CHILDHOOD MALIGNANCIES - DRUGS (SB) Flashcards
What is the annual incidence of cancer in children younger than 20 years?
18.3 per 100,000 children age 0-19 years
What percentage of all new cancer cases in the US are childhood cancers?
Approximately 1%
What are the most common types of childhood cancers?
Leukemias, brain cancers, lymphomas, neuroblastoma, Wilms tumor
What is the leading cause of disease-related mortality in children aged 1-19 years?
Malignant neoplasms (cancer) (12%)
What percentage of children with cancer are cured in high-income countries?
More than 80%
What percentage of children with cancer are cured in low-and middle-income countries (LMICs)?
15-45%
Can childhood cancer generally be prevented or screened for?
No
What treatments can cure most childhood cancers?
Generic chemotherapy, surgery, and radiotherapy
What are comprehensive cancer services?
Diagnostics, therapeutics, disease surveillance, and monitoring
What are common causes of avoidable deaths from childhood cancer in LMICs?
Lack of diagnosis, misdiagnosis, delayed diagnosis, obstacles to care, poor compliance, treatment abandonment, toxicity, relapse
What is the purpose of childhood cancer data systems?
To improve care quality and inform policy decisions
What are the three components of early cancer diagnosis?
- Awareness of symptoms, 2. Accurate and timely clinical evaluation, 3. Access to prompt treatment
What percentage of all malignancies are childhood cancers?
1-3%
What percentage of childhood cancers occur at age 14 years and below?
Only 3%
What are the most common pediatric malignancies?
Leukemia, brain tumors, retinoblastoma, lymphomas, bone malignancy
What cancers are most common in children aged 0-5 years?
Neuroblastoma, Wilms tumor, retinoblastoma, PNET
What cancers increase in incidence during the second decade of life?
Sarcomas, osteosarcoma, Ewing sarcoma, Hodgkin lymphoma, testicular cancer, ovarian cancer
What factors influence childhood cancer incidence?
Gender (higher in boys), race/ethnicity (higher in whites), country of residence
What is the biological basis of childhood cancer?
Disruptions in genetic control of cellular growth and development
What hereditary disorders predispose to childhood malignancy?
Down syndrome, Beckwith-Wiedemann syndrome, Neurofibromatosis Type 1, Tuberous sclerosis, Von Hippel-Lindau disease
What are some viruses associated with pediatric cancers?
Polyomaviruses (BK, JC, SV40), Epstein-Barr virus (EBV)
What vaccine-preventable viruses are linked to pediatric cancer?
Hepatitis B (Hepatocellular carcinoma), HPV (Cervical cancer, oropharyngeal and anal cancers)
What are common signs and symptoms of childhood cancer?
Pallor, bruising, pancytopenia, persistent fever, unexplained pain, morning headaches with vomiting, lymphadenopathy, abdominal mass, eye changes (proptosis, leukocoria)
What childhood cancer is associated with leukokoria (white pupil)?
Retinoblastoma
What childhood cancer is associated with periorbital ecchymosis?
Neuroblastoma
What symptoms suggest lymphoma?
Fever of unknown origin, weight loss, night sweats, painless persistent lymphadenopathy
What cancers are associated with hypertension?
Neuroblastoma, pheochromocytoma, Wilms tumor
What imaging is best for diagnosing CNS tumors?
MRI
What is the gold standard diagnostic procedure for leukemia?
Bone marrow biopsy with flow cytometry, cytogenetics, and molecular studies
What tumor markers are useful in diagnosing germ cell tumors?
AFP, HCG
What is the purpose of multimodal therapy in pediatric cancer treatment?
To provide multidisciplinary care combining multiple treatment modalities for optimal outcomes.
What are the primary modalities used in multimodal therapy for pediatric cancer?
Chemotherapy, surgery, radiation therapy, and biologic agent therapy.
Which treatment modality is most widely used in pediatric cancer?
Chemotherapy.
What is the purpose of surgery in cancer treatment?
To remove the primary source of malignancy.
Why is radiation therapy used sparingly in children?
Children are more vulnerable than adults to its late adverse effects.
What is the primary purpose of chemotherapy in pediatric cancer treatment?
To eradicate systemic spread of cancer.
Why is chemotherapy used more widely in children than in adults?
Children tolerate acute adverse effects better, and childhood cancers are more responsive to chemotherapy.
What type of tumors use a surgical staging system?
Wilms tumor, neuroblastoma, and rhabdomyosarcoma.
What is the primary treatment modality for childhood leukemia?
Chemotherapy.
What is the role of radiation therapy in treating childhood leukemia?
It is used in a small proportion of patients to prevent or treat overt CNS leukemia.
What is the primary treatment modality for non-Hodgkin lymphoma in children?
Chemotherapy, with radiation therapy for CNS involvement.
Why is systemic chemotherapy necessary for most solid tumors?
Because tumor dissemination is generally present even if undetectable.
What is the best chance for curing cancer?
During the initial course of treatment.
What is the recommended action when cancer is suspected in a child?
Referral to an appropriate specialized center as soon as possible.
How much does chemotherapy improve the 5-year survival rate in pediatric cancer?
Up to 80%.
Why are multidrug combination regimens preferred over monotherapy in chemotherapy?
To overcome resistance to individual agents and achieve synergistic cytotoxic effects.
What is a key principle in administering chemotherapy?
Administer chemotherapy before metastasis develops.
What is the rationale behind using multidrug chemotherapy regimens?
To overcome resistance and enhance synergistic cytotoxic effects.
What is the mechanism of action of methotrexate?
It is a folic acid antagonist that inhibits dihydrofolate reductase.
What cancers is methotrexate used to treat?
ALL, non-Hodgkin lymphoma, osteosarcoma, Hodgkin lymphoma, medulloblastoma.
What are common adverse effects of methotrexate?
Myelosuppression, mucositis, dermatitis, hepatitis, osteopenia, renal and CNS toxicity.
What is the mechanism of action of 6-mercaptopurine?
It is a purine analog that inhibits purine synthesis.
What cancer is 6-mercaptopurine primarily used to treat?
ALL.
What are common adverse effects of 6-mercaptopurine?
Myelosuppression, hepatic necrosis, mucositis.
What drug increases the toxicity of 6-mercaptopurine?
Allopurinol.
What are the most common acute adverse effects of chemotherapy?
Myelosuppression, immunosuppression, nausea, vomiting, mucositis, dermatitis, alopecia.
What life-threatening adverse effects are associated with chemotherapy?
Cardiomyopathy (anthracyclines) and renal failure (platinum-containing agents).
What is the mechanism of action of cytarabine?
It is a pyrimidine analog that inhibits DNA polymerase.
What cancers is cytarabine used to treat?
ALL, AML, non-Hodgkin lymphoma, Hodgkin lymphoma.
What are common adverse effects of cytarabine?
Nausea, vomiting, myelosuppression, hemorrhagic cystitis, pulmonary fibrosis.
What is the mechanism of action of cyclophosphamide?
It alkylates guanine, inhibiting DNA synthesis.
What cancers is cyclophosphamide used to treat?
ALL, non-Hodgkin lymphoma, Hodgkin lymphoma, soft tissue sarcoma, Ewing sarcoma, Wilms tumor, neuroblastoma.
What are common adverse effects of cyclophosphamide?
Nausea, vomiting, myelosuppression, hemorrhagic cystitis, pulmonary fibrosis.
What is the mechanism of action of ifosfamide?
It alkylates guanine, inhibiting DNA synthesis.
What cancers is ifosfamide used to treat?
Non-Hodgkin lymphoma, Wilms tumor, soft tissue sarcoma.
What is a serious adverse effect of ifosfamide?
CNS dysfunction and cardiac toxicity.
What is the mechanism of action of doxorubicin and daunorubicin?
They bind to DNA via intercalation.
What are the main cancers treated with doxorubicin and daunorubicin?
ALL, AML, osteosarcoma, Ewing sarcoma, Hodgkin lymphoma, non-Hodgkin lymphoma, neuroblastoma.
What is the most serious adverse effect of doxorubicin?
Cardiomyopathy.
What is the mechanism of action of vincristine?
It inhibits microtubule formation.
What cancers is vincristine used to treat?
ALL, non-Hodgkin lymphoma, Hodgkin lymphoma, Wilms tumor, Ewing sarcoma, neuroblastoma, rhabdomyosarcoma.
What is a common side effect of vincristine?
Peripheral neuropathy.
What should be ensured before administering vincristine?
IV site patency to prevent extravasation and local cellulitis.
What is the mechanism of action of L-asparaginase?
It depletes L-asparagine.
What is the main indication for L-asparaginase?
ALL.
What is a major adverse effect of L-asparaginase?
Pancreatitis and coagulopathy.
What is the difference between L-asparaginase and pegaspargase?
Pegaspargase is a polyethylene glycol conjugate of L-asparaginase for prolonged asparagine depletion.
What is a key advantage of pegaspargase over L-asparaginase?
It can be used in patients with allergy to L-asparaginase.
What is the mechanism of action of prednisone and dexamethasone?
They cause lymphatic cell lysis.
What cancers are prednisone and dexamethasone used to treat?
ALL, Hodgkin lymphoma, non-Hodgkin lymphoma.
What are common adverse effects of prednisone and dexamethasone?
Cushing syndrome, osteoporosis, diabetes, infection, psychosis.
What is the mechanism of action of carboplatin and cisplatin?
They inhibit DNA synthesis.
What are major adverse effects of carboplatin and cisplatin?
Renal dysfunction, ototoxicity, neurotoxicity.
What is the mechanism of action of etoposide?
It is a topoisomerase inhibitor.
What cancers is etoposide used to treat?
ALL, non-Hodgkin lymphoma, germ cell tumors, Ewing sarcoma.
What is the mechanism of action of tretinoin and isotretinoin?
They enhance normal cell differentiation.
What cancers are tretinoin and isotretinoin used to treat?
Acute promyelocytic leukemia, neuroblastoma.
What are serious adverse effects of tretinoin and isotretinoin?
Birth defects, pseudotumor cerebri, premature epiphyseal closure.
What is the goal of immunotherapy in pediatric cancer?
To enhance the patient’s immune system to kill malignant cells.
What are CAR-T cells?
Genetically engineered T cells designed to recognize and attack tumor cells.
How do CAR-T cells work?
They proliferate, release cytokines, and cause tumor cell death.
Why is overtreatment a risk in pediatric cancer treatment?
Because some patients have a more favorable prognosis and may receive excessive therapy.
What is a risk of undertreatment in pediatric cancer?
It may compromise an otherwise high potential for cure.
