objectives To understand the incidence of childhood cancers and the chances of seeing it in GP To increase confidence in diagnosis particularly RED FLAGS Briefly discuss the common cancers and treatments ID: 1038261
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1. Childhood CancerPolly Bennion
2. objectivesTo understand the incidence of childhood cancers and the chances of seeing it in GPTo increase confidence in diagnosis, particularly RED FLAGSBriefly discuss the common cancers and treatmentsConsider the role of the GP during treatment and importantly afterwards
3. How common is it?Childhood cancer is the biggest medical cause of death in children aged 1 – 14 in the United Kingdom1 in 500 children in the UK will develop cancer by age 141 in 285 children and young people will develop cancer before the age of 20The average GP surgery would expect to see a case of cancer in a child or young person approximately every two and a half yearsThe average GP would expect to see a case of childhood cancer just under every 11 years, meaning they may see 3 or 4 cases in a career
4. Which ones are the most common?Leukaemias 30%Brain and Spinal tumours 27%Lymphomas 11%Soft tissue tumours 6%Neuroblastoma 5%Renal tumours 5%Malignant bone tumoursGerm cell tumoursRetinoblastomaHepatic tumours
5. diagnosisDIFFICULTBEWARE OF SYMPTOMS THAT ARE PERSISTANT, UNUSUAL OR WORSENINGPAIN THAT WAKES A CHILD FROM SLEEP CAN NOT BE IGNORED3+ ATTENDANCES – increases the risk of the symptoms being due to cancer up to 10-fold
6. Weight LossHeadaches(worse in the morning)Persistent vomiting(especially in the morning)Constant tirednessPallorExcessive bruisingSudden vision change, true diplopia, new onset squint, loss of red reflexRecurrent or persistent fevers of unknown originRED FLAGS
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8. leukaemiaAcute Lymphoblastic Leukaemia (ALL)Over production of lymphoblasts (B cell and T cell)Infiltrate bone marrowInhibit normal cell functioning400 new cases a year in UKPeak incidence 2-3 years of ageBoys>girlsLengthy treatment 2 years for girls, 3 years for boysStem cell transplants for high risk groups and early relapseAlmost 90% survivalAcute Myeloid Leukaemia (AML)Over production of myeloblasts70 new cases a year in UK6 months intensive treatmentHigh remission rate but up to 25% will relapse65% 5 year survival Pallor, persistent fatigue, bone pain, unexplained pyrexia and infections, lymphadenopathy, night sweats, weight loss, hepatosplenomegaly, unexplained bruising, petechiae, bleeding
9. Cns tumoursMost common solid tumours400 new cases a year in UKLate presentationAstrocytoma (40%) most common75% are low grade and have a 95% 5 year survival butHigh grade has less than 20% 5 year survivalTreatment usually surgery plus radiotherapyNeurological disabilitiesPersistent or recurrent vomiting (especially in the morning), new balance or co-ordination problems, behaviour/personality change, tiredness, headaches, unusual eye movements, new squint, blurred vision, diplopia, new seizure onset
10. lymphomasHodgkinReed-Sternberg cell!M>f96% 5 year survivalNon-HodgkinM>FB cell ( usually in the abdomen)T cell (usually in the chest)88% 5 year survivalPainless lymphadenopathy of a single gland, fevers, night sweats, itching, weight loss, cough/breathlessness
11. The Role of the gp during treatmentOften very little contact but:Named GP acting as single point of contact within the surgery keeping up-to-date with the progress can be very beneficial particularly for the familyAnnual influenza vaccine (not live nasal version) for all children receiving chemotherapy and for 6 months afterCan provide support Recommend resourcesChildren’s Cancer and Leukaemia GroupGrace Kelly Ladybird TrustThe Rainbow TrustThe Teenage Cancer TrustThe Compassionate FriendsA Child Of MineHeadSmart
12. The role of the gp after treatmentVaccination schedules often need to be repeated from the beginningChildhood cancer survivors are on every GP list (35,000 in the UK)95% will have a significant health-related issue by the time they are 45 Direct from the cancerFrom the treatments – growth and pubertal problems, fertility problems, cardiomyopathies, neurocognitive, dentitionFrom psychosocial aspects e.g. PTSD, depression, anxietyIncreased risk of primary malignancies later in lifeLow threshold for referral to specialist services7 out of 10 children and young adults survive their cancer