Oncology / Haematology Flashcards by Eilidh Seaton

What is the most common cancers in children

Leukaemia - 33%
Brain tumour - 25% but higher mortality (posterior common)
Extra-cranial

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What are extra cranial

Lymphoma - Hodgkin's / non-Hodgkin's 
Neuroblastoma
Soft tissue 
Nephroblastoma 
Retinoblastoma 
Malignant Bone 
Germ cell 
Hepatic

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What causes cancer in childhood

Sporadic
Genetics
Environment - Radiation / infection - HPV
Iatrogenic - RT / chemo

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What is the prognosis of childhood cancer

> 80% 5 year survival

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How do you classify childhood cancer

International Classification of Childhood Cancer (ICCC)

Based on tumour morphology and primary site

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What genes are involved

Downs syndrome 
Fanconi 
Beckwith Weidemanne syndrome (BWS) 
Li-Fraumeni p53 
Neurofibromatosis

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What age group is most likely to get cancer

Peak at 0-4 = highest rate

Another peak at 18-22

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What are people with Down’s likely to get

Leukaemia

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What is Li-Fraumeni syndrome

Autosomal dominant
p53 gene
50% chance of cancer by 30
90% chance of cancer by 70

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What suggests immediate referral to hospital (same day)

Unexplained petechiae

HSM

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What suggests urgent referral (48 hour)

Repeated attendance with same problem
New neuro symptoms
Abdominal mass

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What suggests a referral (2 week) + FBC in 24 hours

Rest pain
Back pain
Unexplained lump
Lymphadenopathy 
Unexplained and persistent symptoms
Extreme fatigue
Extreme weight loss
Changes in mole

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Symptoms of brain tumour

Commonly posterior 
Persistent vomiting - morning
Persistent headache 
Signs of raised ICP 
Cerebellar signs - DANISHP 
Behaviour change
Lethargy 
Fits / seizures 
Abnormal head position 
Blurred / double vision 
Delayed puberty 
CN palsies

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Signs of cancer to be aware off

UNEXPLAINED 
PERSISTENT 
Lump / bump / swelling 
Extreme tiredness
Excessive Sweating 
Significant weight loss
Changes in a mole / bruising

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How do you Dx what the tumour is and where it is

Tumour markers of germ cell / liver

Scans - USS for screen / MRI
Biopsy - pathology
Tumour marker on bloods / pregnancy test on man for bHCG  
ALP = live / baby / bone 
Stage - scans / bone marrow

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How do you Rx cancer

MDT
Chemo
Surgery
RT
CAR-T cells revolutionise leukaemia

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What are acute risks of chemo

Hair loss 
N+V
Mucositis
Diarrhoea
Constipation
Bone marrow suppression

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What are chronic risks of chemo

Organ impairment - ECHO / bone density etc.
Reduced fertility
Second cancer

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What are acute risks of RT

Lethargy
Skin irritation
Swelling
GORD 
Cytsitis 
Dermatitis 
Organ inflammation

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What are chronic risks of RT

Fibrosis
Reduced fertility
Second cancer

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What are oncological emergencies due to treatment

Sepsis
Febrile neutropenia
Raised ICP
Spinal cord compression
Mediastinal mass / SVC obstruction 
Tumour lysis syndrome

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What do people who have had childhood cancer have a higher risk of

Chronic disease in adult life

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What can be used to provide chemotherapy

Central line or port

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What do child with splenectomy get

Pneumococcal vaccine

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When can you not give NSAID

Chemo | DDAVP

What is the mot common malignancy in childhood

ALL | - SEE HAEMATOLOGY

When are you caution if going chemo

AVN

What is a neuroblastoma

Most common solid tumour formed from neural crest cells in ANS Common at adrenal gland and abdomen

What are the symptoms

Mass

How do you Dx

AXR USS IV urogram Increased catecholamines in urine

What does a nephroblastoma present

``` Abdominal mass = most common Abdominal pain / flank - unilateral Haematuria Lethargy Anorexia Weight loss Fever HYpertension Lung mets Associated with Beckwith Weidman ```

How do you Dx and treat a nephroblastoma

``` USS IV urogram CT / MRI to stage Biopsy for definite Dx Chemo Surgery - nephrectomy Post-op RT ```

What causes a retinoblastoma

Autosomal dominant

What are features of retinoblastoma

Squint Decreased vision Proptosis No red light reflex

How do you treat retinoblastoma

``` Surgery not the only option depending on how advanced - enucleation RT Cyrotherapy Photocoagulation Screen parents and siblings as AD ```

What is most common cause of anaemia in children

Iron deficiency - Blood loss e.g. menstruation - Diet - lots of milk - Malabsorption e.g. coeliac

What are other causes

``` Thalassaemia Sickle cell Sideoblastic Haemolytic Bone marrow failure ```

What causes normochromic

Chronic disease - renal / hypothyroid / infections | ALL / bone marrow failure

What causes bone marrow failure

Leukaemia Lymphoma Storage disorders Aplastic

What causes haemolytic

Autoimmune Hereditary spherocytosis G6PD Haemoglobinopathy - sickle cell / thalassemia

What are symptoms of anaemia

``` Lethargy Pallor SOB Koilonychia Atrophic tongue / mouth Tachycardia Flow murmur ```

What is important not to miss

HSM - more severe Petechiae Jaundice Height and weight

What are important questions

``` Diet / feeding Milk = high risk Weight loss Bleeding or bruising Jaundice Bone pain Fever Hx illness FH of disorders ```

How do you investigate

``` FBC + MCV Film Bone marrow aspirate if abnormal Reticulocyte / DAT to see if haemolytic Ferritin Anti TTG Hb electrophoresis - haemoglobinopahy Blood / urine culture - chronic infection ```

When do you do aspirate

If film abnormal | Shows blasts

What does FBC show

Severity and type of anaemia

What is less worrying

Single cytopenia over pancytopenia

What is Ddx of lethargy

``` Iron defieincy Coeliac Malabsorption Blood disorder that cause anaemia ALL ```

What blood disorder

Haemolytic anaemia - jaundice? Thalassemia Sickle cell Hereditary spherocytosis / G6PD

What is reticulocyte high in

Haemolysis as RBC need to be made as destroyed

What is reticulocyte low in

Decreased production due to bone marrow failure Lack of Fe Lack of folate

Wha causes bleeding / bruising in neonate

``` Haemorrhagic disease of newborn Maternal thrombocytopenia Trauma Infection Haemophilia ```

What causes bleeding or bruising in infant / children

``` Injury Haemophilia vWF ITP Congenital infection / sepsis Liver disease ALL ```

Main causes of bleeding

Trauma Bleeding disorder - vWF / ITP Malignancy - ALL

What is important to ask

``` FH bleeding disorder or heavy period What is bruises like How long to go Any joint pain / limp / bleeding Any bleeding during dental surgery / vaccination Any spontaneous bleeding Nose bleed Signs of anaemia ```

What is normal length of nose bleed

<15 minutes

What is important to look in examination

ALL - HSM / LN enlargement

What investigations

``` FBC, ferritin + clotting vWF Factor 8 (A) Factor 9 (B) Blood group O as causes low vWF ```

What causes epistaxis

Nose picking Foreign body Allergic rhinitis / URTI

When do you refer

<2 FH >15 minutes

If <2 what is it due to

Trauma | Bleeding disorder

What can you prescribe if >2 and no evidence of abnormality

Topical neomycin | Discourage nose picking

Oncology / Haematology Flashcards

(62 cards)