1. Childhood Cancer
Polly Bennion

2. 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
Consider 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 Kingdom
1 in 500 children in the UK will develop cancer by age 14
1 in 285 children and young people will develop cancer before the age of 20
The average GP surgery would expect to see a case of cancer in a child or young person approximately every two and a half years
The 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 tumours
Germ cell tumours
Retinoblastoma
Hepatic tumours

5. diagnosis
DIFFICULT
BEWARE OF SYMPTOMS THAT ARE PERSISTANT, UNUSUAL OR WORSENING
PAIN THAT WAKES A CHILD FROM SLEEP CAN NOT BE IGNORED
3+ ATTENDANCES – increases the risk of the symptoms being due to cancer up to 10-fold

6. RED FLAGS
Headaches
(worse in the morning)
Constant tiredness
Weight Loss
Persistent vomiting
(especially in the morning)
Sudden vision change, true diplopia, new onset squint, loss of red reflex
Excessive bruising
Recurrent or persistent fevers of unknown origin
Pallor

8. leukaemia Acute Lymphoblastic Leukaemia (ALL)
Pallor, persistent fatigue, bone pain, unexplained pyrexia and infections, lymphadenopathy, night sweats, weight loss, hepatosplenomegaly, unexplained bruising, petechiae, bleeding
leukaemia
Acute Lymphoblastic Leukaemia (ALL)
Over production of lymphoblasts (B cell and T cell)
Infiltrate bone marrow
Inhibit normal cell functioning
400 new cases a year in UK
Peak incidence 2-3 years of age
Boys>girls
Lengthy treatment 2 years for girls, 3 years for boys
Stem cell transplants for high risk groups and early relapse
Almost 90% survival
Acute Myeloid Leukaemia (AML)
Over production of myeloblasts
70 new cases a year in UK
6 months intensive treatment
High remission rate but up to 25% will relapse
65% 5 year survival

9. Cns tumours Most common solid tumours 400 new cases a year in UK
Persistent 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
Cns tumours
Most common solid tumours
400 new cases a year in UK
Late presentation
Astrocytoma (40%) most common
75% are low grade and have a 95% 5 year survival but
High grade has less than 20% 5 year survival
Treatment usually surgery plus radiotherapy
Neurological disabilities

10. lymphomas Hodgkin Non-Hodgkin
Painless lymphadenopathy of a single gland, fevers, night sweats, itching, weight loss, cough/breathlessness
Hodgkin
Reed-Sternberg cell!
M>f
96% 5 year survival
Non-Hodgkin
M>F
B cell ( usually in the abdomen)
T cell (usually in the chest)
88% 5 year survival

11. The Role of the gp during treatment
Often 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 family
Annual influenza vaccine (not live nasal version) for all children receiving chemotherapy and for 6 months after
Can provide support
Recommend resources
Grace Kelly Ladybird Trust
The Compassionate Friends
Children’s Cancer and Leukaemia Group
The Teenage Cancer Trust
The Rainbow Trust
HeadSmart
A Child Of Mine

12. The role of the gp after treatment
7 out of 10 children and young adults survive their cancer
Vaccination schedules often need to be repeated from the beginning
Childhood 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 cancer
From the treatments – growth and pubertal problems, fertility problems, cardiomyopathies, neurocognitive, dentition
From psychosocial aspects e.g. PTSD, depression, anxiety
Increased risk of primary malignancies later in life
Low threshold for referral to specialist services