Oncology Flashcards
(46 cards)
How common is cancer in children?
Rare < 1% of all cases of malignancy Average GP will see 1 case in 15 years Average DGH will see 5 cases a year 1 in 8000 develops cancer every year 1 in 600 develops cancer before age of 15
How common is death in chilhood?
In 1st year of life - 580 deaths per 100,000
Age 1-4 27 deaths per 100,000
Age 5-14 12 deaths per 100,000
What are the main causes of death in children?
Injury Cancer CNS disorders Respiratory disease Congenital abnormalities Infectious causes
How has survival of cancers improved?
Improved over the last 30 years
- > 75% cured
- 1 in 900 adults had cancer as a child
What has the change in cancer survival done in terms of effects of treatment?
New problems - longer survival, new therapies
Life long follow-up essential
What are the differences between adult and childhood cancers?
Carcinomas are very rare in children
Embryonal tumours are rare in adults
Leukaemia occurs at all ages but more common in younger children
Bone tumours and lymphomas - peak incidence in early adolescence and early adulthood
Name 2 types of embryonal tumours
Wilms - kidney
Neuroblastoma
Rhabdomyosarcoma
What causes cancer in children?
Most cases unknown cause
- < 5% due to identifiable genetic abnormalities
- Double hit theory - interaction between environment and genetic susceptibility
Mutations in cellular genes
- Oncogenes, tumour suppressor genes, inherited eg retinoblastoma or sporadic
Some children at increased risk of cancer - Downs, immuno-compromised, NF1
How can cancers in children present?
Localised mass - lymphadenopathy, organomegaly, soft tissue or bony mass
Problems from disseminated disease - bone marrow infiltration
Problems from localised mass - airway obstruction from lymphadenopathy
Non-specific symptoms
What could the diagnosis be in a child with recent UTI, pale and tired?
Post viral
Leukaemia
What could the diagnosis be in a child with lump in neck, otherwise well?
Atypical mycobacteria
Hodgkin’s
What could the diagnosis be in a child with early morning headache?
Sinusitis
Brain tumour
What could the diagnosis be in a child with recurrent fever and bone pain?
Arthritis
Leukaemia
Ewing’s
Neuroblastoma
What could the diagnosis be in a child with abnormal red reflex in eye?
Retinoblastoma
What could the diagnosis be in a child with proptosis?
Infection
Neuroblastoma
Rhabdomyosarcoma
What could the diagnosis be in a child with recurrent discharging ear?
Infection
Rhabdomyosarcoma
LCH
When should you consider malignancy in children?
In any child whose condition doesn’t resolve or respond to treatment in the normal way
What is the most common type of ALL?
B cell
How does ALL present?
Fever Fatigue Frequent infection Lymphadenopathy Hepatomegaly and/or splenomegaly Anaemia Bruising/petechiae Bone or joint pain
What investigations should you do for ALL?
Blood film Serum chemistry CXR Bone marrow aspirate LP
What is the treatment for ALL?
Chemotherapy - 5 phases
Haemopoietic stem cell transplant
What are the 5 stages of chemotherapy and how does it differ from boys to girls and why?
Induction Consolidation Interim management Delayed intensification Maintenance Boys treated for longer as higher risk of relapse
When do you give haemopoietic stem cell transplants?
High risk patients in first remission
Relapsed patients
How do CNS tumours present?
Signs of raised ICP - headache often worse lying down, vomiting especially early morning, papilloedema Squint Nystagmus Ataxia Personality or behaviour change
