Oncology Flashcards
2 most common primary malignant bone tumors during childhood and adolescence
Osteosarcoma and Ewing sarcoma
Unilateral pain. Not relieved by NSAIDS. Most common distal femur or proximal tibia then humerus. Occurs in metaphyseal region of long bones
Osteosarcoma
Xray demonstrates periosteal reaction (sunburst pattern). Can also see codman triangle (reaction at junction of mass and periosteum)
Osteosarcoma
Group of small, round-cell undifferentiated tumors of neural crest origin. PRIMARILY bone tumor, but can arise from soft tissue
Ewing sarcoma
Present with pain and swelling of flat bones (ribs, pelvis) and diaphyses of long bones. Can have systemic findings (fever, weight loss)
Ewing sarcoma
Xray demonstrates lytic lesion with lamellated/onion skin periosteal reaction
Ewing Sarcoma
Common benign cartilage-forming bone tumor. Often asymptomatic and in metaphysis of long bones
Osteochondroma
On xray - stalks of broad-based projections from the surface of the bone. usually a cartilage “cap” which can be as thick as 1cm
Osteochondroma
Benign tumor. Presents with unremitting and worsening pain that is relieved by ASA and NSAIDs. Usually proximal femur and tibia
Osteoid osteoma
On xray - round or oval metaphyseal or diaphyseal lucency surrounded by sclerotic bone
Osteoid osteoma
Diseases that are risk factors for CNS tumors
Neurofibromatosis type 1, neurofibromatosis type 2, tuberous sclerosis, li-fraumeni syndrome, turcot syndrome, nevoid basal cell carcinoma syndrome, von hippel-lindau disease
Parinaud syndrome
triad of impaired upward gaze, dilated pupils with better reactivity to accomodation than light and retraction or conversion nystagmus with lid retraction. Due to compression of midbrain tectum
Side effect methotrexate
myelosuppression, renal and hepatic toxicity
side effect cyclophosphaide
hemorrhagic cystitis
side effect doxorubicin
cardiotoxciity
side effect bleomycin
pulonary fibrosis
side effect vincristine
peripheral neuropathy
side effect cysplatin
nephrotoxic, ototoxic, neurotoxic
presents with headache, vomiting, seizures, motor symptoms, behavioral abnormalities. Account for 40% of all childhood brain cancers - 25% are GBM
High grade astrocytoma
presents with clumsiness and usteadiness of hte arms and legs. Headaches and vomiting also occur. Tend to have best prognosis of intracranial malignancies
Cerebellar astrocytoma
present with morning headache, ovmiting and lethargy. Ataxis of trunk/limbs. Often have hydrocephalus at diagnosis. Can have head-tilt due to 4th cranial nerve dysfunction or impending herniation
medulloblastoma
Symptoms depend on tumor location - but relate to blockage of CSF flow
Ependymoma
present with parinaud syndrome (imapired upward gaze, dilated pupils with better reactivity to acoomodation than light and retraction/conversion nystagmus with lid retraction) can also have hormonal secretion
Germ cell tumors
present with headache and vomiting. Often have visual changes and can have endocrinologic changes. Often have personality or sleep pattern changes as well
craniopharyngioma
Rare, except in children with neurofibromatosis type 2 OR long term survivors of other brain tumors who have received radiation
Meningioma
Neuroblastoma primary sites
40% arise within the abdomen (adrenal medulla) and 30% in nonadrenal abdomen (paravertebral ganglia, pelvic ganglia and organ of zuckerkandl). 20% occur in paravertebral ganglia of chest/neck
Common neuroblastoma metastasis sites (often metastasized already at presentation)
lymph nodes, bone, bone marrow, liver, skin (subQ bluish nodules), orbital (raccoon eyes - differentiate from NAT)
Neuroblastoma diagnosis
biopsy with histology of neural origin tumor. Neural crest cells so metabolize catecholamines - increased urinary metabolites HVA and VMA
Wilms tumor associated disorders
GU anomalies (cryptorchidism and hypospadias), hemihyperplasia, sporadic aniridia
Wilm’s associated syndromes
WAGR (wilms, aniridia, GU anomalis, reduced intellect), beckwith wiedmann, denys-drash (wilms, nephropathy, male undervirilization)
Tumor that would lead to bitemporal vision loss
pituitary tumor or craniopharyngioma
loss of visual perception in a single visual field
occipital tumor
Risk factors for hepatoblastoma?
Pre-term birth and beckwith-wiedemann syndrome
Differential time course presentation for HCC versus hepatoblastoma?
Hepatoblastoma more common in children < 3, HCC more common in children > 3
Most common sites of involvement for langerhans cell histiocytosis
skull, femur, ribs, vertebra and humerus
a lytic, “punched out” circular lesion on xray
Langershans cell histiocytosis
Various things that can present with langerhans cell histiocytosis
bony lesions, cutaneous lesions (seborrheic like often, but can be variable), lymph node enlargement, hepatomegaly, pituitary dysfunction (with DI)
Typically high grade in pediatrics, originating in peyers patches of the GI tract (Ileocecal junction most common)
burkitt’s lymphoma
