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Paediatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

What are the most common types of pediatric malignancies? Name the top 3.

A
  1. Leukemia (40%)
  2. Brain tumours (20%)
  3. Lymphomas (15%)
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2
Q

What is the most common extracranial tumour in children?

A

Neuroblastoma

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3
Q

What are the typical presenting features of leukemia?

A
  • *Bone marrow failure**
  • Anemia
  • Neutropenia: increased rate of infections
  • Thrombocytopenia: easy bruising, gum bleeding etc.
  • *Organ infiltration**
  • Gingival hypertrophy (esp. M4 AML)
  • Hepatosplenomegaly (esp. ALL)
  • Lymphadenopathy
  • Testicular enlargement – painless (esp. ALL)
  • Bone: bone pain, pathological fractures
  • Skin: leukemia cutis
  • Eyes: Roth spots, cotton wool spots, vision changes

Constitutional symptoms
- Fever
- Weight loss
- Night sweats
>> “B symptoms”

  • *Leukostasis/hyperleukosis syndrome**
  • Diffuse pulmonary infiltrates
  • Respiratory distress
  • CNS bleeding
  • Altered mental status
  • Myocardial infarction
  • Priapism
  • *Metabolic effects aggravated by treatment**
  • Increased uric acid: nephropathy, gout
  • Released phosphate
  • Released procoagulants: DIC (esp. M3 AML)

If T-cell lymphoma –> thymic enlargement/lymphoma mediastinal mass can cause airway obstruction

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4
Q

What is the definition of acute leukemia?

A

Presence of 20% or more blast cells in the bone marrow aspirate at presentation
>> Usually <5%

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5
Q

What are the differential diagnosis of leukemia in children?

A
  • *Infection**
  • EBV
  • Miliary TB
  • *Autoimmune diseases**
  • SLE
  • JIA

Langerhan’s cell histiocytosis: look for skin rash
>> Benign!
>> Characterized by cloncal proliferation of Langerhans cells (dendritics)
>> Painful bone swelling (esp. skull)
>> Rash: extensive eruptions on the skull, red papules in intertriginous areas
>> Diabetes insipidus is very common – involvement of the hypothalamic-pit axis

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6
Q

What are the investigations helpful in the diagnosis for leukemia?

A

Blood tests
- CBC
- Clotting profile in case of DIC (AML M3)
- Peripheral blood smear for blasts
>> Circulating blasts with Auer rods are pathognomonic for AML M3
- Baseline RLFT
- Serum hormone levels (not necessarily for leukemia)
>> AFP, B-hCG and LDH
:: Germ cell tumours
:: Hepatoblastoma
>> Testosterone/estrogen
:: Germ cell tumours
>> Renin levels for Wilm’s tumour
- Bone profile: primary bone tumours/metastasis
>> Increased PO4: released from blasts
>> Decreased Ca

  • *Bone marrow aspirate**
  • AML >20%
  • Morphologic, cytochemical and/or immunotypic features to establish lineage

Trephine biopsy

  • *Urine (not for leukemia)**
  • Catecholamines for neuroblastoma
  • *Imaging**
  • Bone scan: for bone metastasis
  • CXR: for lung metastasis
  • CT/PET-CT/MRI brain as indicated
  • ECG and MUGA scan prior to chemotherapy (baseline for cardiotoxicity)
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7
Q

What is the treatment for AML?

A

CHEMOTHERAPY

M3 AML with t(15:17) translocation – all-trans-retinoic acid and arsenic trioxide

  1. Induction: cytarabine + daunorubicin
  2. Consolidation
  3. Supportive care: screening for infection + transfusion
    >> Give allopurinol before chemotherapy to prevent gout
    >> A total of 4-6 courses of induction and consolidation tx over 4-6 months
    >> Each course is associated with 3-4 weeks of severe pancytopenia

Note: Treatment is much more aggresive in AML than in ALL, but
there is no evidence for CNS prophylaxis in AML

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8
Q

What is the management for ALL?

A
  1. Induction: 4-5 weeks
  2. Consolidation: 3-5 months
  3. Maintenance treatment: up to 2-3 years
  4. CNS prophylaxis: intrathecal methotrexate/irradiation

>> Intensive inpatient treatment for 6 months +
less intensive home maintenance treatment for up to 2-3 years

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9
Q

What is the prognosis for ALL?

A

5-year-survival rate: ~80%

  • Good risk: 90%
  • Intermediate risk: 70-80%
  • Poor risk: 25%
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10
Q

What are the specific investigations to perform for neuroblastoma?

A
  1. Urine catecholamines
  2. Image-guided biopsy
  3. For genetic markers for prognosis: n-myc amplification
  4. Staging scans:
    • Bone scan
    • MIBG scan
    • CT/PET-CT
    • BM aspiration for Homer-Wright rosettes
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11
Q

What is the management for neuroblastoma?

A

COMBINATION

  1. Neo-adjuvant chemotherapy
  2. Surgical debulking
  3. Post-op chemotherapy
  4. Radiotherapy
  5. Autologous BM transplant
  6. Target therapy
  7. Differentiating agent: cis-retinoic acid
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12
Q

What is the most common cancer in the first year of life?

A

Neuroblastoma

  • Metastasis are common at presentation (>50%)
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13
Q

What is the most common age of presentation for leukemia?

A

Can occur at any age

Mean age of diagnosis: 2-5 years

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14
Q

What are the differential diagnoses for periorbital ecchymoses (“panda eyes”)?

A
  • Basal skull fracture: rule out child abuse
  • Craniotomy
  • Disseminated neuroblastoma
  • Amyloidosis in multiple myeloma
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15
Q

What are the peak ages for Hodgkin lymphoma?

A

Bimodal peaks

  • 15-34 years
  • >50 years
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16
Q

What is the common age of presentation in non-Hodgkin lymphoma?

A

7-11 years

17
Q

What is the defining feature of Hodgkin lymphoma?

A

Reed-Sternberg cells

18
Q

What are the classifications of non-Hodgkin lymphoma?

A
  1. Lymphoblastic
  2. Large cell
  3. Burkitt’s
    >> T-cell VS. B-cell
    >> Always do a CXR for any mediastinal masses
    >> Rapidly growing tumour with distant metastases
19
Q

What is the CHOP regimen and what is it used for?

A

Usually for Hodgkin lymphoma but can also be applied to non-Hodgkin lymphoma

C: Cyclophosphamide
H: Hydroxydonorubicin
O: Oncovin (Vincristine)
P: Prednisone

+ Rituximab in B-cell NHL

20
Q

What is the prognosis for Hodgkin lymphoma?

A

>90% 5-year survival

21
Q

What is the prognosis for non-Hodgkin lymphoma?

A

75-90% 5-year survival

22
Q

What is the prognosis for AML?

A

50% 5-year event-free survival

23
Q

What is the prognosis for stage 4 neuroblastoma?

A

40% 5-year event-free survival

24
Q

What is the difference between allogenic and autologous bone marrow transplant?

A
  • *Allogenic donor**
  • HLA (human leukocyte antigen) identical siblings
  • Mismatched family donor
  • Haplo-identical family donors (half-matched)
  • Unrelated donor
  • *Autologous**
  • Patient’s own bone marrow
  • Used in AML
  • Used in highly malignant solid tumours requiring high-dose chemotherapy that have potentially detrimental effects on the bone marrow (namely stage 4 neuroblastoma)
25
Q

How is bone marrow transplant done?

A

Megadose chemotherapy +/-
total body irradiation to eradicate residual leukemic cells
>> infuse normal stem cells to reconstitute the bone marrow system

26
Q

What are the indications for bone marrow/stem cell transplant in ALL?

A
  • Early bone marrow relapse
  • High risk (philadelphia chromosome, failed induction) ALL before relapse
27
Q

What are some known specific side effects of asparaginase?

A
  • Venous thrombosis
  • Pancreatitis
28
Q

What is hyperleukocytosis?

A

Total WBC >100x10^9/L

  • A common presenting feature of leukemia
  • A MEDICAL EMREGENCY
  • Complications
    >> Intracranial hemorrhage
    >> Pulmonary leukostasis syndrome
    >> Tumour lysis syndrome
    >> Chest crisis
    >> Myocardial infarction
    >> Priapism
29
Q

What are the features of malignant lymphadenopathy?

A
  • Firm
  • Discrete
  • Non-tender
  • Enlarging
  • Immobile

>> Fluctuance, warmth or tenderness are more suggestive of benign nodes

30
Q

Cancer is the second most common cause of death after injuries in children
after 1 year of age.

A

Paediatrics (16 decks)

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