Malignancies in Childhood Flashcards
A 3 yr. old patient presents with malaise, fever, bone/joint pain, bruising, lymphadenopathy, hepatosplenomegaly. Duration 2-3 months. You assume it is the most common childhood cancer. What is it?
ALL
ALL common lab findings
WBC: 50% of all cases have normal WBC. Blasts on smear.
Hgb: Low, normal (MCV WNL to increased)
Platelets: Moderately or severely decreased.
What is Leukemic Hiatus
-Peripheral smear has mature granulocytes and very immature cells (blast cells) but nothing else.
DDX for ALL
- EBV/CMV
- HIV
- Pertussis
- Other leukemias (AML, CML)
- JIA
- SLE
- Aplastic anemia
- Others…
What is the most common location for a brain tumor? What are common presentations of the patient? Most common histologies?
- Posterior fossa
- Wide-based unsteady gait, Ascending cranial nerve palsy, N/V, HA
- Medulloblastoma, Astrocytoma
What type of brain tumor is associated with drops mets, sugar coated mets, and is the most common single histology? In brainstem and cerebellum.
Medulloblastoma
Most common brain tumor in children
Astrocyte
Treatment of Brain tumor
- Surgery is definitive
- Chemo
- Radiation
What is this? Arises in sympathetic chain/adrenal medulla, peak incidence is 1-2 years, metastatic sites include bone, marrow, lymph nodes, skin, lungs.
Neuroblastoma
Common presentation of neuroblastoma
- Painless mass
- Nerve compression
- Fever, irritability
- Limp/Bone pain
- HTN
- Opsomyoclonua
- FTT
What is this: Painelss abdominal mass arising from kidney. Peak incidence 2-3 years. May be part of congenital syndromes (Beckwith-weideman, WAGR, Denys-Drash). May be associated with chromosomal loss or advanced paternal age.
Wilms tumor
Early stage Wilms tumor treatment
-Resection and mild chemo. Higher stage require more aggressive treatment.
What is this: Associated with EBV. Charascteristic path=Reed Sternberg Cell. Rare in very young. Till late, confined to Lymph nodes.
Hodgkins Lymphoma
What is this: No reed sternberg cell. Not necessarily assoc. with EBV. Often associated with immune disorders. Occurs in all age groups. Not confined to lymph nodes. Frequently seen in patients with immune deficiency disorders, post-transplant, metabolic derangements during induction chemo.
Non-Hodgkins Lymphoma
What is this: Tumor arising in connective tissues, muscle, or bone.
Sarcoma
Common metastatic sites for sarcomas
Lung, Other bones
Common sarcomas in kids and treatment.
- Rhabdomyosarcoma, osteosarcoma, ewing sarcoma.
- Treatment is multimodal: Surgery, chemo, occasional radiation.
Osteosarcoma arises in what part of bone
Diaphyseal areas of long bones
Ewing sarcoma occurs in what part of bone
-Mid-shaft of bones and may arise in axial skeleton and pelvis, as well as soft tissue structure
What is this: Acute electrolyte disturbance due to renal failure secondary to release of uric acid and phosphate as cancer cells die abruptly and in large numbers. Most common cause is Lymphoma, High WBC ALL.
Tumor Lysis Syndrome
Symptoms and treatment of tumor lysis
Symptoms: Range form none to renal failure and cardiac arrhythmias depending on severity and electrolyte derangement.
Treatment: Prevention: Hydration with 2x maintenance IV fluid. Avoid all KCL in IV fluids. Lower uric acid levels with Allopurinol or Raspburicase. Careful monitoring.
Nausea/vomiting after chemotherapy. How would you treat?
Acute: within 24 hours of chemo dose respond to 5HT receptor antagonists- ex: Zofran/kytril, Emend
Chronic: greater than 72 hours after chemo responds poorly to 5HT receptor antagonists. Dexamethasone
Common problems with transfusions include:
1) volume overload.
2) HLA immunization
3) Graft vs host reaction
4) viral infection
- how would you fix?
1) loop diuretic
2) Leuko-depletion
3) radiation of blood product
4) volunteer blood donor, avoid family donors, shorten window of testing
Neutropenic fever pathophys:
Chemo kills all fast growing cells.
-Marrow is killed resulting in decreased WBC production. Disruption of physical barriers (Gut, skin)
Neutropenia:
1) High risk
2) Moderate risk
1) ANC range 0-200
2) ANC range 200-500
Normal= 1500-4500
Management of Neutropenia
- Basic data set
- CVL
- Perianal
- CBC
- Blood cultures
- UA and Culture
- CXR
Treatment of neutropenia
- Prophylactic AB: Cefepime, vanco?, tobramicin?
- Antifungal: FLuconazole
