigations would you do once you’ve confirmed acute leukaemia from bone marrow aspirate?

A

clotting screen
LP
CXR

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25
Q

What might you be looking for on CXR in acute leukaemia?

A

mediastinal mass

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26
Q

Why do you use allopurinol as part of supportive care in acute leukaemia?

A

prevent hyperuricaemia

when therapy causes rapid lysis of cells

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27
Q

What might supportive care of acute leukaemia involve?

A
  • transfuse for anaemia
  • transfuse plt.s
  • treat infection
  • allopurinol
  • hydration
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28
Q 
Transfuse for anaemia
Transfuse plts
Treat infection
Allopurinol
Hydration

is all supportive care for

A

acute leukaemia

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29
Q

There are four steps of chemo for acute leukaemia. What are they?

A
  1. remission induction
  2. intensification
  3. intrathecal chemo
  4. maintenance chemo
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30
Q

What drugs are involved in remission induction for acute leukaemia?

A

combination chemo + steroids

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31
Q

What is the purpose of remission induction for acute leukaemia?

A

eradicate leukaemic blasts

+ restore marrow function

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32
Q

What is the purpose of intensification chemo for acute leukaemia?

A

to consolidate remission

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33
Q

What is the purpose of intrathecal chemo for acute leukaemia?

A

prevent CNS relapse

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34
Q

A 9 yr old girl has been through remission induction, intensification, and intrathecal chemo for acute lymphoblastic leukaemia. How long will she need maintenance chemo?

A

2 yrs

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35
Q

An 8 yr old boy has been through remission induction, intensification, and intrathecal chemo for acute lymphoblastic leukaemia. How long will he need maintenance chemo?

A

3 yrs

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36
Q

How long do boys and girls need maintenance chemo in acute lymphoblastic leukaemia?

A

girls - 2 yrs

boys - 3 yrs

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37
Q

What drug do you give for Pneumocystic jirovecii prophylaxis during chemo?

A

co-trimoxazole

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38
Q

Why would you give a child co-trimoxazole during chemo?

A

co-trimoxazole prophylaxis

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39
Q

How do you manage a relapse of acute leukaemia?

A

high dose chemo (+ radio)

then BONE MARROW TRANSPLANT

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40
Q

What are the two types of acute leukaemia?

A

acute lymphoblastic leukaemia (ALL)

acute myeloid leukaemia (AML)

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41
Q

Give me 5 indicators of prognosis of acute leukaemia?

A
  • age
  • tumour load (WCC)
  • genetic abnormalities in malig cells
  • speed of response to initial chemo
  • “minimal residual disease assessment”
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42
Q

What is the “minimal residual disease assessment” in prognosis of acute leukaemia?

A

are there still tumour markers after remission induction?

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43
Q

What ages are bad for acute leukaemia prognosis?

A

<1 or >10

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44
Q

What are the survival rates for acute lymphoblastic leukaemia?

A

> 90%

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45
Q

Most brain tumours in kids are….

A

primary and infratentorial

below tentorium cerebelli

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46
Q

What child brain tumour in cortex?

A

astrocytoma

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47
Q

What child brain tumour near pituitary tissue?

A

craniopharyngioma

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48
Q

What child brain tumour in brainstem?

A

brainstem glioma

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49
Q

What child brain tumours are cerebellar?

A

medulloblastoma

ependymoma

50
Q

Remnant of Rathke’s pouch. Not malignant but invasive. ?

A

Craniopharyngioma

51
Q

What is the leading cause of childhood cancer deaths in UK?

A

brain tumours

even tho acute leukaemia is most common cancer

52
Q

Infant with developmental delay, increase in head circumference, and bulging fontanelle. Suspect?

A

brain tumour

53
Q

Child/adolescent with recurrent early morn headache, blurred/double vision, worse school performance, poor growth and delayed puberty. Suspect?

A

brain tumour

54
Q

Some symptoms of brain tumour specific to child / adolescent?

A

recurrent early morn headache
blurred / double vision
worse school performance
poor growth / delayed puberty

55
Q

Some symptoms of brain tumour specific to infant?

A

developmental delay
increase in head circumference
bulging fontanelle

56
Q

Afebrile seizures, vomiting, abnormal eye movements, behaviour change, lethargy, and problems with balance/coordination are all symptoms of…

A

brain tumour

57
Q

Name some general brain tumour symptoms for all ages

A 
Afebrile seizures
vomiting
abnormal eye movements
lethargy
behaviour change
probs w balance / coordination
58
Q

This tumour causes seizures, focal neuro deficit, and hemiplegia. It makes up 40% of child brain tumours and is found in the cortex.

A

astrocytoma

~~~~ glioblastoma multiforme

59
Q

What are the 2 consequences of craniopharyngioma (benign but invasive)?

A

BITEMPORAL HEMIANOPIA
PITUITARY FAILURE
(growth failure,, weight gain, diabetes insipidus)

60
Q

Why does craniopharyngioma cause bitemporal hemianopia?

A

presses on optic chiasm

61
Q

Truncal ataxia and decreased coordination. What kind of brain tumour might this be?

A

cerbellar

medullloblastoma, ependymoma

62
Q

Does persistent back pain in children warrant MRI?

A

yes

might be spinal tumour

63
Q

Which brain tumour commonly metastasises to spine?

A

medulloblastoma (cerebellar)

lots have spinal mets at diagnosis

64
Q

Cranial nerve defects. What kind of brain tumour might this be? Would you do a biopsy?

A

brainstem glioma

biopsy too hazardous

65
Q

What is the prognosis like for brainstem glioma?

A

<10% survival.

palliative radiotherapy.

66
Q

Back pain. Arm/leg weakness. Bladder/bowel dysfunction. What kind of tumour might this be?

A

spinal

can be primary astrocytoma in spine or mets from medulloblastoma

67
Q

What are the investigations for a suspected brain tumour in a chid?

A

MRI head + spine
MR spectroscopy

(LP to check for CSF mets for staging but only carefully on neurosurgical advice)

tissue diagnosis from surgery - biopsy

68
Q

When would you do LP for child with suspected brain tumour?

A

only on neurosurgical advice bc risky if raised ICP!

used to check for CSF mets for staging

69
Q

What tends to be the treatment for brain tumour?

A

surgery
(biopsy, treat hydrocephalus, resection is poss)

+/- radio + chemo
(age + stage)

70
Q

What warning signs are included in HeadSmart campaign for diagnosing childhood brain tumours?

A
  • EYES new squint / nystagmus / papilloedema
  • HEAD ache early morn / worse lying down
  • VOM early morn effortless vom
71
Q

What warning signs are included in HeadSmart campaign for diagnosing childhood brain tumours?

A
  • EYES new squint /nystagmus /papil
  • HEAD ache early morn /worse lying down
  • VOM early morn effortless vom
72
Q

The third commonest childhood cancer is lymphoma. What actually is lymphoma?

A

uncontrolled proliferation of lymphocytes (B + T cells)

73
Q

Which lyphoma mainly affects ADOLESCENTS?

A

Hogkins.

also 50yr olds - bimodal

74
Q

Which lymphoma mainly affects children (as opposed to adolescents)?

A

non-Hodgkins

75
Q

Which is the commoner lymphoma?

A

NON hodgkins

76
Q

Which cells distinguish Hodgkins from Non Hodgkins?

A

Reed-Sternberg

77
Q

Painless cervical lymphadenopathy. What FLASHES across your mind?

A

Hodgkins lymphoma

hard rubbery big

78
Q

What staging is used for Hodgkin’s lymphoma

A

ann arbor

I - one lymph node; IV- extranodal

79
Q

What are the symptoms of Hodgkin’s lymphoma?

A

painless cervical lymphadenopathy.
SOB, chest pain, cough

(long Hx)
(B symps rare in kids - weight loss, fever, night sweats)

80
Q

16 yr old presents with painless cervical lymphadenopathy and breathlessness. Hodgkin’s lymphoma should be on your list of differentials. What investigations for that?

A

FBC, ESR
lymph node biopsy - diagnostic
CT chest abdo pelvis
bone marrow biopsy - staging

81
Q

What is it that causes the SOB, chest pain and cough in Hodgkin’s lymphoma?

A

mediastinal lymphadenopathy

82
Q

17 yr old presents with painless cervical lymphadenopathy and cough. After FBC + ESR to exlcude other causes, you do lymph node biopsy. If it’s Hodgkin’s lymphoma, what would you expect to see on histology?

A

Reed-Sternberg cells

multinucleated giant cells

83
Q

A malignant tumour of the lymphatic system that is characterised histologically by the presence of multinucleated giant cells (Reed-Sternberg cells). What’s this?

A

Hodgkin’s

84
Q

name some risk factors for Hodgkin’s lymphoma

A

EBV

immunosuppression, HIV

85
Q

name some risk factors for Hodgkin’s lymphoma

A

EBV

immunosuppression, HIV

86
Q

What kind of scan is good to monitor response to treatment in Hodgkin’s lymphoma?

A

PET scan

87
Q

Investigations into a teenager with Hogkins lymphoma show that the malignancy remains in one lymph node only. What Ann Arbor stage is this?

A

stage I

88
Q

What % of kids with Hogkin’s lymphoma are cured?

A

80%

89
Q

What is the treatment for Hodgkin’s lymphoma?

A

COMBINATION CHEMO (+/- radio)

90
Q

What % of kids with Non Hogkins lymphoma survive?

A

80%

91
Q

Tell me about the long term toxicity of radiotherapy for Hodgkins lymphoma.

A

leukaemia risk

Breast, lung and thyroid Ca risk

92
Q

What is primary lymphoid tissue?

A

bone marrow

93
Q

What is secondary lymphoid tissue? (x4)

A

spleen
blood
lymph nodes
MALT

94
Q

What are B lymphocytes and where are they.

A

plasma cells
memory cells

lymph noes

95
Q

What are T lymphocytes and where are they.

A

T helper
cytotoxic T

thymus

96
Q

Non-Hogkins lymphoma is the commoner lymphoma. It’s uncontrolled proliferation of which lymphocytes mainly?

A

B lymphocytes

97
Q

B cell non hogkin lymphoma can cause lymphadenopathy in head neck and abdo. How can this manifest as symptoms?

A

bowel obstruction (palpable mass, intussusception)

98
Q

T cell non hodgkin lymphoma can cause lymphadenopathy in MEDIASTINUM. What symptoms can this lead to?

A

SVC obstruction
SOB
facial swelling

99
Q

acute leukaemia starts off in the marrow and infiltrates the nodes. Whereas non hogkins lymphoma starts off in the nodes and infiltrates the marrow. yes?

A

yes

100
Q

What is the treatment for non hodgkin lymphoma?

A

MULTIAGENT CHEMO

101
Q

6yr old presents with lymphadenopathy in head and neck, and bowel obstruction with palpable mass. You suspect non hodgkin lymphoma. What investigations do you do?

A

lymph node biopsy
CT chest abdo pelvis
bone marrow biopsy

102
Q

Apart from ‘endemic’ Burkitt’s lymphoma (in areas of Africa with high EBV and chronic malaria), what other types of Burkitt lymphoma are there?

A

sporadic

imm def associated

103
Q

Which part of body does advanced Burkitt’s lymphoma affect?

A

jaw

104
Q

What is treatment for Burkitt’s lymphoma?

A

multiagent chemo

105
Q

What cells uncontrolled proliferation in Burkitts lymphoma?

A

B lymphocytes

its NHL

106
Q

What is neuroblastoma?

A

primary tumour anywhere along sympathetic chain, esp neural crest tissue in adrenal medulla

affects <5s

107
Q

Why is neuroblastoma unsusual?

A

it can spontaneously regress?!

108
Q

What is most common symp of neuroblastoma?

A

abdo mass

adrenal in origin
(if paravertebral - cord compression)

109
Q

What is the key investigation for suspected neuroblastoma?

A

high VMA / HVA

catecholamine metabolites

110
Q

Which radioactive isotope injection scan maps metastases in neuroblastoma?

A

MIBG scan

111
Q

What’s Wilm’s tumour?

A

nephroblastoma

<5yrs

112
Q

How does nephroblastoma present?

A

abdo mass
haematuria
otherwise welll

113
Q

Ix and Rx for Wilm’s?

A

US , CT/MRI - renal mass

chemo then nephrectomy

114
Q

Ewing and osteosarcoma affect bones, whereas rhabdomyosarcoma affects…

A

muscle

115
Q

Which vaccines should be given to children receving treatment for Hodgkin’s lymmphoma?

A

penumococcal vaccine

flu jab

116
Q

Child <3yrs with squint and white pupilllary reflex (absentt red reflex). Which cancer do you suspect?

A

retinoblastoma.

laser therapy

117
Q

Langerhans cell histiocytosis a.k.a

A

eosinophilic granuloma

histiocytes are dendritic antigen presenting cells

118
Q

Abnormal prolif of histiocytes, causing bone lysis and diabetes insipidus. Rare AF. What’s this?

A

Langerhans cell histiocytosis

119
Q

What age kids does acute lymphoblastic leukaemia affect?

A

ALL (all)

120
Q

List 6 long term effects of paediatric malignancy / chemo / radio / surgery.

A 
specific organ dysfunction
poor growth
infertility 
second cancer
neuropsychological
social / educational

Paediatrics (14 decks)

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