Oncology Flashcards
Most common childhood cancers
Leukemia Brain tumors Lymphoma Neuroblastoma Soft tissue sarcoma Wilms Bone tumors
Wiskott-Aldrich syndrome
B/T cell dysfn, atopic dermatitis,, TCP, assoc w/ lymphoma and leukemia
X-linked lymphprolif disease
Assoc w/ EBV, may result in lymphoma
Genetic disorders assoc w/ leukemia
Downs, Trisomy 13, 18, Fanconi anemia, Bloom syndrome, NFm I
leukocoria
white reflex in pupil from retinoblastoma
ALL
most common childhood cancer, 85% of childhood leuk, 2-6 yo,
Cell morpho- L1 = small w/ little cyctoplasm, indinstinct nucleoili, L3 = large w/ nucleoli
T pheno 25%, B-cell < 5%, Pre-B = 70% then split into Calla positive (70%), versus calla-neg
Fever, bone/joint pain, pallor, bruise, HSm, LA
Dx w/ CBC anemia TCP, wbc by 1/3 rule, leukemic blasts seen (normal CBC is not a rule out though)
Bone marrow biopsy w/ marrow replacement by lymphoblasts
No staging..better if 1-9 yo, Female, white, <50K cells, hyperploid, no other orgs, and calla +
ALL management
Induction- destroy as may cells as possible, for remission. Use steroids, vincristine, l-asp, intrathecal methotrexate, 95% remission
Consolidation- systemtic chemo + prophylactics to stop CNS w/ more intratech methotrex + cranial irradiation in high risk
Mantenance = daily/periodic chemo for up to 3 years
Transplant for high risk kids/relapse
ALL compx
Neutropenia infections (worry about sepsis by staph, staph epi, pseudo, e. coli)
Opportunitic infec like PCP, fung, hsv during immunosupp, give bactrim prophylaxis
Mets- tumor lysis => hyperuricemia (renal issue), hyperK (heart), hyperphosph- hypocal + tetany
Also meds => pancreatitis, cardiomyo, cystitis, brain rads=> MR, growth delay
85% survival!
AML
Assoc w/ downs, fanconi, kostmann, neurofib, ionizing rad
Classify- m1 = no mature, m2 = some mature, m3 = promyelocytic auer rods, m4 = acute myelomonocytic, m5 = monocytic, m6 = erythroleukemia, m7 = megakaryocytic leuk
CNS involvement more comon, gingival hypertrophy
Dx- leukemic myeloblasts, conform with bone marrow biopsy
AML - need intesive myeloablative therapy to induce remission, then transplant.
Agressive chem works in 50%, matched sibling bone marrow tx in 70%, AML from downs very responsive
CML
Least common, 3-5% childhood leukemia
Adult CML = 2x as common, in adolescents, philly chromo 9 22 transloc, bcr/abl1
Juvenile JMMl = infants/kids under 2, no philly, chromo 7/8
Adult = massive splenomeg (also fatigue wl, pain)
JMML = fever, eczema-ish face, supp LA, petech, leukocytosis
MGMT w/ bone marrow transplant (matched or not). Rads no work, but imatinib in adults => remission
Adults- biphasic course…initial chronic controlled by chemo, but acute phase deterioration. JMML often fatal, 50% relapse even w/ transplant
Hodgkin’s
Cancer of antigen-processing cells in lymph nodes
EBV assoc, 2-4x risk w/ EBV, older kids/adolesc
Clin x= painless LA cervical/supraclav, 30% w/ systemic sx
Dx= LN biopsy, reed-sternberg- multinuke
Ann Arbor Stage- A = no systemic, B = systemic (f, ns, wl)
I= single LN, II = 2+ LN on same side, or extension to extralymph site + 1+ LN on same side of diaphragm, III= Ln on both sides (spleen = LN), IV = diffuse/dissem
MGMT - chemo + rads, compx = growth slow, secondary malig (breast, aml, non-hodg), hypothy, male sterility
>80% survival for stage I/II
Non-Hodge
Very aggressive, 1.5X more common than hodge
Males, immunodef (hiv, wiskott, ataxia telang, prior EBV, up incidence after 5 yo)
Dx- pathology examine tissue + CXR or CT scan, A/P scan, bone scan, liver trasam measure, bone marrow biopsy, CSF analysis
Tx RAPIDLY b/c aggressive, debulk + chemo + prophylaxis + tx tumor lysis syndrome
Best outlook for localized lymphoma
Large cell lymphoma = B cell- enlarged Lymphoid in tonsis, adenoids, peyes
Lymphoblastic lymphoma
T-cell origin, like ALL, presents w/ anterior MS mass, SVC syndrome, airway obstruction
Small noncleaved cell lymphoma
Burkitt’s, most common lympho of childhood, B-cell origin
P/w intussusception, ab pain, mass, lead point in any child > 3yo- think abt lympho
