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Pediatrics > Cancer > Flashcards

Cancer Flashcards

1
Q

Which cells promote cell division?

A

Proto-oncogenes

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2
Q

Which gene slows down cell division and cause cells to die?

A

tumor-suppressor genes

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3
Q

What are the top three cancers in children?

A
  1. Leukemia*
  2. Brain/Spinal cord
  3. Lymphoma

*broad term for cancers of the blood cells

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4
Q

What does it mean to be cured from cancer?

A

There are no traces of your cancer after treatment and the cancer will never come back.

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5
Q

What does it mean to be in remission from cancer?

A
  • Remission can be partial or complete.
  • In a complete remission, all signs and symptoms of cancer have disappeared. After a certain amount of years complete remission can transition to “cured” status.
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6
Q

Why would a doctor use a variety of chemo drugs instead of just using one for a single patient?

A

Tumors possess ability to develop resistance to chemo; if a variety of drugs are used treatment will be less likely resisted.

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7
Q

What are the three causes of childhood cancer?

A
  1. Genetics*
  2. Failure of immune system to distinguish abnormal cells
  3. Carcinogens

abnormal proto-oncogenes and non-functioning tumor suppressor gene

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8
Q
  1. What are anti-neoplastic drugs?
  2. What is a known side effect?
A
  1. Chemo drugs designed to destroy abnormal tissue cells (cancer)
  2. Can target normal healthy rapidly dividing cells too (e.g., hair cells)

Alopecia

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9
Q

When would you expect to see peak bone marrow suppression in a child on chemotherapy?

A

7 to 10 days
after beginning treatment.

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10
Q

What risk factors occur during peak bone marrow suppression while going through chemotherapy?

A
  • Risk for infection (neutropenia)
  • Risk for bleeding (thrombocytopenia)
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11
Q

What are the 4 gastrointestinal side effects of chemotherapy?

A
  1. Mucosal ulcerations
  2. Nausea and vomiting
  3. Esophagitis
  4. Constipation
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12
Q

Why would you place a central line in a patient requiring chemotherapy?

A

peripheral veins cannot tolerate chemotherapy medications

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13
Q

What are the two central lines discussed for chemotherapy?

A
  1. Broviac
  2. Portacath
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14
Q
  1. Describe a Port cath?
  2. What are the pros?
  3. What are the cons?
A
  1. Surgically implanted catheter under the skin of the chest connected to a large vein.
  2. Less risk of infection and minimal care required
  3. Can be difficult to access and uncomfortable

Numbing cream can be used to reduce discomfort

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15
Q
  1. Describe a Broviac cath?
  2. What are the pros?
  3. What are the cons?
A
  1. Cather connected to a large vein
  2. Contains a double lumen*
  3. Requires sterile dressing and changes.

Different meds, fluids, and blood can be infused at the same time.

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16
Q

What are four specific sides effect related radiation?

A
  1. Alterted bone growth and skeletal malformations in children.*
  2. Cranial radiation can affect cognitive development
  3. Increased risk of other cancers
  4. Impair skin integrity

Not as common in adults, because they are fully grown already

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17
Q

What is a debulk and resect?

A

Surgical removal of as much of a tumor as possible.

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18
Q

What is biotherapy?

A

uses of the body’s immune system to fight cancer.

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19
Q
  • What is Bone Marrow and Stem Cell transplant indicated for?
A
  • Indicated for malignancies that cannot be cured by other means (e.g., chemo, radiation, surgery)
  • Cancer relapse.
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20
Q

What are the three types of Bone Marrow and Stem Cell Transplants?

A
  1. Syngenic
  2. Autologous
  3. Allogenic
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21
Q

What type of Bone Marrow & Stem Cell Transplant comes from an identical twin?

A

Syngenic

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22
Q

What type of Bone Marrow & Stem Cell Transplant comes from yourself?

A

Autologous

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23
Q

What type of Bone Marrow & Stem Cell Transplant comes from a matching donor?

A

Allogenic

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24
Q

How is bone marrow & stem cell administered into a patient?

A

IV administration

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25
Q
  1. What is engraftment?
  2. When does engrafting usually occur?
A
  1. When your transplanted cells are working properly and start to rebuild*.
  2. Occurs usually within 2-4 weeks after transplant.

WBC, RBC, and platelet production begins

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26
Q

What is Graft vs. Host Disease?

A

When graft or bone marrow (WBC) from donor identify patient’s as foreign and attacks them.

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27
Q
  1. What type of bone marrow & stem cell transplant causes graft v. host disease (GvHD)?
  2. What are the interventions for GvHD?
A
  1. Allogenic
  2. Immunosuppresants and steroids*

steroids are for severe GvHD experiences.

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28
Q

Signs and symptoms of Graft vs. Host Disease

  1. Gastrointestinal
  2. Liver (hepatic)
  3. Integumentary
  4. Ocular
A
  1. Nausea, vomiting, diarrhea
  2. Elevated liver enzymes
  3. Skin rash
  4. Ocular toxicity (e.g., blurry vision)
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29
Q
  1. What are example of neutopenic diet?
  2. Who would be prescribed to be on this diet?
A
  1. Ø raw vegetables, Ø fruits that cannot be peeled, Ø soft cheese, food must be cooked thoroughly.
  2. Patients on immunosuppresants due to foodborne pathogens.
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30
Q
  1. Which growth factor medication increases production of WBC?
  2. Which one increases RBC?
A
  1. Neuopogen is for WBC production
  2. Epogen is for RBC production
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31
Q

What is the formula for Absolute Neutrophil Count (ANC)?

A

Total % of neutrophils × White Blood Cell Count = ANC

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32
Q

How is total % neutrophils calculated in ANC?

A

poly/segs + bands

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33
Q

Mature neutrophils are referred to as?
Immature neutrophils are reffered to as?

For ANC calculation

A
  • “polys or segs” = mature neutrophils
  • “bands” = immature neutrophils
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34
Q

What is tumor lysis syndrome?

A

The lysis of tumor cells and rapid release of contents of intracellular compartment into extracellular fluid (blood).

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35
Q

What three things does tumor lysis syndrome elevate in the ECF?

intravascular fluid (blood) of ECF

A
  1. Uric acid
  2. Potassium (K+)
  3. Phosphate

Elevated levels in Blood

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36
Q

What are the interventions for tumor lysis syndrome?

Elevated uric acid, potassium, and phosphate.

A
  1. Allopurinol for uric acid
  2. Sodium bicarbonate w/ IV insulin dextrose for potassium
  3. Phosphate binder for phosphate
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37
Q

What two things can cause tumor lysis syndrome?

A
  1. Cancer itself
  2. Side effect of treatment
38
Q

Which two cancers commonly cause tumor lysis syndrome?

A
  1. Acute lymphocytic leukemia (ALL)
  2. Non-Hodgkin’s Lymphoma
39
Q

What is Acute Lymphocytic Leukemia (ALL)?

A

the proliferation of immature white blood cells.

40
Q

What is the most common childhood cancer?

A

Acute Lymphocytic Leukemia (ALL)

41
Q
  1. Which gender is more likely to develop acute lymphocytic leukemia?
  2. What age does it peak in childhood?
A
  1. Males
  2. Ages 2-6
42
Q

Which geographic areas are acute lymphocytic leukemia more common?

A

Industralized areas

43
Q

Which antineoplastic* drugs is associated with acute lymphocytic leukemia development?

*Chemotherapy drugs

A

Alkylating agents

44
Q

What is the role of genetics in acute lymphocytic leukemia (ALL)?

A

90% of those diagnosed w/ ALL have some kind of abnormal chromosomal on the cell itself. (e.g., Philadelphia)

45
Q

Exposure to what may cause acute lymphocytic leukemia (ALL)?

A

Ionizing radiation & certain chemical toxins

46
Q

What are the expected changes in CBC with acute lymphocytic leukemia (ALL)?

A
  1. White blood cell ↑
  2. Anemia (RBC ↓)
  3. Thrombocytopenia (Platelet ↓)
47
Q

What are the effect of acute lymphocytic leukemia (ALL) on normal cells?

A

Normal cells are deprived of essential nutrients of metabolism → cellular destruction

48
Q

What is the definitive diagnosis for acute lymphocytic leukemia (ALL)?

A

Bone marrow aspiration

49
Q

Why is a lumbar puncture performed after a definitive diagnosis of acute lymphocytic leukemia (ALL)?

A

If infiltration of WBC occurred in the CNS

50
Q

Favorable prognostic factors for acute lymphocytic leukemia (ALL)

  1. Leukocyte count
  2. Age
  3. Immunologic subtype
  4. Sex
  5. Cytogenetics
A
  1. WBC < 50,000/mm²
  2. Age 2-10
  3. CALLA positive precursor B
  4. Female
  5. No chromosomal abnormality
51
Q

When does remission usually occur for acute lymphocytic leukemia (ALL)?

A

1st month of chemo

52
Q

What is the diagnosis for remission in acute lymphocytic leukemia (ALL)?

A

Less than 5% blast cells

immature WBC

53
Q

Where is chemotherapy administered for acute lymphocytic leukemia (ALL)?

A

Central and Intrathecal* (spinal cord)

prevent spread of ALL to CNS.

54
Q

What can occur with vaccines during chemotherapy?

A

antibodies may be wiped and boosters may be indicated

55
Q

What must be observed when chemotherapy is given for the first time?

A

anaphylactic reactions

severe, potentially life-threatening allergic reaction

56
Q

What is the most common solid tumor?

an abnormal mass of tissue that does not contain cysts or liquid areas.

A

Brain tumor

57
Q

What is the cause of brain tumor?

A

unknown
but suspected to be cranial radiation

58
Q

Where do most brain tumors occur?

A

Posterior Fossa

includes cerebellum, brain stem and fourth ventricle

59
Q

What is the most common type of brain tumor in children?

A

Medulloblastomas

starts in the lower back part of the brain, cerebellum.

60
Q

What is the hallmark symptom of brain tumor?

A

headache with morning vomiting related to child rising

61
Q

What two factors are the symptoms of brain tumors affected by?

A
  1. Tumor size
  2. Location of tumor
62
Q

How are brain tumors diagnosed?

A

CT scan or MRI w/ contrast

63
Q

When is surgery not advised as treatment for brain tumor?

A

if the brain tumor is located near the brain stem

Risk of nervous system damage

64
Q

What age is cranial radiation avoided w/ brain tumor treatment?

A

Children < 3

65
Q

What are the three possible treatments for brain tumors?

A
  1. Surgery
  2. Cranial radiation
  3. Chemotherapy
66
Q

What is indicated if a tumor is inteferring w/ drainage of cerebral spinal fluid in ventricles?

risk for hydrocephalus

A

Ventriculoperitoneal (VP) shunt

monitor VP shunt for infection and obstruction

67
Q

What is the most common malignant extracranial solid tumor of childhood

A

Neuroblastoma

68
Q

What two interventions are indicated to reduce cerebral edema s/p brain tumor?

A
  1. Osmotic diuretic (Mannitol)
  2. Hypertonic IV solution
69
Q

What is the most common cancer in infancy and may be found at birth?

A

Neuroblastoma

70
Q

What is the treatment for neuroblastoma for children under 12 months?

A

no treatment is indicated due to possible spontaneous remission

71
Q

Which cells do neuroblastoma originate from?

A

Neural crest cells

develop into sympathetic nervous system & adrenal medulla

72
Q

Raccoon eyes are associated w/ which disease?

A

Neuroblastoma

73
Q

Most neuroblastoma cells have genetic abnormalities involving which chromosome?

A

Chromosome #1

74
Q

Which three parts of the body are scanned for neuroblastoma?

A
  1. Chest
  2. Abdomen
  3. Pelvis
75
Q

How long must infants be in remission for neuroblastoma to be considered cured?

A

1 year

76
Q

Which cancer is most common in adolescence and young adult?

A

Hodgkin’s Disease

77
Q

What is the positive finding for Hodgkin’s Disease w/ a biopsy?

A

Sternberg-Reed cells

(looks like owl eyes)

78
Q

What three things does Anne Arbor staging look for in Hodgkin’s disease?

A
  1. Spread to other site
  2. Which lymph nodes are involved*
  3. Presence of other symptoms

*above or below diaphragm

79
Q

What is the most common bone cancer?

A

Osteogenic Sarcoma

80
Q

Where does ostogenic sarcoma usually develop?

A

areas where the bone is growing quickly, such as near the ends of the long bones.

(metaphysis of femur)

81
Q

Which type of cancer treatment is not indicated for ostogenic sarcoma?

A

Radiation

82
Q

What is the common site of metastasis for osteosarcoma?

A

Lungs

83
Q

Which Hodgkin’s stage is characterized by

wide spread, including multiple involvement at one or more extranodal (sites such as the bone marrow).

A

Stage 4

84
Q

Which Hodgkin’s stage is characterized by

lymph node regions on both sides of the diaphragm are affected.

A

Stage 3

85
Q

Which Hodgkin’s stage is characterized by

two or more lymph node regions on same side of diaphragm

A

Stage 2

86
Q

Progressive, insidious or intermittent pain at tumor site relived by position change is a symptom of which cancer?

A

Osteogenic Sarcoma

87
Q

Urine excretion of ____ is an indicator for neuroblastoma

A

catecholamines

88
Q

What is the two most common clinical manifestation for neuroblastoma?

A
  1. abdominal mass
  2. protuberant firm abdomen.
89
Q

What clinical manifestations are associated with Hodgkin’s Disease “B”

A
  1. Low grade fever
  2. Weight loss
  3. Night sweats
90
Q

What is a prognosis indicator for Osteogenic Sarcoma?

A

Elevated levels of ALP and LDH is high risk for Tx failure

Alkaline Phosphatase (ALP) and Lactate Dehydrogenase (LDH)

91
Q

What % of blasts (immature WBC) in indicative of acute lymphocytic leukemia?

A

30% ≥

Pediatrics (10 decks)

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