Oncology Dx
Physiology
Cancer predisposition
Leukaemia
Solid (?organ) tumours
by type
by site
Cardiac tumours
Brain tumours Gastric tumours
Ix
Urine catecholamines
Tumour markers
Rx
Pharmacology
Side effects
Complications:
Of Disease
Long term complications
Endocrine
Neurological
Oncological: secondary malignancies
Cancer predisposition
Leukaemia
- ALL
- B-cell
- T-cell
- AML
Solid (?organ) tumours
by type
- Wilms
- Rhabdomyosarcoma
- Neuroblastoma
- Most common extra cranial solid tumour in children
- embryonal Peripheral SNS from the neural crest
- linked to Phox2B, Hemihypertropy
- Horners if thoracic/cervical
- Mets to liver, bone,
- Medulloblastoma
- Epyndymoma
- Glial cell
- Retinoblastoma
- Hepatoblastoma
- Osteosarcoma
- Ewing's tumour
- Gonadal cell tumour
- Carcinoma (Adrenal)
- Pheochromocytoma
by site
Cardiac tumours
Brain tumours Gastric tumours
- PUD
- Malignancy (ill-defined margins, night pain, mets to lung/bones)
- Ewing's Sarcoma (more common than osteo <10y)
- Onion skin, usually diaphysis, fever
- Undifferentiated small round cell, probably of neural origin
- Survival 60% without mets, 30% with
- Osteosarcoma (more common than ewings >10y)
- Sun-burst, usually metaphysis , sclerotic (opac) or lytic (luc), presents post injury
- Spindle cell–producing osteoid, Metaphyses
- Associations: Retinoblastoma, Li-Fraumeni syndrome, Paget disease, radiotherapy
- Survival 70% without mets, 20% with
- Ewing's Sarcoma (more common than osteo <10y)
- Benign (Well defined margins, relief with NSAIDs)
- Osteochondroma (exostosis): Metaphysis of long bone, on stalk pointing away from joint
- Multiple hereditary exostoses: as above short stature, limb-length inequality, premature partial physeal arrests/deformity
- Enchondroma: centrally in bone, usually solitary and in the hand
- Ollier disease: multiple leading to bone dysplasia, short stature, limb-length inequality, and joint deformity
- Maffucci syndrome: multiple and associated with soft tissue angiomas
- Chondroblastoma: lucency in epiphysis, often involving joint and causing joint pain
- Chondromyxoid fibroma: lobular, metaphyseal radiolucency with sharp, sclerotic, and scalloped margins
- Osteoid osteoma: round / oval metaphyseal / diaphyseal lucency (~1.0 cm) sclerotic margin (to small for X-ray > seen on CT)
- Osteoblastoma: usually in spine, often with malignant features so need biopsy
- Fibromas: sharply marginated eccentric lucency in the metaphyseal cortex
- Aneurysmal bone cyst: eccentric lytic destruction and expansion of the metaphysis surrounded by a thin sclerotic rim
- Unicameral bone cysts: solitary, centrally located lesions within the medullary portion of the bone
- Fibrous dysplasia: polyostotic disease, precocious puberty, and cutaneous pigmentation is known as Albright syndrome
- Osteofibrous dysplasia: tibial cortical diaphyseal lesions surrounded by sclerosis
- Eosinophilic granuloma: a type of Langerhans’ cell histiocytosis, usually skull, but can be anywhere, variable appearance on X-ray mandates biopsy
- Malignant (AFP up)
- Hepatoblastoma (65%)
- usually <3yo
- Associated with FAP (familial adenomatous polyposis) and Beckwith-Wiedemann
- Asymptomatic abdominal mass
- BhCG production (mimics LH to stimulate testosterone) can promote vitalisation
- Rx Resection (up to 85% of liver can be taken), if too big Chemo then recheck, if still to big, Liver transplant
- Cisplatin, vincristine and 5-fluorouracil or doxorubicin
- Mets to LN and Lung
- Survival 90% if resectable, 60% in not but no mets, 30% if mets
- Hepatocellular carcinoma (most of the rest)
- Usually in adolescence in association with Hep B/C
- Abdominal mass
- US to define vascular v malignant
- CT/MRI to define if amenable to surgery
- Surgery difficult
- cisplatin, doxorubicin, etoposide, and 5-fluorouracil
- 30% long term survival
- (neuroblastoma / lymphoma metastasis)
- rare: embryonal sarcoma, angiosarcoma, malignant germ cell tumor, rhabdomyosarcoma, and undifferentiated sarcoma.
- Hepatoblastoma (65%)
- Benign
- hemangiomas, hamartomas, and hemangioendotheliomas. (usually present in <6mo)
- H Pylori
- adenocarcinoma
- MALT (mucosa-associated lymphoid tissue) lymphomas
Ix
Urine catecholamines
Tumour markers
Rx
Pharmacology
Side effects
Complications:
Of Disease
- Pain
- Malignant hypercalcaemia
- Spinal cord compression
- SVC obstruction
- Pericardial tamponade
- Bone marrow suppression
- Febrile neutropenia
- Tumour Lysis Syndrome
- Mucositis
- Graft V Host Disease
Long term complications
Endocrine
Neurological
Oncological: secondary malignancies