Mind Map by , created over 5 years ago

Paediatrics (Malignancy) Mind Map on leukaemia, created by v.djabatey on 01/31/2014.

Created by v.djabatey over 5 years ago
rare tumours
Wilms tumour (nephroblastoma)
brain tumours
Matters of Life and Death GCSE
Function and Structure of DNA
Elena Cade
bone tumours
soft tissue sarcomas
malignant disease in children
1 acute lymphoblastic leukaemia
1.1 =80% of leukaemia in kids
1.2 clinical presentation
1.2.1 peaks @ 2-5 years
1.2.2 results from disseminated disease & systemic ill health from infiltration of bone marrow or other organs w/ leukaemic blast cells general malaise anorexia bone marrow infiltration anaemia pallor, lethargy neutropenia infection thrombocytopenia bruising, petechiae, nose bleeds bone pain reticulo-endothelial infiltration hepatosplenomegaly lymphadenopathy, superior mediastinal obstruction (uncommon) other organ infiltration (rare @ diag, more often @ relapse) CNS headaches vomiting nerve palsies testes testicular enlargement
1.2.3 in most kids, ALL presents insidiously over several weeks in some presentation& progress is rapid
1.3 Ix
1.3.1 abnormal FBC in most low Hb thrombocytopenia evidence of circulating leukaemic blast cells
1.3.2 bone marrow exam to confirm diag to ID immunological & cytogenetic characteristics that give prognostic info
1.3.3 CXR to ID mediastinal mass characteristic of T cell disease
1.3.4 morphological classification for ALL & AML + immunological phenotyping to further subclassify ALL common subtype (75%) T cell subtype (15%)
1.4 Mx
1.4.1 prognostic factors (& also indicate intensity of therapy) age high risk features <1 year or > 10 years old tumour load (measured by WBC) high risk features > 50 x10^9/L cytogenetic/molecular genetic abnormalities in tumour cells high risk features e.g. MLL rearrangement, t(4:11), hypodiploidy (<44 chromosomes) speed of response to initial chemo high risk features persistence of leukaemic blasts in bone marrow minimal residual disease (submicroscopic levels of leukaemia detected by PCR) high risk feature high
1.4.2 remission induction before Rx anaemia may need correcting blood transfusion minimise risk of bleeding platelet transfusion treat infection additional hydration & allopurinol (or urate oxidase when WCC high & risk greater) to protect renal function vs effects of rapid cell lysis remission implies eradication of leukaemic blasts & restoration of normal marrow function 4 weeks of combo chemo given current schedules reach remission rates of 95%
1.4.3 intensification block of chemo given to consolidate remission improves cure rates but w/ increased toxicity
1.4.4 central nervous sys cytotoxic drugs penetrate poorly into CNS additional Rx w/ intrathecal chemo to prevent CNS relapse as leukaemic cells in CNS may survive effective systemic Rx
1.4.5 continuing therapy moderate intensity chemo continued up to 3 years from diag routine co-trimoxazole prophylaxis to prevent Pneumocystitis carinii pneumonia
1.4.6 treatment of relapse high dose chemo, often + total body irradiation + bone marrow transplantation alternative to chemo after a relapse
2 acute myeloid leukaemia
3 acute non-lymphocytic leukaemia
4 chronic myeloid leukaemia & other myeloproliferative disorders
4.1 rare

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