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Sydney Child Health Program > 5.3 Childhood Malignancy > Flashcards

5.3 Childhood Malignancy Flashcards

1
Q

% of new cancers paediatric?

A

1%

1 in 600

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2
Q

Difference in paediatric cancers?

A
  • Not associated with lifestyle (except radiation exposure)

- rarely inherited (down’s leukaemia

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3
Q

Most common paediatric cancers?

A

CNS

bone marrow

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4
Q

Current cancer treatments

A

Chemo
Radiation
Surgery
Biologics

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5
Q

How many % usually children with cancer can be cured?

A

Over 75%

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6
Q

Cardinal symptoms of cancer

A
  • Recurrent fever unknown cause
  • persistent pain - bone pain
  • lymphadenopathy
  • uprpura
  • pallor
  • Strabismus
  • change in coordination/behaviour
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7
Q

Most common paediatric cancer?

A

Acute lymphoblastic leukaemia

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8
Q

Do kids get CML and CLL?

A

Rarely

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9
Q

ALL comes form which cell?

A

Lymphoid progenitor cell

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10
Q

Symptoms of ALL?

A 
Anaemia, 
bruising, 
fever, 
bone pain
Myphadenopathy, hepatosplenomegaly
-malaise
-Anorexia
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11
Q

ALL what do you see in blood tests?

A

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

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12
Q

ALL DDX?

A
  • Idiopathic thrombocytopaenia prupura
  • neutropaenias
  • anaemia
  • CBV
  • infection with lymphadenopathy
  • arthritis
  • child abuse
  • solid tumour with bone metastasis
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13
Q

Prognosis for ALL is better?

A
  • Age 2-10 better
  • lower WCC (<50 000)
  • pred response
  • no CNS disease
  • hyperdiploidy
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14
Q

ALL treatment lasts how long?

A

Around 2 years

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15
Q

ALL treatment regimen?

A
  • 5 weeks induction (98% remission)
  • 6-10 months heavy chemo
  • 1.5 years of gentle oral maintenance chemo
  • bone marrow transplant sometimes
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16
Q

How to treat CNS ALL?

A

Sometimes cranial RT

Intensive Chemo

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17
Q

How does treatment of AML differ from ALL?

A
  • 20% of childhood leukaemia
  • more serious than ALL
  • 60% cure
  • more intensive chemo
  • looks different on bone marrow
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18
Q

Childhood brain tumours usually where?

A

More posterior fossa

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19
Q

Paeds brain tumour presentation?

A 
Headache
Vomiting
Increased head circumference
FTT
Seizures
Altered gait/balance
-diplopia
-focal neuro signs
20
Q

Most common Paeds brain tumour?

A

Medulloblastoma

21
Q

Radiation therapy to brain side effects in which 4 main domains

A
  • neuro-cognitive (worse if younger)
  • neuroendocrine (pituitary, thyroid, sex hormones)
  • carcinogenic
  • hearing
22
Q

What is neuroblastoma?

A

Adrenal gland/sympathetic nerve trunks

23
Q

What is the most common extracranial paediatric tumour?

A

Neuroblastoma

24
Q

Where are most Neuroblastoma located?

A

Abdominal

25
Q

Prognosis of Neuroblastoma?

A

Poor usually

26
Q

Neuroblastoma with favourable prognosis?

A

Below 18 months

27
Q

What is Wilm’s Tumour?

A

Kidney tumour in paeds

28
Q

Difference between children with wilm’s and neuroblastoma?

A

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

29
Q

Who gets Hodgkin’s lymphoma?

A

Typically older kids (teenagers)

30
Q

Hodgkin’s lymphoma presentation?

A

Neck mass
Mediastinal mass
B symptoms

31
Q

Hodgkin’s lymphoma outcomes?

A
  • Generally good with chemo and radiotherapy

- majority are cured

32
Q

Non-Hodgkin’s lymphoma types in paeds?

A
  • T-cell lymphoblastic lymphoma
  • Burkitt’s Lymphoma (B-Cell)
  • Anaplastic large cell
33
Q

Lymphomas in general prognosis?

A

Generally good, curable with chemo only in most cases

34
Q

Ewing Sarcomas occur where?

A
  • Diaphyseal long bones
  • axial skeleton
  • extra-osseous
  • 70% survival if non-metastatic
35
Q

Osteosarcoma happen where?

A
  • Growing ends of long bones
  • distal femur, Prox tibia, Prox humerus most common
  • 70% survival if non meta
36
Q

Two kinds of retinoblastoma?

A

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

37
Q

What are the bad paediatric cancers?

A
  • Metastatic sarcomas
  • Stage IV neuroblastoma over age 1
  • high grade glioma/pontine glioma
  • ALL with bad chromosomes
  • recurrent anything…
38
Q

Paeds oncology transfusion support?

A

Platelets if <10 000

Red Cells if Hb <70

39
Q

Paeds oncology blood products special status:

A

Irradiated
CMV neg
Hi <70
Platelets <10

40
Q

Febrile neutropaenia in kids approach

A

Admit
Bloods/cultures
Antibiotics
THEN call oncologists

41
Q

If fever persists in febrile neutropaenia then what?

A 
Anti fun gals
Looks for source:
Blood
Chest
Urine
Perinatal
42
Q

Additional supportive measures in paeds chemo patients?

A
  • Always central venous lines
  • VZ V infection: prophylaxis
  • Bactrim for pneumocystis jirovecii
  • acyclovir for herpes simplex
43
Q

Immunisations on chemo?

A

No live vaccines ever!

Flu Vac is ok
Live for siblings are ok

44
Q

Late effects of cancer treatment, 5 broad categories:

A 
Organ function
Growth+development
Psychosocial
Carcinogenesis
Fertility+reproduction
45
Q

When start giving vaccines in paeds onc kids? Generally?

A

Non-live - 6 months after treatment

Live - 12 months after treatment

Sydney Child Health Program (113 decks)

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