5.3 Childhood Malignancy

Question 1

% of new cancers paediatric?

Answer 1

1%

1 in 600

Question 2

Difference in paediatric cancers?

Answer 2

• Not associated with lifestyle (except radiation exposure)

- rarely inherited (down’s leukaemia

Question 3

Most common paediatric cancers?

Answer 3

CNS

bone marrow

Question 4

Current cancer treatments

Answer 4

Chemo
Radiation
Surgery
Biologics

Question 5

How many % usually children with cancer can be cured?

Answer 5

Over 75%

Question 6

Cardinal symptoms of cancer

Answer 6

• Recurrent fever unknown cause
• persistent pain - bone pain
• lymphadenopathy
• uprpura
• pallor
• Strabismus
• change in coordination/behaviour

Question 7

Most common paediatric cancer?

Answer 7

Acute lymphoblastic leukaemia

Question 8

Do kids get CML and CLL?

Answer 8

Rarely

Question 9

ALL comes form which cell?

Answer 9

Lymphoid progenitor cell

Question 10

Symptoms of ALL?

Answer 10

Anaemia, 
bruising, 
fever, 
bone pain
Myphadenopathy, hepatosplenomegaly
-malaise
-Anorexia

Question 11

ALL what do you see in blood tests?

Answer 11

Hb 5-60
Thombocytopaenia (platelets 10-20,000)
White cells: lost of blasts
Neutropaenia

Question 12

ALL DDX?

Answer 12

• Idiopathic thrombocytopaenia prupura
• neutropaenias
• anaemia
• CBV
• infection with lymphadenopathy
• arthritis
• child abuse
• solid tumour with bone metastasis

Question 13

Prognosis for ALL is better?

Answer 13

• Age 2-10 better
• lower WCC (<50 000)
• pred response
• no CNS disease
• hyperdiploidy

Question 14

ALL treatment lasts how long?

Answer 14

Around 2 years

Question 15

ALL treatment regimen?

Answer 15

• 5 weeks induction (98% remission)
• 6-10 months heavy chemo
• 1.5 years of gentle oral maintenance chemo
• bone marrow transplant sometimes

Question 16

How to treat CNS ALL?

Answer 16

Sometimes cranial RT

Intensive Chemo

Question 17

How does treatment of AML differ from ALL?

Answer 17

• 20% of childhood leukaemia
• more serious than ALL
• 60% cure
• more intensive chemo
• looks different on bone marrow

Question 18

Childhood brain tumours usually where?

Answer 18

More posterior fossa

Question 19

Paeds brain tumour presentation?

Answer 19

Headache
Vomiting
Increased head circumference
FTT
Seizures
Altered gait/balance
-diplopia
-focal neuro signs

Question 20

Most common Paeds brain tumour?

Answer 20

Medulloblastoma

Question 21

Radiation therapy to brain side effects in which 4 main domains

Answer 21

• neuro-cognitive (worse if younger)
• neuroendocrine (pituitary, thyroid, sex hormones)
• carcinogenic
• hearing

Question 22

What is neuroblastoma?

Answer 22

Adrenal gland/sympathetic nerve trunks

Question 23

What is the most common extracranial paediatric tumour?

Answer 23

Neuroblastoma

Question 24

Where are most Neuroblastoma located?

Answer 24

Abdominal

Question 25

Prognosis of Neuroblastoma?

Answer 25

Poor usually

Question 26

Neuroblastoma with favourable prognosis?

Answer 26

Below 18 months

Question 27

What is Wilm’s Tumour?

Answer 27

Kidney tumour in paeds

Question 28

Difference between children with wilm’s and neuroblastoma?

Answer 28

Wilm’s children are generally well, with large Abdo mass, flank pain, incidental -outlook is generally good

Question 29

Who gets Hodgkin’s lymphoma?

Answer 29

Typically older kids (teenagers)

Question 30

Hodgkin’s lymphoma presentation?

Answer 30

Neck mass Mediastinal mass B symptoms

Question 31

Hodgkin’s lymphoma outcomes?

Answer 31

- Generally good with chemo and radiotherapy | - majority are cured

Question 32

Non-Hodgkin’s lymphoma types in paeds?

Answer 32

- T-cell lymphoblastic lymphoma - Burkitt’s Lymphoma (B-Cell) - Anaplastic large cell

Question 33

Lymphomas in general prognosis?

Answer 33

Generally good, curable with chemo only in most cases

Question 34

Ewing Sarcomas occur where?

Answer 34

- Diaphyseal long bones - axial skeleton - extra-osseous - 70% survival if non-metastatic

Question 35

Osteosarcoma happen where?

Answer 35

- Growing ends of long bones - distal femur, Prox tibia, Prox humerus most common - 70% survival if non meta

Question 36

Two kinds of retinoblastoma?

Answer 36

Non germinal - 29/30months diagnosis -unilateral Germinal - 14-16 months diagnosis -bilateral

Question 37

What are the bad paediatric cancers?

Answer 37

- Metastatic sarcomas - Stage IV neuroblastoma over age 1 - high grade glioma/pontine glioma - ALL with bad chromosomes - recurrent anything...

Question 38

Paeds oncology transfusion support?

Answer 38

Platelets if <10 000 | Red Cells if Hb <70

Question 39

Paeds oncology blood products special status:

Answer 39

Irradiated CMV neg Hi <70 Platelets <10

Question 40

Febrile neutropaenia in kids approach

Answer 40

Admit Bloods/cultures Antibiotics THEN call oncologists

Question 41

If fever persists in febrile neutropaenia then what?

Answer 41

``` Anti fun gals Looks for source: Blood Chest Urine Perinatal ```

Question 42

Additional supportive measures in paeds chemo patients?

Answer 42

- Always central venous lines - VZ V infection: prophylaxis - Bactrim for pneumocystis jirovecii - acyclovir for herpes simplex

Question 43

Immunisations on chemo?

Answer 43

No live vaccines ever! Flu Vac is ok Live for siblings are ok

Question 44

Late effects of cancer treatment, 5 broad categories:

Answer 44

``` Organ function Growth+development Psychosocial Carcinogenesis Fertility+reproduction ```

Question 45

When start giving vaccines in paeds onc kids? Generally?

Answer 45

Non-live - 6 months after treatment | Live - 12 months after treatment