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Oncology Flashcards

1
Q

incidence of cancer in children aged 0-14?

A 
- 13,500 new cases/year in US:
1/7000 kids dx annually
peak incidence: 1st year of life
- 2500 cancer related deaths/year
- #1 cause of disease related mortality
(behind trauma, homicide, and suicide)
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2
Q

Most common cancers 0-14 yos?

A
  • leukemia: 32%
  • CNS 20%
  • lymphoma: 11%
  • neuorblastoma 8%
  • soft tissue sarcomas: 7%
  • kidney (wilms): 6%
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3
Q

Common cancers in 15-19 yos?

A
  • lymphoma: 25%
  • germ cell: 14%
  • leukemia: 12%
  • CNS: 10%
  • soft tissue sarcoma: 8%
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4
Q

Down syndrome is assoc with higher risk of getting what cancers?

A
  • ALL (12x risk)
  • AML (46x risk)
  • AMKL (466x risk)
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5
Q

Beckwith-Wiedeman assoc with higher risk of getting what cancers?

A
  • Wilm’s (4-20%)
  • hepatoblastoma
  • rhabdomyosarcoma
  • adrenocortical carcinoma
  • neuorblastoma reported
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6
Q

Li Fraumeni syndrome is assoc with higher risks of what cancers?

A
  • bone tumor
  • soft tissue sarcomaas
  • breast cancer
  • brain tumors
  • adrenocortical carcinoma
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7
Q

Brain tumors are assoc with what genetic syndromes?

A
  • neuorfibromatosis
  • tuberous sclerosis
  • turcot syndrome
  • von hipple lindau
  • gorlin
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8
Q

Bone tumors are assoc with what genetic syndromes?

A
  • hereditary retinoblastoma
  • paget’s disease
  • Rothmund-Thompson
  • Li-fraumeni syndrome
  • Poikiloderma, small stature, skeletal dysplasia
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9
Q

Kidney tumors are assoc with what genetic syndromes?

A
  • congenital aniridia
  • hemihypertrophy
  • GU malformations
  • WAGR
  • Denys-Drash
  • Frasier
  • Beckwith-Wiedemann
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10
Q

Liver tumors are assoc with what genetic syndromes?

A
  • polyposis
  • gardner
  • beckwith-wiederman
  • hemi-hypertrophy
  • tyrosinemia
  • glucogen storage dx
  • alpha 1 anti-trypsin
  • hemochromotosis
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11
Q

Known environmental causes of cancer in kids?

A
  • ionizing radiation: leukemia, brain tumors
  • radiation therapy: bone tumors
  • radium (high dose): bone tumors
  • prior chemo: bone tumors, leukemia
  • immunosuppression: lymphoma
  • ## EBV infection: lymphoma (burkitts)
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12
Q

If a pt comes in complaining about abdominal pain what should you be thinking about?

A
  • constipation, cyst, bladder etiologies
    (more common)
  • cancer
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13
Q

Common causes of isolated cytopenia?

A
  • infection, ITP, toxin
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14
Q

Posisble cause of recurrent fever and bone pain?

A
  • leukemia
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15
Q

Possible cause of morning HA with vomiting?

A
  • CNS tumor
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16
Q

possible cause of neck mass not responding to abx?

A
  • lymphoma
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17
Q

Possible cause of chronic bone pain, swelling and limp?

A
  • bone tumor
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18
Q

Possible cause of progressive abdominal distension?

A
  • abdominal tumor
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19
Q

Possible cause of bleeding, bruising, pallor and fatigue?

A
  • leukemia
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20
Q

Possible cause of combined cytopenia?

A
  • leukemia, marrow failure
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21
Q

What are the presenting sxs of leukemia?

A
  • sxs due to bone marrow replacement by dysfxnl immune cells (pain - expansion of so many WBCs, thrombocytopenia and anemia b/c of decrease in platelets and RBCs)
  • bone pain, anemia, fatigue, fevers, and infection, petechiae and bleeding
  • infection: because immune cells are dysfxnl
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22
Q

Sxs of brain tumors in children, infants and the specific sites of tumor with correlated sxs?

A 
- infant:
large head, bulging fontanelle, anorexia, FTT, loss of milestones, irritable, shrill cry
- child:
HA (morning)
vomiting
decreased academics
personality changes
  • specific sites:
    vision change
    seizure (less than 99% not a tumor)
    altered speech, handwriting or gait (clumsy)
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23
Q

IICP findings and management?

A 
- neuro-onc emergency:
10-18 mmHg: normal ICP
25-40: decreased blood flow and sxs
greater than 40: unconsciousness
- stroke, herniation, death
- late findings:
cushings triad: HTN, bradycardia, and wide pulse pressure, cheyne-stokes respirations

management:
- oxygenation: increased CO2 levels lead to dilation of cerebral vessels and more ICP
- steroids if edema present
- no prolonged hyperventilation: will lead to blood vessel constriction and decreased perfusion
- EVD: drain into lateral ventricle
- surgical decompression

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24
Q

Sxs of lymphoma?

A 
- localized:
painless enlarged lymph nodes
abdominal pain or mass
emergent: compromise of vital structure 
- systemic:
fevers, night sweats, wt loss, fatigue, pruritus, pain with ETOH ingestion
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25
Mediastinal mass Complications? Management?
- anterior mediastinal mass: compress trachea, pleural effusion - this can lead to tamponade - SVC or superior mediastinal syndromes are medical EMERGENCIES - proceed with extreme caution: small tumors can be sx, all depends on locations, sedation can cause fatal resp failure - anesthesia can aggravate SVC/airway compression, difficult to intubate past obstruction - obtain tissue by least invasive means possible - emergency management may include steroids or radiation: bx may be uninterpretable in as little as 48 hrs
26
Signs and sxs of abdominal tumors?
- distension, palpable mass (clothes won't fit) - N/V/D, constipation, wt loss, fever - obstruction, pain, jaundice, blood in urine, renal failure
27
Signs and sxs of bone tumors?
- pain/tenderness/limp - soft tissue mass - night pain - "growing pains" - hx of minor trauma - pathologic fracture - pain often present for 2-3 months
28
Diff types of leukemia?
ALL: - precursor B cell (B-ALL)most common in young kids - Burkitts (mature B-ALL, tx like lymphoma) - T cell (T ALL) AML: - FAB (old) and WHO classifications: FAB: based on morphology/phenotype. M0-M7, marrow with 30% blasts or more WHO: clinical/molecular dx, marrow with 20% blasts or more, prior therapy, down syndrome, MDS, cytogenics
29
How common is leukemia in peds?
- leukemia 32% of childhood cancers among those less than 15 yrs old - 13% of cancers among those 15-19.99 - 0-5 yrs: ALL 81%, AML 14%, CML 2%, others 3% - 15-19: ALL 51%, AML 36%, CML 9%, other 4% - leukemia causes 30% of cancer deaths among those less than 20
30
Predisposing conditions lead to higher risk of leukemia?
- cancer predisposition syndromes: - Li Fraumeni (SBLA): Tp53 oncogene and other genes - ataxia telangectasia (T ALL, T NHL) - Neurofibromatosis type 1: AML more common than ALL - bloom syndrome (leuk, lymphoma, AML more than ALL) -congenital anomaly syndromes: klinefelters - congenital and acquired immunodeficiences: ataxia telangectasia, Wiskott aldrich syndome, chronic immunosuppresison, AIDs
31
Down sydrome and leukemia?
- 10-20x increased risk of leukemia - relative risk of AML higher but ALL more common during first year of life - risk period limited to first 3 decades - increased risk of toxic death - DS-ALL, DS-AML
32
ALL prevalence?
- 80-85% cases are B-precursor - less than 2% cases are mature B-ALL (burkitt): assoc with t(8;14) - 15% cases are T ALL - incidence peaks at 2-4 yrs in developing countries - incidence in whites almost 2x higher than blacks - little known about causes
33
Presentation of leukemia?
- bone pain!!! (35%): due to expansion of marrow cavity, young children may just be irritable, stop walking, favor painful site if localized - adenopathy (diffuse) - hepatosplenomegaly - thymic expansion: mediastinal mass esp T ALL - CNS sxs: HA, neck pain, CN palsy, seizures - testicular involvement: painless, enlarged, usually rock hard testes, must confirm with bx
34
Heme findings and assoc clinical findings in leukemia?
- WBC can be high, normal or low - decreased neutrophil + and fxn: infection - risk of tumor lysis syndrome with high WBC (more than 50) - hyperleukocytosis (WBC greater than 250-500K) may be assoc with CNS and pulmonary sx but much lower risk with ALL compared to AML - decreased platelets: bruising, bleeding, and petechiae - decreaed RBC: pallor and fatigue
35
DDx of pancytopenia finding?
- leukemia - aplastic anemai (acquired, congenital, viral) - metastatic solid tumor - myelodysplatic syndrome - hemophagocytic lymphohistocytosis - infection, post infectious (EBV especially) - SLE - hypersplenisim - B12 or folate deficiency
36
DDx of hepatosplenomegaly and pancytopenia?
- leukemia: AML and ALL - hepatitis assoc aplastic anemia - metastatic solid tumor - MDS - HLH - SLE
37
What can ALL mimic? Stongest factors predictve of ALL?
- ALL can mimic juvenile RA - strongest factors: low WBC (less than 4000), low-normal platelet count (150-250) and night time pain. Rash and ANA not helpful
38
ITP findings?
- most ITP kids are very healthy and have acute onset of brusing - ITP typically nml Hgb and WBC and platelets less than 50K, no circulating blasts
39
DDx for acute lymphocytosis?
- infection (esp pertussis, EBV, CMV) - ALL - thyrotoxicosis - neutropenias (relative lymphocytosis) - Addison's disease (relative lymphocytosis)
40
DDx of lymphadenopathy?
- infection - metastatic disease - leukemia - lymphoma - autoimmune (JRA, SLE)
41
Labs for dx leukemia?
- CBC with diff, peripheral smear (see lymphoblasts, all monoclonal WBCs, larger than usual) - bone marrow aspirate - LP - flow cytometry, morphology, and cytogenetics - sanctuary sites (CNS and testes): LP, testicular exam
42
Tx for standard risk ALL?
- 4 week 3 drug induction - 4 week oral consolidation with IT - 8 wk Int maintenance - 8 wk delayed intensification - 2nd int maint - maintenance (2 + years)
43
Tx for HR ALL and T ALL?
- 4 wk 4 drug induction - 8 wk IV consolidation - 8 wk Int maint - 8 wk delayed intens - 2nd interim maint - maintenance (2+ years)
44
Tx adjustment if poor response to therapy?
- alters tx regimen - CNS 3 disease typically receives cranial irradiation, many T ALL also receive regardless of CNS status. Intrathecal chemo has been key to improving outcomes
45
Relapse site and time importance?
- site of relapse impt: bone marrow worse than extra medullary (resistant) - time to relapse: earlier much worse than later, worse if less than 18 months since dx - age at initial dx: very poor outcomes for teens who then relapse - genetic features: marrow relapse of T ALL has very poor outcome, subset of low/st risk ALL does relatively well
46
How common is AML? Prognosis compared to ALL?
- 5% of childhood leukemia (0-14) - peaks in infancy and teen years - classification based on old system (FAB) and WHO definitions - tx related (t-AML) diff than de nova AML - cytogenic lesions impt - worse prognosis than ALL, 5 y EFS 60-70%
47
Presentation of AML?
- fever (33%) - bone pain - LAD - HSM - extramedullary disease: leukemia cutis (rash), gingival hypertrophy, and CNS disease (infants, , M4, M5, high WBC) - chloromas - sepsis - hpyerleukocytosis - anemia - thrombocytopenia - hemorrhage: epistaxis, menorrhagia, either due to thrombocytopenia or DIC - DIC: assoc with acute promyelocytic leukemia
48
What is key feature of AML that you will see on peripheral smear?
- Auer rod in AML blast cell
49
Risk groups of AML?
- based on cytogenetics - down syndrome less than 4, tx with less intense chemo - APML tx with All trans retinoic acid (ATRA) and arsenic trioxide - favorable four courses of intense chemo - unfavorable to bone marrow transplant if acceptable donor found after 2 rounds of chemo
50
Tx of AML?
- remission induction: 2 course intense chemo, very high risk of invasive infection - post remission consolidation: transplant for high risk, or 2 courses of intense chemo - CNS prophylaxis: much less intense than ALL due to low rate of CNS relapse. If CNS positive weekly IT chemo until clears - maintenance: survival benefit never demonstrated so no main course - no irradiation even with CNS disease: emergent if life threatening chloroma (spinal cord compression)
51
Different types of lymphomas?
Hodgkin lymphoma: - classic HL: nodular sclerosing, mixed cellularity, lymphocyte predominant, lymphocyte depleted - nodular lymphocyte predominant non-hodgkin lymphoma: - Burkitt, lymphoblastic, diffuse large B cell, anaplastic large cell, many others
52
Epidemiology of lymphoma?
- 11% of childhood cancers (0-14) - 25% b/t 15-19 - NHL more common in young male white children - overall good prognosis
53
Presentation of Hodgkin lymphoma?
- painless lymphadenopathy, mediastinal mass, and or constitutional sxs - B sxs: (prognostic) wt loss (greater than 10% in 6 months), drenching night sweats, unexplained fevers of greater than 38 C for 3 consecutive days - other sxs (not prognostic): fatigue, anorexia, mild wt loss, pain following ETOH ingestion, and pruritis
54
Lab findings in hodgkin lymphoma?
- elevated inflammatory markers: CRP, ESR, ferritin, copper, anemia of chronic inflammation and possible immune dysregulation (autoimmune neutropenia, autoimmune hemolytic anemia, immune thrombocytopenia, or nephrotic syndrome)
55
DDx for hodgkins?
non-malignant: - normal thymus - infection: EBV, atypical mycobacterium, histoplasmosis, toxoplasmosis - lymphoproliferative disorder - progressive transformation of germinal centers malignant: NHL, germ cell tumor, soft tissue sarcoma, metastasis
56
Eval of pt with suspected HL?
- H&P: key to ask about B sxs and eval respiratory/CV status - CBC, CMP, inflammatory markers - CXR - CT neck and chest - CT or MRI of abdomen and pelvis - FDG-PET - if higher stage will need bilateral bone marrow bx and aspirate to eval for metastatic disease
57
Risk stratifiction for HL?
- based on staging, presence or absence of B sxs and bulk disease - bulk disease is more than 1/3 thoracic diameter on PA CXR or greter than 6 cm nonmediastinal mass - bx of tissue is Key!! - malignant cells: Hodgkin Reed sternberg cells, lymphocytic and histiocytic cells - immunostaining of bx very impt, phenotype can determine histology - EBV implicated in some HL
58
Tx for HL?
- multimodal: multi-agent chemo and radiation std, survival over 90% for advanced disease - risk adapted: disease severity determines intensity, used to decrease, increase or omit modalities - new tials designed to minimize late effects: decrease doses of chemo, decrease radiation fields or omit in some pts
59
NHL incidence?
- more common in young (under 10) white male children - 800 cases/yr in US - risk factors: EBV (for some), immunodeficieny, immunosuppression, pesticides - tx depends on exact dx - B sxs not prognostic
60
Emergent presentations of NHL?
- these are frequent - compression of airway due to superior mediastinal syndrome - pulmonary effusions - CV: SVC syndrome, tamponade, arrhythmia - paraspinal/epidural mass complications - electrolyte abnormalities due to lumor lysis - organ failure: renal compromise due to compression 2/2 mass - GI obstruction, intussusception, bleeding, perforation, jaundice, and pancreatitis - cytopenia due to marrow infiltration
61
Diff NHL presentations?
- endemic burkitt: jaw swelling, abdominal or orbital swelling, paraspinal mass, CNS or marrow involvement - sporadic burkitt: rapidly expanding abd mass, spontaneous tumor lysis, non specific GI sx, CNS involvement, marrow infiltration - DLBCL: more diverse (LN, liver, spleen, marrow mediastinum, retroperitoneum) - lymphoblastic: mediastinal mass, pleural/pericardial effusion, pain, dysphagia, dyspnea - ALCL: slowly progressive, systemic sx, organs and skin can be involved
62
Tx of NHL?
- depends on type and staging - all receive CNS ppx - lymphoblastic lymphoma tx like ALL, long therapy with maintenance - most don't receive iradiation (exception: CNS + lymphoblastic lymphoma)
63
Prognosis of NHL?
- overally survival is high - Burkitt 90% - DLBCL: 90% - ALCL: 85% - burkitt leukemia: 80%
64
How common is neuroblastoma in kids?
- 10% of childhood cancers - second most common solid neoplasm in childhood - median age: 22 months (not common over 5) - originates from neural crest tissue - can met to bone, bone marrow, lymph nodes
65
Genetics and neuroblastomas (NBL)?
- familial neuroblastoma assoc with an anaplastic lymphoma kinase (ALK) germline mutation - Noonan syndrome - congenital cardiac defects - constitutional deletion of chr 1p - neurofibromatosis - neurocrsitopathy syndrome
66
Presentation of NBL?
- coincidental finding (30%) - periorbital echymosis (racoon eyes), proptosis - neck mass - GU sx - neuro abnorm - paraneoplastic syndromes: opsoclonus/myoclonus (4%), secretory diarrhea due to vasoactive intestinal peptide - ill appearing: malaise, irritable, wt loss, anorexia - pain: ill defined (40%) - abdominal distension (35%) - fever, resp distress
67
Dx NBL?
- CT/MRI scan (spine): eval primary and nodal met sites - bilateral bone marrow bx and aspirate - radiolabeled MIBG: if non avid then do PET - catecholamine metabolites: vanillymandelic acid (VMA) and homovanillic acid (HVA) 90% - tumor bx: histologic grading, tumor genetic analysis
68
Prognostic criteria for NBL?
- independent variables - all poor prognostic characteristics - age over 18 months - advanced stage dz - Myc-N amplification - poorly or undiff tumor histology - diploid DNA content
69
What is a Wilm's tumor? Incidence?
- nephroblastoma - most common renal tumor in kids (95%) - 4th most common childhood cancer - 8/1mill annual incidence - 50% are less than 3, median age is 43 month girls and 37 months boys - slight female predominance - 5-10% have bilateral tumors
70
Assoc malformations and genetic predisposition related to Wilm's tumors?
- aniridia - hemi-hypertrophy - GU malformation - malformation of any type - children with assoc malformations or bilateral disease are dx earlier - genetic predisposition: WAGR (wilms, aniridia, GU malf, mental retardation) Beckwith-Wiederman, Dneys-Drash syndreom (nephropathy, male pseudohemaphroditism, 90% develop wilms), perlman syndrome, sotos syndrome, simpson-golabi-behmel
71
Presetnation of Wilm's tumor?
- usually presents as asx upper abdominal mass - abdominal pain (20-30%) - fever - anemia (bleed into tumor - BAD!) - hematuria (tumor extension into renal pelvis) - HTN - distortion of renal vasculature - hx esp family hx and congenital defects - physical: BP and congenital anomalies - lab: CBC, UA, BUN, Cr, T bili, alk phos, albumin, SGPT - encapsulated tumor - claw sign
72
Dx of wilm's tumor?
- resection if able: if bx considered and tumor spills - upstaged to at least stage III - CT chest - Abd US (eval for vascular invasion) - CT abdomen - further imaging if tissue not consistent with wilms
73
DDx of wilm's tumor?
- clear cell sarcoma of kidney - rhabdoid tumor - renal cell carcinoma - congenital mesoblastic nephroma
74
Pathology of wilm's tumor?
- favorable histology: 92%, 5-10% will have bilateral disease, 10% multifocal loci in solitary kidney, overall survival is 95% stage 1-III - anaplasia: 8%, focal or diffuse, marker of increased resistance to chemo, overall survival 20-80% depending on stage
75
Staging of wilm's tumor?
- stage 1: confined to kindey - stage II: confined to renal fossa - stage III: gross residual disease - unresectable primary, lymph node mets, positive surgical margins, tumor spill - stage IV disseminated - stage V: bilateral tumors
76
Prognostic factors of wilm's tumors?
- stage: stage II or greater do worse - histology: diffuse anaplasia unfavorable - gene expression profile: LOH 1p or 16q - tumor size: wt of over 550 g worse - age: older than 2 worse
77
Tx of wilms tumors?
- surgical resection if possible - multiagent chemo - radiation for higher stages, pulmonary mets - higher stages get more intense therapy
78
Incidence of retinoblastoma?
- 300 new cases per yr in US - 3% of all ped cancers - 63% less than 2 - 95% less than 5 - 2 clinical forms: non-hereditary or heriditary (more likely to be BL)
79
Clinical presentation of retinoblastoma?
- intraocular disease: leukocoria (65-75%), strabismus, nystagmus - advance intraocular disease: buphthalmos, glaucoma, periorbital cellulitis - extraocular disease: proptosis + LN, metastases
80
Dx retinoblastoma?
- exam under anesthesia: direct visualization of tumors, eval of corneal diameters and IOP - Ocular US - MRI orbits and brain: eval of optic nerve prior to enucleation, eval of CNS (trilateral disease) - bone scan, bone marrow and CSF for advanced disease - genetic counseling: all patients, heritable:25-30%, and non-heritable: 70-75% - + family hx, multifocal dz, or identified RB1 germline mutation
81
DDx of retinoblastoma?
- congenital cataracts - coat's disease (inflammatory process) - persistent fetal vasculature - retinitis - medulloepithelioma (tumor of ciliary pigment epithelium( - astrocytic hamartoma (TS or NF1) - choroidal osteoma
82
Staging and tx of retinoblastomas?
- multiple staging systems: size of tumor and extension are key pts - tx is very individualized, determined by staging, grouping and laterality of disease - goals of tx: cure - eye salvage - vision preservation
83
Prognostic factors of retinoblastoma?
- high risk histology - massive choroidal replacement - ciliary body or iris involvement - optic nerve extension beyond lamin cibrosa - Extra-CNS disease - CNS disease has dismal prognosis - survival overall good if no CNS disease
84
Incidence of brain tumors in peds?
- 1/50000 kids - 3500 new dx in US annually - 2nd most common ped malignancy - presentation differs in peds than adults: seizure is common adult presentation - not so in peds - overall survival: 65% with variability, less than 20% survival for brainstem gliomas, greater than 80% survival for pilocytic astrocytomas
85
Types of childhood CNS tumors?
- ependymoma - high grade glioma - germ cell tumor - medulloblastoma - pilocytic astrocytoma
86
Genetic asociations with CNS tumors?
- neuorfibromatosis 1: optic pathway gliomas, nonneoplastic hamartomas - tuberous sclerosis: subependymal giant cell astrocytoma - retinoblastoma: risk for trilateral disease, region of pineal gland (pineoblastoma)
87
What is a craniopharyngioma? Tx?
- epithelial tumor - arises from Rathke cleft: can occur anywhere along course of the duct, pharynx to sella turcica and 3rd ventricle - adamantinomatous type: cystic appearance with solid component and Ca deposits - 5 yr survival: 80% - tx: surgery and radiation
88
Presentation of cranipharyngioma?
- most common presentation is growth failure and HA in peds - interference with pituitary fxn: hypothyroid, obesity, diabetes insidious - interfere with visual fxn: amblyopia, temporal heminaopsia, blindness, optic atrophy - mass effect: HA, N/V, papilledema
89
What is a medulloblastoma? Presentation?
- most common malignant peds tumor: males greater than females, 40% occur prior to age 5 - 1/3 present with CSF mets - presenation: HA, N/V., papilledema is most common finding - staging: low vs high risk - survival is greater than 50%, low risk: 80%
90
What is an ependymoma? Presentation, survival?
- 10% of ped brain tumors - males = females - glial tumors: arise in ependymal cells, 4th ventricle and spinal cord, 50-80% have calcifications - common presentation:: IICP, HA, ataxia, nystagmus, seizure, increased head circumference - overall survival: 50%, with full resection - 70%, extent of resection is strongest predictor of outcome, radiation is useful, role of chemo unclear
91
What is a pilocytic astrocytoma?
- 50% of ped CNS tumors - Can occur throughout CNS - increased incidence 5-14 - increased incidence assoc with NF-1 - with GTR: 10% year survival is greater than 90% with subtotal prognosis still 50%
92
How common are spinal cord tumors? sxs and signs?
- relatively rare in peds - heterogenous group: neurodevelopmental, astrocytomas, or neuroblastoma - intramedullary, intradural, or extradural. astrocytomas, ependymomas, neurofibromas, extradural: neuroblastoma, bone tumors other mets - signs/sxs: chronic back or neck pain most common, scoliosis assoc with 1/3 of spine tumors, progressive weakness: decreasing motor skills, numbness, paralaysis Eval: PE - strength, sensation, reflexes, and MRI
93
Ped cancers that have greater than 90% 5 yr survival rates? Other cancers with lower survival rates
- ALL - Wilms - hodgkins - retinoblastoma - - NHL: 80% - bone tumors: 68% - CNS tumors: 65% - AML: 50%
94
Why must survivors of cancer be screened for late effects of therapy down the road?
- children receive more chemo and surgery than adults do | - more vulnerable to effects on growth, fertility, heart and neuropsychological fxn
95
Delayed and chonic toxicities effects on the body?
- chemo: secondary AML - anthracyclines: myocardial dysfxn - corticosteroids: osteonecrosis - nephrectomy: HTN - radiation: breast/thyroid neoplasms - 75% of childhood cancer survivors will develop disabilities that alter quality of life

Pediatrics (20 decks)

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