Flashcards in Malignant Disease Deck (65)
Most common childhood cancers
Leukaemia followed by brain and spinal tumours
Ages incidence of leukaemia
Affects all ages but there is an early childhood peak
When are neuroblastoma and Wilms tumour seen
Almost always seen before 6 years old
When are Hodgkin lymphoma and bone tumours most seen?
Peak incidence in adolescence and early adult life
5 year survival of all children with cancers
Which syndromes are associated with an increased risk of cancer?
Down syndrome associate with leukaemia
Neurofibromatosis associated with glioma
What can be used to identify bone marrow disease?
Nuclear medicine imaging eg. Radio labelled technetium bone scan
What is a tumour marker for neuroblastoma?
Urinary catecholamine excretion
What is tumour marker of germ cell tumours and liver tumours?
High alphafetoprotein production
Which age of childhood cancer has poorest prognosis?
Teenagers and young adults have poorer outcomes than children
Role of radiotherapy in childhood cancers
Retains a role in treatment of some tumours but the risk of damage to growth and function of normal tissues is higher than in adults
Therefore need to protect organs and tissues
Also keeping a child still is more difficult
When can bone marrow be useful in childhood cancers and when are the various types used?
Allogenic transplants (from a compatible donor) of stem cells is principally used for high risk or relapsed leukaemia
Autologous (from patient harvested beforehand) are most commonly used for children whose prognosis is poor when use high dose chemotherapy
What is the big risk in children with cancer?
Risk of serious infection due to being immunocompromised as a result of chemo and also the cancer
Therefore need to monitor for fever and neutropenia - if either then antibiotic treatment started
Which opportunistic infections are associated with cancer therapy? x3
PCP (especially in leukaemia patients) and disseminated fungal infections (aspergillosis and candidiasis)
Also coagulate-negative staph infections from CVC's
Which viral infections are worse in cancer patient than a healthy child? x2
Chickenpox and measles can be life threatening
Other viral infections are no worse
Immunoglobulin for at risk children
GIT problems in children with cancer x3
Mouth ulcers are common therefore feeding is painful
Also chemotherapy agents are nauseating and induce vomiting
Therefore often do not feed well
Also chemotherapy induced but mucosal damage cause diarrhoea and may predispose to gram negative infection
What can doxorubicin cause?
What can cyclophosphamide cause?
What can cisplatin cause?
Renal failure and deafness
What can vincristine cause?
Which is the most common leukaemia in children
Acute lymphoblastic leukaemia - accounts for 80% of all leukaemias in children
Peak age of presentation of ALL
How does ALL present? x10
Clinical symptoms and signs are from disseminated disease and systemic ill health from infiltration of bone marrow or other organs
Therefore malaise, anorexia, anaemia (pallor and lethargy), neutropenia (infections), thrombocytopenia (bruising, petechiae, nose bleeds), bone pain from infiltration
Hepatosplenomegaly or lymphadenopathy
Onset of ALL normally
Normal presents insidiously over several weeks - but can progress very quickly
What will FBC show in ALL
Abnormal in most children, low hb, thrombocytopenia, evidence of circulating leukaemic blast cells
What investigation needs to be done to confirm ALL?
Bone marrow examination - essential to identify it but also to provide prognostic information
What other examination should be done in ALL?
Chest X-ray to look for mediastinal mass - characteristic of T cell disease
What needs to be done before ALL treatment can begin? X4
Correct anaemia (blood transfusion), decrease risk of bleeding by giving platelets, treat any infection
Allopurinol (or urate oxidase) when risk is high and high white cell count - to protect renal function against effects of rapid cell lysis
Treatment of ALL
4 weeks of combined chemotherapy - vincristine, steroid, methotrexate intrathecally (normal chemo doesn't cross BBB)
Followed by 3 weeks consolidation (first 3 + thiopurine)
Then monthly maintenance vincristine + steroids, daily 6mcp and weekly methotrexate orally - for up to 3 years
Also delayed intensification at 16weeks to consolidate remission - lots of drugs