Lec 05 Pediatric Oncology Flashcards
True of pediatric malignancies EXCEPT:
A. 10% of all malignancies occur in children.
B. Incidence of pediatric cancer is on the rise.
C. Mortality rate of pediatric cancer is dropping.
D. Retinoblastoma caught intra-ocularly may not need chemotherapy.
E. NOTA
A. Only 1% occur in children.
ID: Delayed diagnosis is a problem in pediatric cancers. Most signs and symptoms are mistakenly attributed to what etiology?
infection
Sunburst appearance is a feature of:
A. Ewing sarcoma B. osteosarcoma C. nasopharyngeal carcinoma D. liposarcoma E. leukemia
B. osteosarcoma
ID: Pain and sometimes awakening pain in adolescent males with osteosarcoma and/or Ewing sarcoma is usually attributed to what?
physical activity pain / growing up pain
ID: Inability to open the mouth and usually seen in tetanic patients. It may be seen also in patients with nasopharyngeal CA.
trismus
T/F: CBC of a leukemic patients can be normal.
T
90% of leukemia patients is treated by what modality/ies?
A. chemotherapy only B. radiotherapy only C. surgery and chemotherapy D. radio and chemotherapy E. NOTA
A. chemotherapy only
2% - radio & chemotherapy
8% - did not opt for treatment
Worldwide, the most common type of pediatric cancer is:
A. lung cancer B. leukemia C. lymphoma D. brain cancer E. sarcoma
B. leukemia (i.e. acute lymphoblastic leukemia)
In PGH, what is the true 2nd most common pediatric cancer?
A. lung cancer B. leukemia C. lymphoma D. brain cancer E. sarcoma
D. brain cancer - most often referred directly to neurosurgery
ID: What are the two peak ages (bimodal distribution) of incidence of pediatric cancer?
1st = 2-5 y/o 2nd = adolescence
Bone malignancies are more common during what age?
A. 1st year B. 2-5 y/o C. after puberty D. A&B only E. AOTA
C. after puberty
Embryonal tumors are common during what age?
A. 1st year B. 2-5 y/o C. after puberty D. A&B only E. AOTA
D. A&B only
Which of the following is TRUE?
A. Neuroblastoma is common during the 1st year of life.
B. Wilms tumor incidence has a biphasic peak.
C. Lymphoma incidence decreases as age increases.
D. A&B only
E. AOTA
D. A&B only
Lymphoma incidence increases as age increases.
This genetic condition is characterized by a large tongue, umbilical hernia, and risk of developing hepatoblastoma and Wilms tumor.
A. Down syndrome B. Neurofibromatosis 1 C. Neurofibromatosis 2 D. Beckwith Wiedemann syndrome E. NOTA
D. Beckwith Wiedemann syndrome
The following are established causes of pediatric cancer EXCEPT:
A. ionizing radiation B. viruses C. chemotherapeutic agents D. pesticides E. non-steroidal estrogens
D. pesticides - only a questionable cause, not an established cause
non-steroidal estrogen - diethylstilbestrol
The following may present as an abdominal mass EXCEPT:
A. Wilms tumor B. Neuroblastoma C. Lymphoma D. Pontine glioma E. NOTA
D. Pontine glioma
It is in the pons.
T/F: Persistent enlarged supraclavicular lymph nodes are all malignant.
T
ID: Most common sign of retinoblastoma.
white pupillary reflex
Botryoid rhabdomyosarcoma commonly presents as:
A. leg pain or swelling B. vaginal mass or bleeding C. increased intracranial pressure D. proptosis E. AOTA
B. vaginal mass or bleeding
T/F: In leukemia, longer duration of chemotherapy is needed in males to achieve cure compared to females.
T
The testes in males is a sanctuary site.
Which is more curable?
A. acute lymphoblastic leukemia (ALL)
B. acute myeloid leukemia (AML)
C. AOTA
D. NOTA
A. ALL
Tumor metastasis in leukemia has predilection for which 2 organs:
A. mediastinum B. liver C. lungs D. brain E. any 2 of the above
A. mediastinum and D. brain
ID: To test for fever of malignancy, give what drug?
naproxen
If fever lyses immediately, it is most probably cancer.
This sign is 95% sensitive in detecting leukemia.
A. positive blasts B. 2 cytopenias C. leukocytosis D. decreased hemoglobin E. NOTA
B. presence of 2 cytopenias
positive blasts (80%) leukocytosis (50%) decreased hemoglobin (80%)
This is the most specific finding in leukemia.
A. positive blasts B. 2 cytopenias C. leukocytosis D. decreased hemoglobin E. NOTA
A. positive blasts
The standard treatment for leukemia is:
A. chemotherapy B. surgery C. radiotherapy D. bone marrow transplant E. NOTA
A. chemotherapy
TRUE of lymphoma:
A. bimodal peak incidence
B. females more commonly affected
C. inguinal node chain involvement mostly
D. localized disease has 70% survival rate
E. AOTA
A. bimodal peak incidence
males more common
cervical chain most involved
localized disease = 90% survival
Most frequent cause of intussusception in children > 6 years old.
A. hepatoblastoma B. Burkitt lymphoma C. rotavirus vaccination D. gastrointestinal stromal tumor E. NOTA
B. Burkitt lymphoma
Radiatherapy in non-hodgkin lymphoma is limited to.
A. central nervous system involvement B. superior vena cava syndrome C. supreior mesenteric artery syndrome D. A&B only E. AOTA
E. AOTA
CNS involvement + life threatening situations
ID: This oncologic emergency resulting from cancer treatment is characterized by increased uric acid, phosphorus, potassium, and creatinine.
tumor lysis syndrome
This is the most common pediatric brain tumor.
A. medulloblastoma B. astrocytoma C. glioma D. schwannoma E. lipoma
A. medulloblastoma
Diagnosis of glioblastoma multiforme in a pediatric patient is staged:
A. I B. II C. III D. IV E. pending results of biopsy
D. IV
Brain tumor in children >8 years old commonly occur in this location.
A. infratentorial B. supratentorial C. frontotentorial D. frontotemporal E. NOTA
B. supratentorial
supra = older infra = younger
T/F: Papilledema due to brain tumor is rare in infants.
T
The head can still expand.
ID: Medulloblastoma commonly arise from what location?
cerebellar vermis
A 6 year old patient presents with an abdominal mass. What is the most likely tumor?
A. hepatoblastoma B. neuroblastoma C. Wilms tumor D. gastrointestinal stromal tumor E. NOTA
B. Wilms tumor
Age Incidence
hepatoblastoma = 1-2 y/o
neuroblastoma = 2-4 y/o
Wilms tumor = 3-6 y/o
GIST = adult tumor
A pediatric patient presents with an abdominal mass. He is cachetic and very irritable. What is the most likely tumor?
A. hepatoblastoma B. neuroblastoma C. Wilms tumor D. gastrointestinal stromal tumor E. NOTA
B. neuroblastoma
hepatoblastoma / Wilms tumor = playful, well looking, non-irritable
GIST = adult tumor
ID: Origin of neuroblastoma.
primitive sympathetic ganglion cells
ID: This syndrome caused by neuroblastoma presents with meiosis, ptosis, enophthalmos and anhydrosis.
Horner syndrome
ID: Possible screening test for neuroblastoma.
VMA / HMA secretion & VIP secretion
Asymptomatic abdominal tumor presenting as a mass on the flank.
A. hepatoblastoma B. neuroblastoma C. Wilms tumor D. gastrointestinal stromal tumor E. colon cancer
C. Wilms
hepatoblastoma = right upper quadrant neuroblastoma = mostly symptomatic
Which is NOT a possible sign or symptoms of Wilms tumor?
A. hematuria B. hypotension C. bleeding D. pain E. NOTA
B. hypotension
Px are commonly HYPERTENSIVE due to increased renin.
True of hepatoblastoma EXCEPT:
A. jaundice is common B. thrombocytosis is common C. AFP elevation is common D. most common liver tumor E. NOTA
A. jaundice
Jaundice is NOT COMMON.
ID: Thrombocytosis occurs in hepatoblastoma due to:
production of cytokines especially THROMBOPOIETIN
What is the definitive cure for hepatoblastoma?
A. chemotherapy B. surgery C. radiotherapy D. bone marrow transplant E. NOTA
B. surgery
ID: A localized disease is described to involve how many liver segments?
ID: Which part of the bone is the predilection of osteosarcoma?
metaphysis of long bones
Most common clinical symptom of osteosarcoma.
A. local pain B. swelling C. decreased range of motion D. sunburst appearance E. NOTA
A. local pain = 90%
Sunburst appearance is the RADIOLOGIC sign.
Beckwith Wiedemann syndrome is associated with:
A. hepatoblastoma B. neuroblastoma C. Wilms tumor D. gastrointestinal stromal tumor E. colon cancer
A. hepatoblastoma
A 15 year old male was diagnosed with osteosarcoma. Surgery as of the moment would require amputation of his arm due to the extent of the cancer. What can you do?
A. proceed with the surgery to save the patient
B. do not do surgery and shift to radiotherapy
C. start on neoadjuvant therapy
D. do conservative surgery instead
E. send the patient home
C. neoadjuvant
Start the Px on neoadjuvant therapy to reduce tumor bulk and allow less debilitating surgery.
