Cancer Flashcards
What percentage of pediatric cancer do leukemias represent?
30%
What is the second most common type of childhood cancer after leukemia?
brain tumors
Where do most pediatric brain tumors arise?
the posterior fossa
What is the most common type of malignant CNS tumor in children?
medulloblastoma
How do supratentorial tumors present?
with seizures and signs of increased ICP
What is the most common presentation of Hodgkin’s disease in children?
painless cervical adenopathy
What is the most common malignant bone tumor in children?
osteosarcoma
In what age group are malignant pediatric bone tumors more common?
over 10 years old
In what part of the bone does a osteosarcoma typically arise?
metaphysis
In what part and what type of bones does Ewing’s sarcoma typically arise?
the diaphysis of long and flat bones (pelvis)
What is the most common site for osteosarcomas?
distal femur
Most common type of leukemia in children?
Acute lymphoblastic leukemia - ALL (80%)
In what age range is the highest incidence of leukemias?
2-5 years old
In what age group are childhood cancers the highest?
15-19
What is the most common cancer in adolescents?
Hodgkin lymphoma
How are leukemias staged?
TMN system
For osteosarcoma and Ewing sarcoma, what is the goal of the initial surgical procedure?
To obtain a definitive diagnosis
What is the goal of the initial procedure with CNS tumors?
gross total resection
What tissues are most affected by chemotherapy?
those with actively dividing cells: intestine, bone marrow, skin
What are two major side effects of methotrexate?
demyelinating encephalopathy, osteopathy
What type of neuropathy does vincristine cause?
length-dependent axonal sensorimotor polyneuropathy
What is the major side effect of cisplatin and carboplatin?
hearing loss
What chemotherapeutic agents causes small fiber neuropathy?
taxanes (paclitaxel)
How do peripheral neuropathies due to platinum drugs present?
in a patchy distribution
What is “coasting” in terms of peripheral neuropathy?
symptoms may progress for months after stopping therapy
What should be suspected in a cancer patient with progressive weakness?
myopathy
How does steroid-induced myopathy present?
painless symmetrical proximal muscle weakness
What steroid more commonly causes steroid myopathy?
dexamethasone
What are 3 major skeletal complications related to treatment for ALL?
osteoporosis, AVN, spinal deformities
When should DXA be done for ALL patients?
during entry to long-term follow-up, typically at 2 years after completion of therapy
When is AVN typical diagnosed in pediatric cancer patients?
about 1-2 years after starting steroid treatment
Which steroid has more bone toxicity?
dexamethasone is more toxic to bone than prenisone
What chemotherapeutic agent causes pulmonary fibrosis?
bleomycin
What age group is more prone to cardiac toxicity from anthracycline agents?
younger than 5 years old
What two cancer treatments put a child a greatest risk for neurocognitive deficits?
cranial radiation, intrathecal chemotherapy
Which children are at higher risk for ototoxicity from platinum based chemotherapy agents?
Those who get therapy at a younger age (less than 5)
Children under what age are at highest risk for neurocognitive impairment from radiation?
4 and under. We try to avoid radiation in those under 3.
What presents with headache, nausea/vomiting, and focal neurologic deficits 6 or more months after CNS radiation therapy?
radiation necrosis
Beside radiation necrosis and cognitive deficit, what are three other potential consequences of radiation that patients should be monitored for?
AVN, scoliosis, stroke due to focal narrowing of vessels
When does acute GVHD develop?
2 - 5 weeks post transplant
What is the treatment for GVHD?
glucocorticoids
What are the four phases of cancer rehabilitation?
preventative, restorative, supportive, and palliative
Below what level Hbg should one consider activity restriction and blood transfusion?
8 g/ml
What is the goal of restorative rehabilitation?
to return patients to previous level of functioning
What is the goal of supportive rehabilitation?
To teach patients to accommodate to their disabilities
Below what platelet level is it recommended to avoid resistance exercises?
50,000
Below platelet level is it recommended to minimize all exercise?
20,000
Children with what genetic syndrome are 15 times more likely to develop ALL?
Down syndrome
Why is dexamethasone the preferred glucocorticoid?
It has superior CNS penetration
What are the three phases of cancer treatment?
Induction, intensification, and maintenance
In what age range are infratentorial tumors most common?
2-10
What is the most common glioma?
pilocystic astrocytoma
What is usually the treatment for a pilocyctic astrocytoma?
surgical resection alone
What is the 2 year survival rate for diffusely infiltrated gliomas?
Less than 20%
What is the most common malignant tumor of childhood?
medulloblastoma
What percentage of posterior fossa tumor resections are associated with posterior fossa syndrome?
25%
In posterior fossa syndrome, within what time frame does mutism typically resolve?
6 months
What is the most common spinal cord tumor?
astrocytoma
How does a osteosarcoma present on X-ray?
with periosteal reaction or sunburst pattern
What is the average age of diagnosis for Ewing sarcoma?
15
Why are Ewing sarcoma’s mistaken for growing pains?
They occur in otherwise healthy and active children
What is seen on X-ray of a Ewing sarcoma?
periosteal reaction or onion skin pattern
What is the more common surgery type for bone tumors, amputation or limb-sparing?
limb-sparing
