Chapter 8- Childhood Cancers

Question 1

What are the most frequent childhood malignancy cancers?

Answer 1

1. acute leukaemia
2. brain tumours
3. lymphoma
4. neuroblastoma

Question 2

When are neuroblastoma, nephroblastoma, retinoblastoma and medilloblastoma more common ? (age of incidence)

Answer 2

• First years of life

- they are congenital

Question 3

Which cancer are more common in the teenage years?

Answer 3

bone malignancy,
hodgkins disease
testicular and ovarian

Question 4

why is mortality and morbidity rates higher in children who recieved radiation and chemo?

Answer 4

• secondary malignancies
• developmental abnormalities related to administration
  future complications

Question 5

Most primary conditions associated with juvenile cancer have significant mortality in and of themselves. Such as?

Answer 5

neurofibromatosis, 
tuberous sclerosis
von hippel-Lindau disease
ataxia telangiectasia 
Down syndrome

Question 6

Which children are at the highest risk of serious late effects from their cancer treatment, including second cancers, congestive heart failure, and eventual joint replacements?

Answer 6

Those treated for:
Brain tumours
hodgkinds lymphoma,
or any use of radiation to the abdomen, pelvis or chest.

Question 7

what tumors is the most common childhood solid tumor, and also the second most frequent malignancy in children and adolescents?

Answer 7

brain tumours

• 45% mortality rate from the disease and highest morbidity
• sxs: headaches, vomiting, papilledema, seizures, personality changes, balance and weakness.
• usually diagnosed late

Question 8

What is the most common juvenile brain lesion?

Answer 8

Astrocytoma

• low-grade malignancies more favourable.
• tx is radiation, chemo and surgery.
• 90% survival

Question 9

which astrocytomas have a more favourable prognosis

Answer 9

Low-grade (grade 1 and 2) with complete excision.

Question 10

What is the most lethal type of astrocytomas?

Answer 10

Glioblastoma (multiform)

Question 11

What is a Medulloblastoma?

Answer 11

occurs exclusively in children

• in posterior fossa of the brain
• complete remove is difficult and usually requires re-excision
• 5 year survival rate of 70%

Question 12

What is the Ependymoma

Answer 12

posterior fossa tumor

• poor prognosis
• tx’ed with radiation,
• 40% 5 year survival rate

Question 13

What is a neuroblastoma?

Answer 13

most common solid extra-cranial tumour in children.

• arise in abdomen (adrenal gland or sympathetic ganglia)
• sxs: bone pain, loss of appetite, weight loss, fatigue≥ Anemia, high platelet and iron counts
• CXR diagnosis, f/u MRI or CT.
• tx: chemo and bone marrow transplant, and radiation. Surgery is not always effective.
• stage 3 and 4 have poor prognosis
• mortality can be sig for 10 years

Question 14

What is Nephroblastioma ( Wilms’ tumour)

Answer 14

• second most common abdo tumour in children
• starts in kidney and is composed of blastema, epithelia and stroma
• 7% Bilateral.
• sporadic + genetic cases
• sxs: asymptomatic mass or swelling, sometime fever or hematuria, HTN
• U/s or CT diagnosis.
• metastasis is common.
• tx: surgery and chemo. post-op radiation if needed

Question 15

What is the survival rate for Wilms’ tumour?

Answer 15

better for stage 1 and 2
5 year survival 90%, unless cells show aggressive behaviour.
- 150% mortality 5-10 years. Better prognosis as kids get older.
- morbidity ^^ d/t radiation = muscle atrophy, bone grow issues, spinal shortening.

Question 16

What are retinoblastomas?

Answer 16

higher rates of cure 90%
cancer is bilateral
dx before 5 yo.
usually familial, 25-30% of dx are d/t mutation in gene RNA
-older age is worst prognosis d/t advancement of disease
- sxs: leukocoria, white papillary reflex of light during
- dx: opthomology exam, ultrasound and bone scans

Question 17

How are retinoblastoma’s treated?

Answer 17

• used to remove whole eye. only now used when 50% of retina is involved with tumour.
• Main tx is radiation, and chemo if child is at risk of metastasis.

Question 18

True or False

those who has the familial type have a significant risk of developing a second cancer?

Answer 18

yes,
develop in and outside of radiation field.
most common second cancer are soft tissue sarcomas, and ostosarcoma.

Question 19

What are the two most common types of malignant bone tumors in children?

Answer 19

osteosarcoma (60) and Ewing sarcoma.

- later occurring cancer (10’s/20’s)

Question 20

what are some growth changes that occur with osteosarcoma?

Answer 20

• usually correlate with growth spurts
• children with dx are taller than peers
• appears in bones with greater increase in size/length ie: distal femur

Question 21

What are the symptoms, and treatments for osteosarcoma?

Answer 21

sxs: pain and swelling,
dx: Xray, and bone marrow/CBC tests. MRI assess the severity.
complication: pulmonary metastases,
tx: chemo, amputation.

Question 22

What is Ewing Sarcoma?

Answer 22

less common, Males > females

• dx made on biopsy,
• sxs: pain swelling and bone mass on Xray signs and diagnostic
• better prognosis, unless metastatic

Question 23

What are Rhadomyosarcoma?

Answer 23

most common pediatric sarcoma,

• occur everywhere in the body
• prognosis is related to age of the child, site or origine, metastasis and lymph node involement.

Question 24

what are the symptoms of rhabdomyosarcomas?

Answer 24

palpable mass,
organ displament d/t tumour
- sxs relate to location of tumour
- hard to diagnose, biopsy and histrochemical staining is most effective diagnostic test.

Question 25

What is the primary treatment for Rhabdomyosarcoma

Answer 25

excision of the lesion, chemo- preoperatively to shrink growth. Radiation is effective means to control local spread - location of disease = better prognosis - second malignancies are most common,

Question 26

When are Germ cell cancers of reproductive organs most likely to occur in the paediatric life?

Answer 26

later ages once organs have begun sexual function - radiotherapy and surgical tx. - favourable long-term outlooks

Question 27

How are Hepatic Tumors treated?

Answer 27

cure rate is only about 50% | chemo and resection of the tumor mass, liver transplant in children

Question 28

What are the two most common problems for juvenile cancer survivors?

Answer 28

psychological and psychosocial complications - they miss school, ongoing academic support requires and psychiatric counselling well into adulthood. - radiation therapy have higher risk of neuropsychological problems (lack of visual motor integration, short-term memory deflicts, and sequencing ability problems).

Question 29

What endocrine problems can occur in children who received extensive chemo and radiation therapy?

Answer 29

hypothalmic-pituitrary-end organ axis is activated prematurely, epiphyseal closure can be premature, and height and growth can be delayed. - hypothyroidism and thyroid cancer ^ reproductive function can be affected when germ cell cancers are treated.

Question 30

Why are cardiopulmonary and renal complications that occur d/t the treatment rather than the disease in children?

Answer 30

bleomycin in a recognized cause of pulmonary fibrosis. Doxorubicin and Adrimycin are known for cardiac toxicity and eventually cardiomyopathy radiation can induce pericarditis and lower EJ Cisplatin causes renal tubular necrosis and renal toxicity

Question 31

What cancers are at higher risk for secondary cancers?

Answer 31

1. Genetic and familial conditions: retinoblastoma | 2. Leukaemia (acute lymphatic leukaemia) and Hodgkin's