EXAM #3: CHILDHOOD CANCER Flashcards
What is the leading cause of mortality in children?
Cancer
Roughly 3,000 kids die per year from cancer
What is the most common cancer of childhood?
ALL
List the most common childhood cancers.
1) ALL
2) Brain and CNS
3) Neuroblastoma
4) Non-Hodgkin Lymphoma
5) AML
What are the familial/ genetic diseases associated with increased childhood cancer?
1) Neurofibromatosis
2) Familial polyposis
3) Li-Fraumeni Syndrome
What mutation is seen in Li-Fraumeni Syndrome?
p53
What major categories of disease cause childhood cancer?
1) Immune deficiencies
2) Metabolic disorders
3) Disorders of chromosome stability
What is the important clinical pearl to remember about the presentation of childhood cancer?
Signs and symptoms are non-specific and masquarade as common viral or bacterial infections
What is the average time/ number of visits to initial neoplastic test for childhood cancer?
3-5 visits
If a child presents with HTN, what imaging should be ordered?
CXR
Abd US
What should you think if you see HTN in a child?
Something is wrong with the renal or cardiac system, most likely a renal/abdominal tumor e.g.
1) Wilm’s tumor
2) Neuroblastoma
What should you order for a child with sudden onset weight loss?
Abdominal US
What should you order for children with petechiae?
1) CBC
2) Manual diff.
What are you concerned about when a child presents with petechiae?
1) Leukemia
2) Neuroblastoma
What should you order if a child presents with lymphadenopathy unresponsive to antibiotics?
1) Surgical consultation
2) CXR
3) CBC
4) Manual diff.
What causes lymphadenopathy unresponsive to antibiotics?
1) Leukemia
2) Lymphoma
What should you generally be concerned about when you see endocrine anomalies?
- Pituitary tumors
- Hypothalamic tumors
- Gonadal tumors
- Adrenal tumors
What should you order for a child with endocrine anomalies?
1) Hormonal assay
2) CT hypothalamic area
3) Abdominal CT
4) Endocrine consult
What are some signs of a brain tumor?
- HA with early AM vomiting
- CN palsy
- Ataxia
- Afebrile seizure
….etc.
What should you consider with leukocoria, proptosis, blindness, wandering eyes, or intraorbital hemorrhage? What should you do?
1) Retinoblastoma
2) Metastatic neuroblastoma
3) Rhabdomyosarcoma
Refer to ophthalmology
What should you consider when a child presents with bulging masses in the external canal, mastoid tenderness, and swelling?
1) Langerhans Cell Histiocytosis
2) Rhabdomyosarcoma
What should you consider when a child presents with a puffy neck and face? What should you do?
1) Mediastinal tumors/ SVC syndrome
What should you consider when a child presents with a pharyngeal mass? What should you do?
1) Rhabdomyosarcoma
2) Lymphoma
3) Nasopharyngeal carcinoma
What should you differential include for a child that presents with a periodontal mass or loose teeth?
LCH
Burkitt’s Lymphoma
Neuroblastoma
Osteosarcoma
Obtain imaging studies and refer for dental consultation
What should you differential include for a child with an extrathoracic mass, or cough/dyspnea without fever, asthma, or allergies?
Soft tissue tumor
Mediastinal tumor
Metastatic tumor
What types of tumors cause abdominal masses that may be found on abdominal exam?
1) Wilms tumor
2) Soft tissue sarcoma
3) Neuroblastoma
4) Hepatoblastoma
5) Hepatocellular carcinoma
What should you suspect if a child presents with a GU mass?
1) Germ cell tumor
2) Rhabdomyosarcoma
What should you suspect if a child presents with masculinization or feminization?
Adrenal tumor
What should you consider with a patient that has pelvic or long bone pain?
1) Osteosarcoma
2) Ewings Sarcoma
3) Leukemia
4) Neuroblastoma
5) Soft tissue sarcoma
What are the signs and symptoms that are concerning for Leukemia?
1) Unexplained fever over 101 F for more than 7 days
2) Petechaie (especially in places of increased pressure i.e. waistline or socks)
3) Unexplained anemia or pallor
4) Generalized lymphadenopathy (LAD)
5) Hepatosplenomegaly
6) Bone or joint pain that wakes from sleep/ is not controlled with NSAIDs
What are the signs and symptoms concerning for a CNS tumor?
1) Seizure
2) Weakness
3) Ataxia
4) Headache and vomiting
When are lymph nodes considered “large?” What are the exceptions?
10mm
- Epitrochlear nodes (5mm)
- Inguinal nodes (15mm)
What should be on the differential diagnosis for a child with LAD?
1) Bacterial infection
2) Atypical mycobacterium
3) Cat scratch disease
4) Viral illness i.e. EBV (mono) or herpes virus
What type of LAD is more likely to be malignant?
Generalized and regional not involving the head or neck
What are the characteristics of LAD that should be especially concerning for malignancy?
1) Hard/rubbery
2) Non-tender
3) Matted
When should you order a lymph node biopsy?
- Enlarging node after treatment for 2-3 weeks
- Nodes on CXR
- LAD + concerning constitutional symptoms
- Nodes in uncommon area
What are the unusual locations for lymph nodes that warrant work-up?
1) Posterior auricular
2) Epitrochlear
3) Supraclavicular
4) Mediastinal
What types of cancer does bone pain point to?
ALL
Ewing’s sarcoma
Osteosarcoma
When should bone pain be evaluated?
1) Persistent bone/joint pain with swelling or mass
2) Limited mobility
3) Wakes from sleep
4) Not relieved by NSAIDs
What masses warrant workup in children?
Any mass unexplained by trauma
