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General Pediatrics > Oncology > Flashcards

Oncology Flashcards

1
Q

Which cancers appear generally in infancy, childhood and adolescents

A

Infancy:

  • Neuroblastoma
  • Wilms tumor
  • Retinoblastoma
  • Primitive neuroectodermal tumor (PNET)

Childhood

  • ALL
  • Non-Hodgkin lymphoma
  • Glioma
Adolescents
-Sarcomas (Osteosarcoma, Ewing Sarcoma, Soft tissue Sarcoma
-Hodgkin disease
-Testicular cancer
Ovarian Cancer
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2
Q

Features of Leukemia

A

Common Features

  • Fever
  • Infection
  • Bruising/Bleeding
  • Bone pain
  • Fatigue
  • Pallor
  • Lymphadenopathy
  • HSM

Less common features

  • Cranial nerve palsies
  • Gum hypertrophy
  • Skin lesions
  • Pathologic fratures
  • Solid tumors
  • Testicular Enlargement
  • Renal failure (Tumor lysis, tumor in kidneys)
  • Spinal cord compression
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3
Q

Top 4 most common childhood cancers?

A
  1. ALL (25%)
  2. CNS solid tumors
  3. Lymphoma (15%)
  4. AML
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4
Q

Which drug must not be given intrathecally?

A

Vincristine

Severely neurotoxic
-Severe vesciant - extravasation damage

Intrathecal administration

  • severe demyelination
  • severe encephalopathy
  • severe pain
  • death
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5
Q

What is Febrile Neutropenia

A

-commonest oncologic emergency

  • Definition:
  • Fever > 38.3 or over 38C for > 1 hour, ANC < 0.5 or predicted to fall w/n next 72 hours

Treatment

  • Broad spectrum Abx (cover both gram + and - bacteria
  • supportive care as appropriate

Organisms

  • cultures often negativs
  • Gram + (Viridans groups strep, Staphlococci, Pneumococci, enterococci)
  • Gram - (Pseudomonas, e coli, Klebsiella
  • Fungi (Candida)
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6
Q

What is a significant side effect of corticosteriods for cancer txt

A

Osteonecrosis

  • Significant side effect of high dose corticosteriods
  • Teens > children
  • Girls > boys
  • Dex&raquo_space; pred

Treatment:
-Supportive care: Analgesia, Ca/Vit D, Bisphosphonates, Surgery

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7
Q

Leukaemias of children and youth classifications

A

Lymphoid

  • Pre-B cell Acute Lymphoblastic
  • T-cell acute lymphoblastic
  • Infant ALL (MLL+ and MLL - )
  • Philadelphia ALL: T(9:22)
  • Mature B-cell leukemia (= Burkitts)

Myeloid

  • Acute Myeloid Leukemia (with genetic changes, with myelodysplastic changes)
  • Acute Promyelocytic Leukemia
  • Chronic Myeloid Leukemia: T(9:22)
  • Transient abnormal myelopoiesis (TAM in Down’s syndrome)
  • Myelodysplasia/Myeloproliferation)
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8
Q

Pre B ALL Classifcation

A

Very High Risk:

  • > 13 yrs
  • > CNS +
  • Induction failure

High Risk:

  • Age 10 - 13
  • WBC > 50
  • Testicular disease

Standard Risk:

  • Age 1 - 10
  • WBC < 50
  • no unfavourable features and MRD negative at D29

Standard/Low Risk

  • Age 1 - 10, WBC < 50
  • Favourable cytogenetics (Trisomy 4 and 10)
  • and MDR negative at D29
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9
Q

Whats the most common initial presenting symptom of Osteosarcoma

A
  • pain with activity
  • then pain with rest and at night
  • pathological if wake up at night with pain
  • not associated with fever
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10
Q

What is the most common site for distant metastasis in Osteosarcoma

A

The lungs

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11
Q

Features of Osteosarcoma

A
  • Sites: ends of long bones, pelvis
  • Usually solitary
  • Metastasis mainly to lungs
  • Txt: chemo, surgery
  • not radiosenstiive
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12
Q

Features of Ewing Sarcoma

A
  • Sites: diaphysis of long bones, axial skeleton, chest wall
  • Metastatic to: lungs, lymph node, bone marrow
  • Txt: chemo, +/- surgery, +/- radiotharpy
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13
Q

Workup for Osteosarcoma

A

-full blood work

  • Imaging:
  • plain Xray primary site
  • MRI primary site
  • CT chest
  • Bone scan

-bx of tumor

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14
Q

Workup Ewing Sarcoma

A

-Full blood work

  • Imaging:
  • Plain xray primary site
  • MRI primary site
  • CT chest
  • Bone Scan
  • PET scan
  • bx of tumor
  • bilat BM bx
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15
Q

What are the side effects of Doxorubicin

A

Immediate SE:
-N/V

Short term SE:

  • myelosuppression
  • hair loss
  • hand/foot syndrome
  • skin pigmentation
  • acute cardiotoxicity

Long term SE

  • cardiomyopathy
  • secondary malignancy
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16
Q

What are the side effects of Cisplatin

A

Immediate SE

  • N/V
  • Hypomagnesaemia
  • Acute renal Tubular Dysfunction

Short Term SE

  • N/V
  • Hearing loss
  • Renal impariment - glomerular and tubular

Long Term SE

  • Hearing loss
  • Renal impariment: decrease GRF
  • Electrolyte disturbance: decrease Mg and K
17
Q

Which med should not be given along with high dose MTX

A

Co - trimoxazole

MTX is a folic acid analog which inhibits dihydrofolate reductase
Cotrimoxazole also affects this enzyme - if you give with MTX will increase side effects

18
Q

What are the different Cancer Predisposition Syndromes

A

NF 1

  • mutation in Neurofibromin gene
  • skin and peripheral neurofibromas, central nerve sheath tumors and gliomas

Cowden Syndrome

  • Mutation in PTEN gene
  • Harmatomas, polyposis, ovarian, endometrial, follicular thyroid carcinoma, breast cancer

Li Fraumeni

  • mutation in p53
  • Sarcomas, breast, medulloblastoma, adrenocortical carcionma

Gorlin Syndrome

  • mutation in PTCH gene
  • BCC, medulloblastoma

DICER-1 syndrome

  • Mutation in DICER-1
  • Pleuroplumonary blastoma, thyroid carcinoma, ovarian stromal tumors, renal tumors
19
Q

What are features of a Mediastinal Mass

A
  • oncologic emergency: must ask about breathing, difficulty lying down
  • compression of: airway, vascular structures (SVC obstruction, Plethora, oedema, venous engorgement)

Txt:

  • radiation
  • steroids
20
Q

What is the DDX for mediastinal masses in the Anterior, Middle and Posterior Mediastinum

A

Anterior Mediastinum

  • Lymphoma
  • Thymoma
  • Thyroid

Middle Mediastinum

  • Lymphadenopathy - lymphoma
  • Metastatic disease
  • Germ cell tumor

Posterior Mediastinum

  • Neuroblastoma
  • Neurofirbroma
  • Ewings
  • Rabdomyosarcoma
21
Q

What are the 5 Ts of Anterior Mediastinal Masses

A 
Thymus
Thyroid masses
Thoracic Aorta
Terrible Lymphoma
Teratoma or germ cell tumors
22
Q

What is the Ann Arbor staging for Hodgkin’s Lymphoma

A

Stage 1
-single lymph node group or extranodal site

Stage 2
-2 or more lymph node regions on the same side of the diaphragm

Stage 3
-lymph node involvement on both sides of the diagram, may include spleen

Stage 4
-Disseminated involvement of extra lymphatic organs/tissues +/- lymph node involvement

B symptoms
-absent or present

23
Q

What are the side effects of Radiotherapy

A

Acute
-N/V (cranial, abdominal)

Long-term

  • Tissue fibrosis
  • Endocrine failure (pit, thyroid, gonadal)
  • decrease potential in irradiated tissue
  • neuropsychological impairment
  • second malignancy risk
  • xerophthalmia (lacrymal duct)
  • xerostomia (salivary glands)
24
Q

How do you manage acute hydrocephalus in CNS tumors

A

Acute Hydrocephalus

  • common with aggressive tumors
  • tumor may invoke oedema
  • Blockage of drinage channels - acute hydrocephalus (severe hydro gives cerebral oedema too)

Txt:

  • definitive: divert or remove blockage
  • immediate: dex to reduce oedema
25
Q

Which Tumors are associated with alpha-feto protein

A
  • Hepatoblastoma
  • Hepatocellular carcinoma
  • yolk-sac tumors

Alpha fetoprotein= fetal albumin
-Raised in: infancy, down syndrome

26
Q

Which Tumors are associated with B-Human Chorionic Gonadotropin

A

Produced by Malignant placental tumors

  • hydatid moles
  • choriocarcinoma
  • chorionic elements in mixed GCT
  • germinoma/seminoma)
  • produced by placental tissue
  • promotes corpus luteum in pregnancy
27
Q

List the Germinomatus (3) tumors and the Non-Germinomatous (6) tumors

A

Germinomatous

  • Germinoma
  • Seminoma
  • Dysgerminoma

Non-Germinomatous

  • Embryonal carcinoma
  • Endodermal Sinus tumor/yolk sac
  • Choriocarcinoma
  • Teratoma
  • Polyembryoma
  • Gonadoblastoma
28
Q

What are the sites of disease for Germinomatous and Non-Germinomatous tumors

A

Gonads:
-Ovary/Testis

Extragondal

  • Cranial: Pituitary, Hypothalamus
  • Mediastinum/Neck
  • Sacrococcygeal/Pelvis

General Pediatrics (19 decks)

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