Oncology Flashcards
% AML vs ALL
80% AML, 20% ALL
Predisposition for childhood luekemia
T21, T21, T21, NF-1., Li-Fruameni, Bloom syndrome, Noonan syndrome
Bone marrow failure syndromes, - fanconi, dyskeratosis congentia, severe congenital hneutropneia, schwachmann diamond, DBA
How often is WBC normal in leukemia
50% fo the timw
Higher risk leuekmia
age <1 or >10, initial WBC >50%, CNS/testicular disease, ufnfavorable cytogenetics, poor response to treatment
Unfavorable cytogenetics
philidelphia, KMT2AR, hypodiploidy
Favorable leukemia cytogenetics
hypodiploidy (trisomy 4, 10), ETV6-RUNX1
Treatment for ALL
2.5 years, chemotherapy, rarely radiation therapy unless CNS relapse
AML trestment
6mo +/- allogenic HSCT
EFS for ALL
90%, slightly less for very high risk
AML EFS
20%
1 cancer age 15-19
lymphoma
Pathogneumonic cells for Hodgkins lymphoma
reed-sternberg cells
risk factors for Nonhogkins lymphoma
immunodeficiency, ataxia telangectasia, bloom syndrome, WAS< SCID, 2yo post BMT
Lymphoma staging
Stage 1- localized
Stage 2 - above dipahragm
Stage 3- below diaphragm
Stage 4- metastatci
worse prognostic factors for lymphoma
higher stage, B symptoms, bulky disease, extranodal extension
Parinaud syndrome
Convergence retraction nystagmus
Light near dissociation
upgaze paralysis
eyelid retraction
skew deviation
Where is the tumor with parinaud syndrome
pineal
collier sign
lid reetraction
diencephalic suyndrome
happy FTT kids, look for brain tumor
Most common tumor in cerebral hemispheres
astrocytoma, meningioma, PNET
most common tumpr in sella/chiams
craniohparyngioma, germ cell tumor, optic glioma
most common cerebellar tumor
medulloblastoma, e[endymoma, astrocytoma
modst common infant brain tumors
medulloblastoma, glioma, ependymom, DIPG, ATRT
Age for medulloblastoma
5-7
Age for choroid plexus tumors
75% under 2
Age for ATRT
66% under 3yo
Age for germ cell tumor (midline)
second decade
Predisposition for astrocytoma
NG-1 (optic gliomas), TS
Predisposition medulloblastoma
turcot syndrome,gorlin syndrome, li-fraumeni, fanconi
average risk medulloblastoma
> 3, negative CSF, normal spine MRI, <1.5cm tumor residual undofferentiated
Hwere does medulloblastoma met
spine, outside CNS
Where does wilms met
lung, liver
predisposition wilms tumor
familial WT1 gene mutation, beckwith wiedmann, WAGR, li-fraumeni, denys-drash, perlman
most common solid extracranial tumor in children
neuroblastoma
opsoclonus myoclonus ataxis is suggestive of
neuroblastoma
how do you treat opsoclonus myoclonus ataxia
IVIG, steroids, ritux
How to investigate neuroblastoma
urine catecholamines, CT/MRI of primary site, MIBG, biopsy, BMA
neuroblastoma mets
bone, bone marrow, lymph nodes, slin, liver
stage 4S neuroblastoma
<12mo with stage 1-2 dissemination limited to skin/liver/bone marrow
good prognsosis for neuroblastoma
<12-18mo, stage 4S, higher DNA content in biology
Osteoid osteoma x-ray findings
well defined lucency with surroudnibgg sclerotic bone
chondroma x-ray
stalk projection
What bone tumor gives you B symptoms
Ewing’s
Extra test needed for ewings
bone marrow aspirate
Where do yu get tumors in ewings
chest wall, pelvis, fibula/tibia (axial, below the knee)
where osteosarcoma
distal femur, proximal tibia, humerus
what part of bone ewings
diaphysis, metadiaphsysi
what part of bone is osteosarcoma
metaphysis
soft tissue component more ewings or osteo
ewings
mtes for ewing
lung, bone, bone marrow
osteo mets
lung, bone
x-ray ewings
onion skinning
osteochondroma x-rays
sunburst pattern
Asparaginase side effects
anaphylaxis, coaguloapthy, pancreatitis
cisplatin SE
fanconi syndrome, nephrotoxic, tinnitus, SNHL
cyclophosphamide SE
hemorrhagic cystitis, infertility, 2nd malignancy
cytarabine SE
fevers, rash, conjunctivitis
doxorubicin SE
red secretions, acute arrhythmia, heart failure
etoposide SE
allergic reaction, 2nd malignancy
methotrexate SE
mucositis, transaminitis, neurotoxicity, leukoecephaloapthy, LD
vincristine SE
constipation foot drop, jaw pain, peripheral neurpathy, SIADH
Bloemycin SE
pulnonary fibrosis
alkylating agents
cyclophosphamide, ifosfamide, melphalan, busulfan, etoposide
Predisposition CNS tumors
NF1, NF2, TSC, VHL, Forlin, Turcot syndrome
RF hepatoblastoma
BW, FAP
Risk factors hepatocellular carcinoma
alagille syndrome, hereditary tyrosinemia, NF1, AT, FA
neuroblastoma predisposition
PHOX2B, BWS
sarcomas predisposition
LFS, NF1, BWS, RB
Transient myelporliferative disorder gene
GATA1
High risk malignancies for Tumor lysis
burkitt lymhoma, other NHL, AML
Mgmt tumor lysis
iv fluids, allopurinol. rasburicase