Ch 21 - Malignant Disease Flashcards Preview

Paediatrics > Ch 21 - Malignant Disease > Flashcards

Flashcards in Ch 21 - Malignant Disease Deck (14):
1

ALL: features (7)

Presentation peaks at 2-5 yrs. Features are a sign of disseminated disease & infiltration of BM. BM infiltration: anaemia - pallor + lethargy; thrombocytopenia - bruising + petechiae + nose bleeds, Neutropenia - infection Bone pain Hepatosplenomegaly LN pathy

2

ALL: Ix (2)

FBC Blood film

3

ALL: management - induction (3), maintenance (5), relapse (2)

Induction - Vincristine + dexamethasone + intrathecal methotrexate Maintenance - Vincristine + dexamethasone + 6 Mercaptopurine + methotrexate + co-trimoxazole Relapse - total body irradiation + BM transplant

4

Brain tumours general features: (6)

In children almost always primary & 60% infratentorial Clinical features are result of either raised ICP: vomiting, headache, personality change, papilloedema, tense fontanelle or from spinal tumours/mets - back pain, limb paresis, bowel bladder dysfunction

5

Give 4 types of brain tumours:

Astrocytomas - benign to highly malignant - gliobastoma multiforme Medulloblastoma - arises from midline of posterior fossa > Raised ICP - vomitting morning headache > ataxia, CN 6 & 7 signs Ependymoma - mostly in post. fossa - behaves like medulloblastoma Craniopharyngioma - a developmental tumour arising from remnant of Rathke pouch. Not truly malignant, but locally invasive & grows in suprasellar region.

6

Ix (1) & management (2) of brain tumours

MRI M - treat hydrocephalus, attempt resection

7

Give 3 features that the tumours would elicit depending on site of tumour: Supratentorial cortex, Midline, Cerebellar + 4th ventricle, Brainstem

Supratentorial cortex - seizures + hemiplegia + focal neuro

Midline - bitemp hemianopia, pituitary failure e.g. DI, growth failure Cerebellar + 4th vent - Truncal ataxia + coordination difficulties + abnormal eye movements

Brainstem - CN defects, pyramidal tract signs, cerebellar signs

8

Hodgkins Lymphoma: features (4), Ix (2), managemnet (3)

Adolsence > childhood

F - assymetrical painless LNpathy (neck), B symptoms - night sweats, weight loss, fever

Ix - LN biopsy, BM biopsy,

M - comination chemo - ABVD; adreomycin, Bleomycin, Vinblastine, Dacarbazine, +/- radio 80% cure rate

9

Non Hodgkins lymphoma: Features - T cell (3), B cell (2), Ix (3), management (1)

F - T cell; mediastinal mass, SVC obstruction, BM infiltration

B cell; localised LN disease - pain from obstruction

Ix - Radiology, biopsy, BM + CSF examination

M - multi-agent chemo e.g. B cell give rituximab

10

Neuroblastoma: definition, features (8), Ix (3), management (2)

D - tumour arising from neural crest of adrenal medulla + SNS, disease spectrum from Benign (ganglioneuroma) > v. malignant (neuroblastoma)

F - pallor, weight loss, abdo mass, hepatomegaly, bone pain, limp, paraplegia, proptosis, skin nodules

Ix - raised urinary catecholamine + BM biopsy + MIBG scan (radioisotope uptake scan)

M - Surgery for primaries, chemo for metastatic

11

Nephroblastoma (Wilm's tumour): D, features (4), Ix (1), Management (3)

D - tumour of embryonal renal cells

F - most often it will jst be an abdo mass, but sometimes  can also have abdo pain + HTN + haematuria

Ix - CT/MRI

 

Rx: Chemo > delayed nephrectomy > staged to guide radiotherapy

Good prog

12

Soft tissue sarcomas: features - head/neck (3), genitourinary (4), Ix (2), management (3)

Rhabomyosarcoma is most common

head/neck - proptosis, blood stained nasal discharge, nasal obstruction

Genitourinary - bloody vaginal discharge, scrotal mass, dysuria, urinary obstruction0

Ix - Biopsy + imaging

M - chemo, radio, surgery

13

Bone tumours: osteogenic sarcoma & Ewing sarcoma most common, features (1), Ix (2), management (3)

F - usually jst persistent bone pain

Ix - MRI, bone scan (Ewing sarcoma shows substantial soft tissue mass)

M - chemo, radio, surgery

14

Retinoblastoma: Definition, features (3), Ix (2), Management (2)

D - malignant tumour of retinal cells; dominant inhertiance - Cr 13 (if bilat is defo hereditary)

F - White pupillary reflex instead of red + squint

Rx - chemo to shrink > then laser therapy