Oncology Flashcards
4th leading cause of death in children
CA
MC malignancy in children (nearly 1/3 of all pediatric cancers)
Acute Lymphoblastic Leukemia
(ALL)
- Leukemic blasts replace bone marrow
- Uncontrolled proliferation of immature lymphocytes
- >25% blasts in bone marrow aspirate
- Unknown cause - but may have a genetic link
- Peak age: 4 years old (usually 2 - 10 yo)
dx?
Acute Lymphoblastic Leukemia
(ALL)
A blood stem cell goes through several steps to become a ? (3)
RBC
WBC
platelet
Where does CA start in regard to stem cell development?
- after differentiating from a common lymphoid progenitor
- before becoming a NK cell and smal lymphocyte
ALL develops from what type of stem cell?
lymphoid blast
s/s of ALL
- dec bone marrow production of RBCs, WBCs or platelets
- fevers, bone pain, pallor, petechiae (and easy bruising), purpura, progressive weakness, dyspnea, infection, fatigue
- Enlarged liver and spleen, Anemia
- LAD
w/u for ALL?
-
CBC w/ diff
- 95% have dec in at least one cell type - neutropenia, thrombocytopenia or anemia
- ANC < 1k, even if WBC normal - peripheral smear
- BMP, Uric Acid, LDH, PT/PTT
- DX: BM aspirate
- LP
- CXR
- Lymphoblasts on peripheral smear
- Pancytopenia (all 3 cell lines are decreased)
likely dx?
ALL
ALL - Abnormal white cells reveal hyperdiploidy and translocation of chromosomes ___ and ____
12 and 21
how to perform BM aspirate and bx?
- numbed
- insert Jamshidi needle (a long, hollow needle) hip bone
- Samples of blood, bone, and bone marrow are removed for examination under a microscope
mgmt for ALL
- phase 1: Remission Induction - chemo + dex/pred +/- intrathecal MTX
- Phase 2: Intensification Consolidation Phase - Intrathecal chemo +/- radiation
- Phase 3: Continuation Therapy / Maintenance - Daily, oral chemo, wkly MTX, pulses of IV chemo and oral steroids
Treatment for 15 - 18 months, overall cure rate 90%
goal remission % during phase 1 for ALL?
95% remission on bone marrow aspirates
RF for ALL
- XR
- Downs syndrome
- 2nd MC leukemia in children
- Untreated can result in death within weeks
- Primarily a cancer of bone marrow and lymph nodes
Acute Myeloid Leukemia
(AML)
Also called Acute Myelogenous Leukemia
s/s of AML
- Early flu-like sx
- Fatigue
- Bleeding
- Infection
- Adenopathy
- Skin nodules
- HSM
w/u for AML
- CBC w/ diff
- BM aspirate
- LP, CXR
- CBC reveals neutropenia, anemia, and thrombcytopenia
- Bone marrow aspirate shows 30% blasts with histochemical staining and morphology of leukemic cells
- Peripehral smear shows auer rods
dx?
AML
AML comes from what stem cell?
myeloblast - either myeloid stem cell or myeloid blast
general mgmt approach of AML
- Less responsive, more intense
- Chemo - systemic and intrathecal - aggressive induction therapy (80-85% remission)
- Radiation - sometimes
- BM transplant
- Cord blood transplant
tx phases of AML
- Phase 1: Remission Induction Chemo - 1 month; Kill as many leukemic cells ASAP = cancer goes into remission
- Phase 2: Consolidation Preventative - Stop spread of cancer to brain and spinal cord; Intrathecal chemo +/- radiation
- Phase 3: Intensification - high dose of chemo; 1-2 tx lasting 2 mo x 9 mo
RF for AML
- Ionizing radiation therapy
- Previous chemo
- Syndromes - Neurofibromatosis, Downs
disposition and prognosis of AML
- Can reoccur
- Remission when WBC in normal range
- 75-85% remission
- 35-50% long-term survival
- Account for 50% of lymphomas in children
- peak before adolescence and again >50 y/o
- Germinal center B cells undergo malignant transformation for unknown reasons
Hodgkin’s Lymphoma
what are the 3 different forms of Hodgkin’s?
- Childhood form - < 14 y, inc risk with large family size, dec socioeconomic status
- Young Adult form - 15 - 34 y, Higher socioeconomic status and earlier birth order (oldest child)
- Older Adult form
what decreases the risk of childhood form Hodgkin’s?
Early exposure to common infections in childhood
- Painless cervical LAD (70-80%) or supraclavicular (25%)
- Mediastinal mass (50-75%) and asx
- Fatigue, wt loss, anorexia, night sweats and cough, fever
dx?
HL
B sx: F, wt loss, night sweats
w/u for HL?
- CBC
- ESR - elevated
- EBV titers
- LN bx
- BM aspirate; LP
- CXR, CT; bone scan; PET
Reed-sternberg cell is associated with what dx?
HL
suspected HL, Early bx of enlarged LN if:
- Lack of infectious cause
- Lymph node > 2 cm
- Supraclavicular node
- Abnormal CXR
- Increasing node size >2 wks of abx, or failing to dec in size in 4-6 weeks
tx and prognosis of HL
- Chemotherapy
- Disease free survival at 90-95% = Cure
- Prognosis correlates with “B sx”
- Immature lymphocytes grow out of control and fail to mature and accumulate in lymph tissue (nodes, spleen, thymus)
- Arise from lymphoid cells
Non-Hodgkin’s Lymphoma (NHL)
3rd MC cancer in children?
Non-Hodgkin’s Lymphoma (NHL)