Oncology Flashcards
Which cancers appear generally in infancy, childhood and adolescents
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
Features of Leukemia
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
Top 4 most common childhood cancers?
- ALL (25%)
- CNS solid tumors
- Lymphoma (15%)
- AML
Which drug must not be given intrathecally?
Vincristine
Severely neurotoxic
-Severe vesciant - extravasation damage
Intrathecal administration
- severe demyelination
- severe encephalopathy
- severe pain
- death
What is Febrile Neutropenia
-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)
What is a significant side effect of corticosteriods for cancer txt
Osteonecrosis
- Significant side effect of high dose corticosteriods
- Teens > children
- Girls > boys
- Dex»_space; pred
Treatment:
-Supportive care: Analgesia, Ca/Vit D, Bisphosphonates, Surgery
Leukaemias of children and youth classifications
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)
Pre B ALL Classifcation
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
Whats the most common initial presenting symptom of Osteosarcoma
- pain with activity
- then pain with rest and at night
- pathological if wake up at night with pain
- not associated with fever
What is the most common site for distant metastasis in Osteosarcoma
The lungs
Features of Osteosarcoma
- Sites: ends of long bones, pelvis
- Usually solitary
- Metastasis mainly to lungs
- Txt: chemo, surgery
- not radiosenstiive
Features of Ewing Sarcoma
- Sites: diaphysis of long bones, axial skeleton, chest wall
- Metastatic to: lungs, lymph node, bone marrow
- Txt: chemo, +/- surgery, +/- radiotharpy
Workup for Osteosarcoma
-full blood work
- Imaging:
- plain Xray primary site
- MRI primary site
- CT chest
- Bone scan
-bx of tumor
Workup Ewing Sarcoma
-Full blood work
- Imaging:
- Plain xray primary site
- MRI primary site
- CT chest
- Bone Scan
- PET scan
- bx of tumor
- bilat BM bx
What are the side effects of Doxorubicin
Immediate SE:
-N/V
Short term SE:
- myelosuppression
- hair loss
- hand/foot syndrome
- skin pigmentation
- acute cardiotoxicity
Long term SE
- cardiomyopathy
- secondary malignancy
What are the side effects of Cisplatin
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
Which med should not be given along with high dose MTX
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
What are the different Cancer Predisposition Syndromes
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
What are features of a Mediastinal Mass
- oncologic emergency: must ask about breathing, difficulty lying down
- compression of: airway, vascular structures (SVC obstruction, Plethora, oedema, venous engorgement)
Txt:
- radiation
- steroids
What is the DDX for mediastinal masses in the Anterior, Middle and Posterior Mediastinum
Anterior Mediastinum
- Lymphoma
- Thymoma
- Thyroid
Middle Mediastinum
- Lymphadenopathy - lymphoma
- Metastatic disease
- Germ cell tumor
Posterior Mediastinum
- Neuroblastoma
- Neurofirbroma
- Ewings
- Rabdomyosarcoma
What are the 5 Ts of Anterior Mediastinal Masses
Thymus Thyroid masses Thoracic Aorta Terrible Lymphoma Teratoma or germ cell tumors
What is the Ann Arbor staging for Hodgkin’s Lymphoma
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
What are the side effects of Radiotherapy
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)
How do you manage acute hydrocephalus in CNS tumors
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
Which Tumors are associated with alpha-feto protein
- Hepatoblastoma
- Hepatocellular carcinoma
- yolk-sac tumors
Alpha fetoprotein= fetal albumin
-Raised in: infancy, down syndrome
Which Tumors are associated with B-Human Chorionic Gonadotropin
Produced by Malignant placental tumors
- hydatid moles
- choriocarcinoma
- chorionic elements in mixed GCT
- germinoma/seminoma)
- produced by placental tissue
- promotes corpus luteum in pregnancy
List the Germinomatus (3) tumors and the Non-Germinomatous (6) tumors
Germinomatous
- Germinoma
- Seminoma
- Dysgerminoma
Non-Germinomatous
- Embryonal carcinoma
- Endodermal Sinus tumor/yolk sac
- Choriocarcinoma
- Teratoma
- Polyembryoma
- Gonadoblastoma
What are the sites of disease for Germinomatous and Non-Germinomatous tumors
Gonads:
-Ovary/Testis
Extragondal
- Cranial: Pituitary, Hypothalamus
- Mediastinum/Neck
- Sacrococcygeal/Pelvis
