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TAS Oncology > Patterns Of Presentation > Flashcards

Patterns Of Presentation Flashcards

1
Q

What is the problem with the diagnosis of cancer?

A

Early symptoms of cancer in children are often non-specific and easily explained by more common illnesses, which can lead to delayed diagnosis

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2
Q

When should children undergo further investigation or referral for cancer?

A

Repeat attendance without a unified diagnosis

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3
Q

What is an important component of the history in suspected cancer?

A

Developmental review

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4
Q

Why is developmental review important in suspected cancer?

A

Loss of previously attained developmental milestones in a young child, and changes in school performance in an older child, may be the only indicators of a spinal cord compression or underlying brain tumour

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5
Q

What are the common patterns of presentation in children with malignancy?

A
  • Pancytopenia
  • Lymphadenopathy/unexplained mass
  • Respiratory symptoms
  • Bone/joint pain and swelling
  • Abdominal mass
  • Raised ICP
  • Neurological signs
  • Endocrine or systemic disturbances
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6
Q

What causes pancytopenia in malignancy?

A

Displacement of marrow by leukaemia or disseminated malignancy

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7
Q

What are the clinical features of pancytopenia?

A
  • Pallor/lethargy due to low haemoglobin
  • Recurrent fever/infection due to low white count
  • Bruising and/or petechiae due to low platelets
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8
Q

What features of lymphadenopathy are suspicious of malignancy?

A
  • Lymph node with diameter greater than 2cm
  • Non-tender, rubbery, hard or fixed in character
  • Supraclavicular or auxiliary location
  • Associated with other features, e.g. pallor or lethargy or hepatosplenomegaly
  • Systemic symptoms, e.g. fever, weight loss, night sweats
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9
Q

What are the respiratory symptoms suspicious of malignancy?

A
  • Orthopnoea

- Reduced air entry

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10
Q

Why is orthopnoea a feature suspicious of malignancy?

A

It is suggestive of intrathoracic mass

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11
Q

What should be considered when there is reduced air entry with suspected malignancy?

A
  • Pleural effusion

- Tumour bulk

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12
Q

What features of bone pain are suspicious of malignancy?

A
  • Persistent back pain
  • Night pain
  • Reluctance to weight-bear, or limp
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13
Q

What might cause bone pain and joint swelling in malignancy?

A
  • Bone marrow infiltration with leukaemia
  • Mets
  • Spinal tumour or impending/actual spinal cord compression
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14
Q

What are the features suspicious of malignancy with abdominal masses?

A
  • Association with general malaise

- Hypertension

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15
Q

What malignancy can cause abdominal mass associated with general malaise?

A

Neuroblastoma

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16
Q

What is the association between an abdominal malignancy and hypertension?

A

Can occur secondary to compression of the renal vasculature in Wilms’ tumour or neuroblastoma

17
Q

When might an abdominal mass be a painless and isolated finding in malignancy?

A

Wilms tumour

18
Q

What a re the clinical features of raised ICP?

A
  • Headache, especially if associated with vomiting or ataxia
  • Papilloedema
  • III and VI CN palsies
19
Q

What is the classical feature of a headache caused by raised ICP?

A

Upon waking (but timing can be non-specific)

20
Q

What is the limitation of papilloedema as a sign of raised ICP?

A

It is a late sign

21
Q

What neurological signs are suspicious for malignancy?

A
  • Cranial nerve deficits or cerebellar signs, including head tilt
  • Visual disturbances or abnormal eye movements
  • Behaviour change, deteriorating school performance, or developmental regression
  • Increasing head circumference in infants
22
Q

What are the endocrine signs that are suspicious of malignancy?

A
  • Diabetes insipidus
  • Growth hormone deficiency
  • Precocious puberty
23
Q

What are paraneoplastic phenomena?

A

Symptoms that are not directly attributable to the tumour, but arise as part of the bodies response to the disease

24
Q

Are paraneoplastic syndromes common in paediatrics?

A

No, they are rare

25
Q

What is the best example of paraneoplastic phenomena in paediatric malignancy?

A

Opsoclonus-myoclonus-ataxia syndrome (dancing eyes) in neuroblastoma

TAS Oncology (3 decks)

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