Paediatric Oncology
Implications of cancer on a child’s future:
Fertility
POI: due to rx or chemotherapy.
Presents as delayed puberty, amenorrhoea, premature menopause.
Uterus: Rx can damage uterine function, pregnancies may be of higher risk.
HPA: Rx can lead to hypogonadotrophic hypogonadism (delayed puberty).
Growth
Rx and chemo stunts growth
Steroids cause AVN
, Leukaemia
Acute lymphocytic leukaemia
More frequently occurs in children age 2-5y. Associated with T21 (after 5y),
NF1.
May be B-ALL or T-ALL.
Cells of myeloid lineage reduced:
Anaemia (lethargy), Neutropenia (infection), Thrombocytopenia
(petechiae, bleeding), Infiltration (bone pain, hepatosplenomegaly,
lymphadenopathy).
May present with CNS signs (mets).
B-ALL: CD10, CD19, CD20 (EBV binds 21 – bar/21/get EBV)
Good chemotherapy response. Needs scrotal and CSF chemo prophylaxis (barriers
here mean cells build up).
Prognosis depends on cytogenetics: t(12;21) good prognosis, seen
in children. t(9;22) has poor prognosis, seen in adults (Ph+ ALL).
T-ALL: CD2-8
Thymic mass in teenager. As is a mass acute lymphoblastic
lymphoma.
Investigations
Need film in any case of pancytopenia. Note WCC may be low, normal or high.
See lymphoid blast cells (scant, agranular cytoplasm) - BM exam is essential.
Bloods: anaemia, thrombocytopenia, raised lymphoblasts, check for DIC
BM: 20%+ blasts, TdT+
CSF: CNS spread
CXR: mass
Immunophenotyping
- CALLA found in 80% ALL cases, also in blast crisis of CML
- TdT raised means high white cells are malignant, not due to infection (pre-B and
pre-T)
- MPO (myeloid lineage) is reduced
- B ALL: CD19, CD22, CD79
- T ALL: CD2-8
Management
Responsive to therapy; correct levels, hydrate/allopurinol (protect from TLS), give
chemotherapy and steroids.
SE: Cushingoid, osteoporosis.
If CNS involvement, rx or intrathecal chemotherapy.
Implications of cancer on a child’s future:
Fertility
POI: due to rx or chemotherapy.
Presents as delayed puberty, amenorrhoea, premature menopause.
Uterus: Rx can damage uterine function, pregnancies may be of higher risk.
HPA: Rx can lead to hypogonadotrophic hypogonadism (delayed puberty).
Growth
Rx and chemo stunts growth
Steroids cause AVN
, Leukaemia
Acute lymphocytic leukaemia
More frequently occurs in children age 2-5y. Associated with T21 (after 5y),
NF1.
May be B-ALL or T-ALL.
Cells of myeloid lineage reduced:
Anaemia (lethargy), Neutropenia (infection), Thrombocytopenia
(petechiae, bleeding), Infiltration (bone pain, hepatosplenomegaly,
lymphadenopathy).
May present with CNS signs (mets).
B-ALL: CD10, CD19, CD20 (EBV binds 21 – bar/21/get EBV)
Good chemotherapy response. Needs scrotal and CSF chemo prophylaxis (barriers
here mean cells build up).
Prognosis depends on cytogenetics: t(12;21) good prognosis, seen
in children. t(9;22) has poor prognosis, seen in adults (Ph+ ALL).
T-ALL: CD2-8
Thymic mass in teenager. As is a mass acute lymphoblastic
lymphoma.
Investigations
Need film in any case of pancytopenia. Note WCC may be low, normal or high.
See lymphoid blast cells (scant, agranular cytoplasm) - BM exam is essential.
Bloods: anaemia, thrombocytopenia, raised lymphoblasts, check for DIC
BM: 20%+ blasts, TdT+
CSF: CNS spread
CXR: mass
Immunophenotyping
- CALLA found in 80% ALL cases, also in blast crisis of CML
- TdT raised means high white cells are malignant, not due to infection (pre-B and
pre-T)
- MPO (myeloid lineage) is reduced
- B ALL: CD19, CD22, CD79
- T ALL: CD2-8
Management
Responsive to therapy; correct levels, hydrate/allopurinol (protect from TLS), give
chemotherapy and steroids.
SE: Cushingoid, osteoporosis.
If CNS involvement, rx or intrathecal chemotherapy.
