Oncology 2 Flashcards
Brain tumors by incidence?
- Glial cell tumors (astrocytomas)
- primitive neuroectodermal tumors (medulloblastoma)
- ependymomas
- craniopharyngiomas
Most common type of brain tumor? High-grade arise from? Low-grade arise from?
Glial cell tumors; supratentorial region, infratentorial region
Features of optic glioma?
Diminished vision, visual field deficits, strabismus
Features of craniopharyngioma?
- Growth Retardation, delayed puberty
- Visual changes
- Diabetes insipidus and other hormonal problems
Tumor markers:
- Germs cell tumors?
- Medulloblastoma?
- AFP or B-HCG
2. Homovanillic acid, vanillylmandelic acid, Polyamines
Prognosis for
- astrocytoma?
- Medulloblastoma?
- Brainstem gliomas?
- > 75% if low-grade; 35% if high-grade
- Greater than 75% if resectable and child is over four years
- Poor prognosis – not resectable and Chemotherapy is ineffective
Second most common solid tumor? Peak incidence?
Neuroblastoma (tumor of neural crest cells); within first five years of life;
Pelvis >mediastinum > neck
Clinical features of neuroblastoma – Based on location? All tumors may have?
Pelvic – abdominal mass crossing midline, abdominal pain, anorexia
Mediastinal – respiratory distress, incidental finding
Cervical location – tracheal compression, Horners
- Catecholamine effects – flashing, hypertension, headache, sweating,
- Non-Specific – fever, weight loss
- Acute cerebellar atrophy
Acute cerebellar atrophy?
Ataxia, monoclonals, opsoclonus (random eye jerks)
Neuroblastoma – prognosis? (Serum markers of poor prognosis?)
Good prognosis in children under 1
Poor prognosis associated with N-myc, ferritin, lactic dehydrogenase, neuron specific Enolase
Wilm’s tumor – age of onset? Associated genetic syndromes? Clinical features?
<5 years; Beckwith-Weigman, chromosome 11 deletion, WAGR
- Abdominal mass that does not cross the midline
- abdominal pain
- Hematuria
- Hypertension
- GU abnormalities
- Hemihypertrophy, aniridia
Treatment for Wilms tumor? Prognosis?
Chemotherapy; add radiation for advanced disease
Cure rare >90%
Rhabdomyosarcoma – age of onset? Associated with? Initial presentation? Most common sites of involvement? Diagnosis? Treatment?
<10 years; neurofibromatosis
Painless soft tissue mass
- Head and neck
- GU tract
- Extremities
Biopsy
Complete surgical resection with adjunct chemo/radiation
Specific location of head/neck rhabdomyosarcomas (and Symptoms)?
- Orbit – proptosis, eyelid swelling, nerve palsies
- Nasal pharyngeal – epistaxis, chronic sinusitis, airway obstruction
- Laryngeal – hoarseness
Most common malignant bone tumor? Incidence when? Associated with? Diagnosis? Management?
Osteogenic sarcoma; growth spurt
Retinoblastoma, paget’s disease, previous radiation, fibrous dysplasia
Biopsy;
Surgery, chemo
Ewings sarcoma – characterization? Genetic association? Diagnosis? Management?
Small, round, blue cell tumor
chromosomes 11 and 22
Radiographic findings, MRI. Definitive diagnosis via biopsy
Multiagent chemotherapy followed by surgical excision (add radiation if complete excision not possible)
Osteogenic sarcoma versus Ewings sarcoma:
- Site
- Local findings
- systemic findings
- Radiographic findings
- Metastasis
- Metaphysis of tubular bones (femur, tibia, humorous) versus flat bones and diaphysis of tubular bones (pelvis, humorous, femur)
- Pain, swelling, soft tissue mass in both
- None versus fever, malaise, leukocytosis, ESR
- Sunburst appearance versus onionskin appearance
- Less (lungs > bone) versus more (Lungs >bone/BM)
Most common type of liver tumor childhood? Age? Associated with?
Hepatoblastoma; younger than 3; Beckwith-Wiedemann
Hepatocellular carcinoma – age? Associated with?
Both children and adolescents
- Chronic hepatitis B infection
- Biliary atresia
- Glycogen storage disease
- Alphaz1-antitrypsin deficiency
- Hereditary tyrosinemia
Liver tumors – clinical features? Absent feature? Marker? Diagnosis? Treatment? Prognosis?
- Upper right abdominal mass
- Anorexia/weight-loss
NO jaundice
AFP
CT/MRI with increased AFP
Surgical resection and chemo
Poor
Teratoma – definition? Types?
Containing 2+ primary germ so players
- Sacrococcygeal – 1st year of life in females. Benign. Resection
- Anterior mediastinal – airway obstruction. Benign
- Ovarian – most common. Benign. Calcium in tumor on radiograph.
Most common testicular tumors in order of occurrence? Ages? Association with? Unlike adult testicular tumors?
Yolk sac tumors > teratomas >seminomas/embryonal
Younger than 5 or in adolescence
Cryptorchid testes
One third are benign (all malignant in adults)
Clinical features of yolk sac tumor? Treatment?
- Solid, firm, painless testicular mass
- Elevated AFP
Radical orchiectomy and retroperitoneal node dissection
