Flashcards in Paeds malignancy, haem, derm Deck (245)
What type of tumour are the majority of CNS tumours in children?
Astrocytoma (pilocystic astrocytoma = most common)
Where are astrocytomas found?
Where are medulloblastomas found?
Where are ependymomas found?
What is the WHO grade for pilocystic astrocytoma?
What syndrome is associated with pilocystic astrocytoma?
How will pilocystic astrocytoma appear on MRI?
Cerebellar, well-circumscribed, cystic and enhancing
What mutation is most common in pilocystic astrocytoma?
Recall the signs and symptoms of pilocystic astrocytoma
Headaches (worst in morning)
Gait problems, co-ordination problems
Vomiting on waking
Failure to thrive
Behaviour/ personality change
Later sign = papilloedema due to raised ICP
What is the typical picture of benign intracranial HTN (not malignant cause)?
Normal MRI, normal exam, papilloedema, 14y/o, high BMI
Which investigation is most appropriate in investigating an astrocytoma?
What is the specialised member of the MDT in childhood cancer cases?
CLIC Sargent (cancer and leukaemia in children social worker)
What is the first-line management for astrocytoma?
Which CNS tumours can be treated with radiotherapy?
Gliomas and metastases
Which CNS tumours can be treated with chemotherapy?
High grade gliomas
What % of ALL is B lineage vs T lineage?
85% B, 15% T
What % of leukaemia is ALL vs AML in children?
80% ALL, 20% AML
Recall the signs and symptoms of ALL
BM failure (anaemia, thrombocytopaenia, neutropaenia)
Local infiltration --> lymphadenopathy, hepatosplenomegaly, bone pain, testes/CNS
Leukaemia cutis = petechial rash on face + trunk
What is raised in tumour lysis syndrome?
Potassium, LDH, phosphate, uric acid
What will be seen on CXR in ALL?
What results of BM biopsy would be diagnostic of ALL?
>20% blasts in BM/ peripheral blood
Immunological and cytological characteristics
What should be the immediate management of a high WCC in ALL?
TLS needs to be reduced: allopurinol and hyperhydration
How many years of chemotherapy are necessary in ALL?
Boys are treated for longer because testes are a site of accumulation of lymphoblasts
What therapies can be given alongside chemotherapy in ALL?
CNS-directed therapy (if LP is negative initially)
What types of molecular treatment are available for ALL?
Imatinib (TK inhibitor) for Ph +ve cases
Rituximab (monoclonal antibodies against CD20 for B cell depletion)
What age group are NHL/HL most common in?
NHL = childhood
HL = adolescence
Which of NHL/HL is more likely to be localised to one nodal site?
Compare the spread of HL vs NHL
HL = spreads contiguously to adjacent lymph nodes
NHL involves multiple sites and spreads sporadically
Recall the signs and symptoms of HL
Painless cervical lymphadenopathy
B symptoms are uncommon, even in advanced disease
Painful on drinking alcohol (in 10%)