Onc Flashcards
When can you give vaccines (live) post chemo
- wait at least 3-6 months from the end of immunosuppressive therapy
- extend this to 24mths for post BMT
Hodgkin lymphoma: presentation
● Patients mostly present w/ painless, nontender, firm, rubbery cervical and supraclavicular LN
- Usually have some degree of mediastinal involvement
- HSM is rare
⅓ have B symptoms
● Presence of B Sx is key for staging
→ defined as unexplained fever > 38 Celsius, wt loss > 10% of total BW over 6m, and drenching night sweats
List 5 childhood conditions that predispose them
to development of leukemia
- Trisomy 21
- Neurofibromatosis Type 1
- Ataxia Telangiectasia
- Fanconi anemia
- Li-Fraumeni Syndrome
- Bloom syndrome
- Noonan syndrome
Indications for a BMA?
▫ Unexplained and significant depression ≥ 1 cell
lines
▫ Blasts on peripheral smear
▫ Leukoerythroblastic changes on peripheral smear
▫ Association with unexplained lymphadenopathy
or hepatosplenomegaly
▫ Association with an anterior mediastinal mass
%age of each subtype of ALL?
B-cell ALL: 85%
T-cell ALL: 15%
Peak age for ALL?
3-5 year
What is prognosis for ALL?
What are prognostic factors?
90% cure
Factors:
- Age: <1, >10
- WBC>50
- CNS/Testic disease
- Cytogenetics
- MRD (at end of induction)
Prognosis for AML
60% cure
Late Effects of Onc Therapy
Varies according to therapy received and complications: ▫ Obesity --> steroids ▫ Bone health issues --> steroids ▫ Endocrine dys-regulation --> steroids ▫ Neurotoxicity --> intra-thecal chemo, MTX ▫ Cardio-toxicity --> anthracyclines (doxo/dauno) ▫ Secondary neoplasms --> lots of drugs ▫ Psychosocial Effects ▫ ? Infertility
Leukemia: acute management
• PIV for supportive care • CXR • Labs- CBC/smear, critical chemistries, coags, type and screen, cultures (if febrile) • Hydration (IVF) • Allopurinol (rasburicase) • Antibiotics (if febrile) • Blood products (as indicated)
What are Leukemia emergencies
- Hyperleukocytosis
- Tumour lysis syndrome
- Mediastinal mass
- Sepsis
- Bleeding diathesis
Hodgkin Lymphoma: prognosis
> 90% cure
Risk factors for NHL
- Ataxia telangiectasia
- Wiskott Aldrich syndrome
- Congenital hypogammaglobulinemia
- Post SOT
- HIV
• Think immunodeficiency …..
Types of NHL
1) Mature B-cell:
- Burkitts
- Large B-cell
2) Mature T-cell
- Anaplastic large
3) Precursor B or T cell
- Lymphoblastic (like leukaemia but <25% BM, mostly T-cell, Med mass)
Concerns/complications of mediastinal mass?
▫ Airway compromise
(CXR, CT, PFTs, no lying flat!)
▫ SVC syndrome
(echo)
▫ RVOT obstruction
(echo)
▫ Cardiac tamponade
(pulsus paradoxus, EKG, echo)Lab findings consistent with TLS?
- hyper-k
- hyper-PO3
- hypo-Ca
- hyperuricemia
- hypo-Na (~)
- low bicarb (acidosis)
3 side effects of : vincristine
- peripheral neuropathy
- SIADH
3 side effects of : asparaginase
- allergic reaction
- hepatitis/pancreatitis
- coagulopathy/thrombosis
3 side effects of : prednisone
- weight gain/obesity
- bone health
- endocrine (DM), HTN
Expected side effects of treatments for:
- Teens with sarcomas
- Teens with HL
- AML
- High risk neuroblastoma
• Teens with sarcomas
▫ Cardiac toxicity due to anthracyclines
▫ Alkylators (ifosfamide/cyclo) –> infertility
• Teens with HL
▫ Heart, lungs, fertility, risks of RT
• AML
▫ Very high dose of anthracyclines (heart)
• High risk neuroblastoma
▫ Hearing loss, renal toxicity
List 6 long-term side effects of Hodgkin’s Lymphoma treatment
Hypothyroidism (RT)
Infertility (Alkylator, RT)
Cardiomyopathy, CAD (Anthracycline, RT)
Pulmonary Fibrosis (Bleomycin, RT)
Second CA – breast, thyroid, skin, … (RT)
MDS/Leukemia (Alkylator)
Avascular Necrosis. (Steroid)
The most common organism isolated in episodes
of febrile neutropenia
CONS
Beckwith Wiedemann - associated with what malignancy?
Hepatoblastoma : AFP q 3 months until age 4
Wilms’ Tumor : Abdo U/S q 3 months until age 8
Wilm’s tumour associated with what conditions?
- 11p deletion/WAGR
- BWS
- NF-1
LCH: features
- Single bone lesion
- Multiple bone lesions
- Multi-organ involvement:
- Bone (skull, limb, single or multiple) - 80%
- Skin/scalp (scaly, waxy rash) – 50%
- CNS, Pituitary (DI)
- Lungs
- Bone marrow, liver, spleen
- Eyes, ears,
LCH: treatment
▫ Curretage/biopsy for isolated bone lesion
▫ Topical therapy if rash only
▫ Chemo for wide spread disease
HLH: 2 types
1) Primary/familial
- younger, AR
2) Secondary/acquired
- Usually older child/adult
• Triggered by:
• Infection (viral [EBV], bacterial)
• Rheum condition (MAS)
• Cancer
HLH: Diagnostic criteria
Diagnostic criteria (5 of 8):
- Fever
- Cytopenia
- Splenomegaly
- Hemophagocytosis
- Hyperferritinemia
- Hypertriglyceridemia or hypofibrinogemia
- Low/absent NK cell activity
- Increased sIL2R
HLH: Treatment
- Chemo
- IVIG
- Steroids
what is osteopetrosis
• Inherited bone disease:
- dense, sclerotic bones –> fracture
- growth impairment, dental abnormalities, HSM, epilepsy, ID
- BM can be affected due to bone density –> cytopenias
Tx: BMT
Most common type of solid tumor in children?
Brain tumours
Headaches: features/indications for head imaging (r/o ca)
The headache:
• Change in type, increasing severity/frequency
• Sudden/severe onset, associated with trauma
• Early AM, awakens from sleep, assoc w/
straining
The patient: • Abnormal neurologic signs/symptoms • Seizures or loss of consciousness • Linear growth regression • School or behavior change
DDx for an abdominal tumour
- Neuroblastoma
- Wilms tumor
- Hepatoblastoma
- Lymphoma
List investigations for abdominal mass NYD
- Imaging: Ultrasound, CT Scan, bone scan, MIBG
- Blood work: lytes, urate, LDH, AFP
- Urine: HVA/VMA, Urinalysis
- Other: BMA +/- biopsy
Most common extra-cranial solid malign tumour?
Neuroblastoma
Predisposing conditions for hepatoblastoma?
- BWS, Hemihyperplasia
- FAP – family history of polyps
- Prematurity/LBW
