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7 Pediatrics > L10 Oncology > Flashcards

L10 Oncology Flashcards

1
Q

Ped cancer epidemiology

A
  • 9620 kids under 15 will be diagnosed with cancer
  • 85% of children with cancer now survive 5 years or more, depends on type and other factors
  • second leading cause of death in kids 1-14, accidents #1
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2
Q

Most common cancers for kids

A

leukemia
brain
lymphoma
rhabdyomyosarcoma
retinoblastoma
bone

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3
Q

Adolescent and Young Adult cancer epidemiology

A
  • AYA are diagnosed 84,100 a year (ages 15 to 39)
  • 4th most common cause of death for 15-19 yo
  • clinicians need to be aware of cognitive, emotional, and social development of AYA, b/c it can impact their functions
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4
Q

Most common cancers for AYA

A

breast
thyroid
testicular
melanoma

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5
Q

Child leukemias

A

acute lymphoblastic
acute myeloid
chronic myeloid

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6
Q

Acute lymphoblastic leukemia

A

80% of all childhood leuk cases

5 year survival rate is 90%

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7
Q

Acute myeloid leukema

A

less common
5 year survival rate is 65-70%

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8
Q

Chronic Myeloid Leukemia

A

lowest incidence in children
treated with oral chemp

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9
Q

S/s of leukemias

A
  • start in bone marrow where new blood cells are created
  • leukemia cells grow and divide until they crowd out the other normal blood cells
  • marrow produces less normal, healthy blood cells leading to lower blood cell ocunt
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10
Q

Phases of Tx for Leukemia

A
  • based on cancer stage and pathologic characteristics
  • includes 3 phases Induction, Consolidation, Maintenance
  • those with ALL with receive a bone marrow transplant
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11
Q

Induction

A

4 weeks of intense chemo

check for minimal residual disease

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12
Q

Consolidation

A

12-16 weeks of more chemo

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13
Q

Maintenance

A

2-3 years with less frequent,, mostly oral chemo and intrathecal to maintain remission

ALL may begin to move to spinal fluid if not watched closesly

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14
Q

Hematopoietic Stem CEll transplant

A

Involves several types: PBSCT, autogenic (bone marrow of child), allogenic (bone marrow of donor

  • intense chemo prior to transplant, sometimes total body irridiation
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15
Q

Post-Transplant Complications, Acute

A

infection
veno-occlusive disease
mucositis
acute graft vs host disease (only in allogenic)

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16
Q

Post-Transplant Complications chronic

A

Chronic graft vs host disease, allogenic BMT only, treated with steroids

opportunistic infections due to immunosuppression to minimize failure of transplant

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17
Q

PT exam post BMT

A
  • Graft vs Host –> ROM in UE
  • CIPN – balance
  • Fatigue –6MWT
  • not meeting PA guidelines
  • cognitive
  • sarcopenia –5STS
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18
Q

Graft vs Host disease

A

stem cells develop into new blood cells, immune cells may attack host tissues

skin changes can cause loss of ROM of joints, may require splinting in severe cases

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19
Q

CAR-T cell therapy

A
  • chimeric antigen receptror
  • an immunotherapy to treat several blood cancers
  • targets CD19, called Kymriah
  • very expensive
20
Q

Side effects of CAR-T cell therapy

A
  • mass die off of antibody producing B cells and infections
  • cytokine release syndrome (CRT)
  • immune effector cell-associated neurotoxicity syndrome (ICNS)
21
Q

CRS

A

dangerously high fevers
drops in BP
can be fatal
treated with steroids

22
Q

ICANS

A

severe confusion, seizures, impaired speech

treated with steroids

23
Q

CNS Tumors

A
  • 2nd most common
  • most common solid tumor, responsible for 25% of peds cancer deaths
  • most common form is astrocytomas, with medulloblastomas the most common aggressive type
24
Q

Diffuse Intrinsic Pontine Glioma

A
  • 10-20% of all childhood brain cancers
  • most common between 5-10 yrs
  • limited treatment options
  • survival rate is low, no cure
25
Q

CP of DIPG

A
  • problems with eye movements
  • impaired balance and walking
  • problmes with chewing and swallowing
  • nausea and vomiting
  • morning headache
  • facial weakness
26
Q

Sarcomas

A
  • two types; bony and soft tissue
  • bony is more prevalent in kids and YA
27
Q

Osteosarcoma

A
  • affects metaphyseal joints in long bones
  • more common in males and adolescents
  • osteoblasts are affected, resulting in poor reconstruction of bones. lots of fractures and brittle
  • 60%+ survival rate
  • treatment involves removal of bone, chemo, radiation
28
Q

Ewing Sarcoma

A
  • occurs in children and young adults
  • highly aggressive and mets quickly
  • typically in pelvis, tibia, femur, ribs
  • treatment is chemo, surgery, radiation
  • 60-75% survival, but low survival if it mets
  • presents as swelling and pain in affected area
  • may impact soft tissue like thorax, lungs, gluteal muscles
29
Q

PT Tx Planning Tips for Cancer

A
  • possible effects of disease on systems of mobility
  • possible effects of treatment on systems of mobility
  • prioritizing impairments for treatment plan
30
Q

Prehabilitation

A

time between dx and start of medical treatment for cancer

should perform baseline assessment of global development, functional mobility, and body structure/function

exercise program

31
Q

Baseline Assessment during Prehabilitation

A
  • CP status and aerobic capcity
  • functional mobility testing
  • strength and ROM assessment
  • sensory testing
  • cognition assessment
  • balance and coordination
  • developmental milestones
32
Q

Prehabilitation exercise program should

A
  • decrease debility due to treatment related impairments
  • patient and family education
33
Q

Bone Health (PT considerations related to treatment effects)

A
  • bone loss during treatment and decreased bone formation due to impaired mobility and muscle mass loss
  • osteopenia and osteoporosis occur in lone bones and spine
  • osteonecrosis may occur in kids after glucocorticoids or radiation
34
Q

Osteonecrosis

A
  • symptoms include pain, avoidance of area
  • can be asymptomatic
  • at risk for fracture
  • possible WB restrictions or activity restrictions
35
Q

CIPN

A
  • common neurotoxic chemotherapies used to treat kids
  • present with pain, sensory loss, motor loss, autonomic symptoms
  • PT treatment is similar to adults, should include assessment for AFO to improve participation in gait/play
  • majority of children will show CIPN or motor impairments due to chemo
36
Q

____ is more common in children than adults with CIPN

A

foot drop

37
Q

Childhood Lymphedema

A
  • relatively rare
  • carries significant burden for lifelong management and risk of secondary complications
  • exam and treatment is similar to that of adults
38
Q

Developmental Progression and Cognition

A
  • infants and toddlers living with and beyond cancer display delayed developmental milestones when compared to their same aged healthy peers
  • children who receive whole brain radiation and chemo may demonstrate cognitive impairments
  • not sure who is at higher risk, need more research
39
Q

Children treated before age 4

A
  • progress more slowly in areas including vocab, attention, and memory, motor skills
  • social and emotional development delays to lesser extent
40
Q

Cognitive impairments after whole brain radiation include

A
  • decreased IQ, processing speed, working memory, executive function, attention
  • can be persistent 3 years post radiation
  • cognitive rehab is effective to help treat
41
Q

< 18 yo social issues

A
  • interrupted social skills development
  • high school achievement graduation delays
  • delays in living independently
  • difficulty establishing employment
42
Q

18-25 yo Social Issues

A
  • delays in higher education
  • interruption in employment
  • barriers to achieving financial independence
  • difficulties obtaining health insurance
  • difficulty establishing relationships
43
Q

26+ yo social issues

A
  • difficulties establishing and maintaining relationships
  • difficulties with intimate relationships
  • fertility issues
  • challenges managing multitude of life roles
  • barriers to achieving financial independence
  • barriers to health insurance
44
Q

Palliative and End of Life Care

A

children w/cancer who receive ped palliative care were significantly more likely to have fun, experience events that added meaning, and die comfortably at home

45
Q

Adult survivors of childhood cancers are at higher risk of

A
  • heart or lung problems (CVD, more likely to die from it too)
  • lymphedema
  • slowed or delayed growth and development
  • changes in sexual development and ability to have children
  • learning problems
  • increased risk of other cancers later in life

7 Pediatrics (10 decks)

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