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RC: Specialties Woo Hoo > Oncology > Flashcards

Oncology Flashcards

1
Q

List 3 tumour lysis RF:

A
  • large tumour burden (bulky, organ)
  • high tumour proliferation (high grade lymphoma like Burkitt)
  • uncommon AML or other solid
  • on ppt= nephropathy, dehydration, low BP
  • inadequate hydration
  • high K or PO4-
  • delayed uric acid removal
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2
Q

Tumour Lysis BW

A

Release cell
= K++
= PO4- ++ (and low ca2+ as result)
= Uric Acid ++

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3
Q

Tx for Tumour Lysis Syndrome?

A
  • **Hyperhydration
  • **High K= no IV K, kayexlate, insulin + glucose, ventolin
  • High uric acid= **allopurinol +/- urinary alkalization
  • High phosphate= amphogel (**Aluminum OH)
  • Low Ca2+= no tx unless ECG or symp
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4
Q

6 y.o. w/ diplopia, h/a, ataxia. Where is lesion? Two most likely brain tumour for lesion?

A

Posterior fossa tumour (brainstem + cerebellum)

2 most likely:

  • cerebellar astrocytoma
  • medulloblastoma
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5
Q

Impaired upward gaze. Dilated pupil. Doesn’t respond to light. What is this called and which location of brain tumour suggested?

A

Parineaud’s Syndrome

Midbrain

Likely germ cell tumour

  • alpha-feto protein, beta HCG, AFP
  • MRI
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6
Q

2 life threatening ppt of anterior mediastinal mass

A
  1. Airway Obstruction
  2. SVC syndrome
    (facial, upper limb swelling from vascular compression)
  3. Cardiac Tamponade

Treatment for Mass= Radiotherapy + Steroids

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7
Q

T or F: most mediastinal masses are malignant in kids.

A

True.

> 50%= always investigate!

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8
Q

What are the most common mediastinal mass CA

A

Lymphoma

Neuro

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9
Q

How do you remember ddx of anterior, posterior middle, mediastinal mass ?

A

Anterior Mediastinal mass= 5T’s

  • Thymus (thymoma)
  • Teratoma
  • Terrible lymphoma
  • T cell leukaemia
  • Thyroid Mass

Middle= A+B

  • Adenopathy (infection, Histio, TB, neoplasm, mets)
  • Bronchogenic cyst

Posterior= Neuro

  • neurofibroma
  • neurosarcoma
  • ganglioneuroma
  • neuroblastoma
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10
Q

3 y.o. Fever, arthralgia, lethargy, lymphadenopathy, big liver. Pain w/ exertion. WBC normal. Hub 98. Plt 140. Next test:

  • Bone marrow aspirate
  • EBV
  • follow
A

Bone marrow aspirate

ALL: non specific

  • persistent bone pain; refusal wt bear, limp
  • lymphadenopathy (> 1/2 of all kids; non tender, firm, matted)
  • big liver
  • big spleen
  • most BW: anemia, thrombocytopenia. WBC anything.
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11
Q

15 y.o. M with SOB and b/l wheeze the improve w/ steroid + ventolin. One wk later radiologist say widened mediastinum. Likely cause?

= ALL
= Hodgkin’s lymphoma
= Sarcoidosis
= Thymoma

A

Mediastinal mass
5T’s

Teen = Hodgkin’s lymphoma
- (+) Reed Sternberg cell
= Owl’s eye in RBC

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12
Q

Abdo RUQ mass. Systolic murmur at LSB + RUQ. Conjugated hyperbili. Low plt. Likely Dx? And Next BW?

A

Kasabach Merritt Syn

= low plt + consumption coagulopathy

Next: DIC W/U

  • low fibrinogen
  • D dimer up
  • PTT and aPTT normal or up
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13
Q

Which condition associated w/ childhood leukaemia?

  • Electromagnetic field exposure during preg
  • NF1
  • FHX parent leukemia
A

NF1

*Certain inherited dx associated w/ higher risk leukaemia:
=
- Down Syndrome
- NF 
- Fanconi anemia
- Shwachman Syn
- Bloom Syn
- Ataxia Telangiectasia
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14
Q

T or F: supraclavicular lymphadenopathy associated w/ malignancy in kids

A

True

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15
Q

What workup should kids with supraclavicular adenopathy get:

A

CBC + diff
CXR
lymph node bx (unless abscess or cellulitis)

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16
Q

Poor prognosis of ALL:

a. F
b. age < 1 y.o.
c. CALLA positive
d. mediastinal mass
e. splenomegaly

A

Age < 1 year

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17
Q

When does ALL (acute lymphoblastic leukaemia) usually peak?

A

2-3 y.o.

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18
Q

What are lymphoid or myeloid cells?

A

Hematopoiesis==>
Lymphoid Stem= T, B
> ALL= malignant transformation of progenitor cell

Myeloid Stem= monocyte, macrophage, erythrocyte, plt (megakaryocytic), neutrophil, eosinophil, basophil
> AML

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19
Q

What is a “blast”?

A

Progenitor cell undergo malignant transformation.
Immature WBC= Blast.
These multiply and replace normal bone marrow.

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20
Q

List 3 Leukemia RF:

A

**Genetic:
- T21
- NF1
- Shwachman- Diamond Syn
- Fanconi
ALL= Klinefelter syn, Ataxia-Telangiectasia, Bloom Syn
AML= Prior Chemo
** FHX

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21
Q

What is the most common malignancy of childhood:

A

Leukemia

**ALL most common
1/4 of all kid CA= ALL
1/3 of all kid cancer= CNS
10-25%= AML
Every other solid CA collectively= 1/3 of all cases
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22
Q

T or F: nocturnal bone pain can be non specific sign of leukaemia?

A

True

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23
Q

How is leukaemia diagnosed?

A

Bone marrow show > 25% cells = blast

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24
Q

List the three stages of chemo:

A
  1. Induction- destroy leukaemia cells (min. 29 days then test for minimal dx test)
  2. Consolidation- prevent growth, reduce cells present and prevent relapse
    (min. 4-8 months)

+/- delayed intensification phase

  1. Maintenance- kill any leukaemia cells we can’t see (x 2-3 yr; BW and med q4 wk with LP q 3 mo.)
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25
Q

List 5 RF for poor ALL outcomes:

A
  1. Age (< 1 or > 10)
  2. Type (T cell)
  3. Initial WBC > 50
  4. CNS disease
  5. Chromosomal abnormality (philadelphia chromosome)
  6. Slow to respond to tx
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26
Q

Best prognosis in neuroblastoma associated with:

a. female
b. age < 1y.o.
c. high VMA urine
d. normal BP
e. unilateral

A

Age < 1 y.o. (except newborn)

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27
Q

What is the most common cancer in infants

A

Neuroblastoma

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28
Q

Most common solid tumour in kids

A
  1. CNS

2. Neuroblastoma

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29
Q

Neuroblastoma age typically

A

infant- 2 y.o.

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30
Q

T or F: Neuroblastoma is associated with paraneoplastic syndromes?

A

True.

  • Opsoclonus-Myoclonus ataxia
  • VIP secretion (diarrhea with low K)
31
Q

What is the most common ppt of neuroblastoma

A

Adrenal glands (50%)

32
Q

T or F: neuroblastoma tumour can spontaneously regress?

A

True.

In infants = less aggressive + may mature to benign.

But if > 1 likely aggressive and invade.

33
Q

What may be neuroblastoma adrenal symptoms?

A
  • abdo mass/fullness
  • sweat
  • HTN
  • diarrhea (due to profound VIP)
34
Q

T or F: infants may have unique bluish skin nodules (like blueberry muffin baby) as ppt for neuroblastoma.

A

True

35
Q

T or F: Urine testing is (+) in almost ALL cases.

A

True.

  • Urine catecholamine breakdown product (vanillylmandelic acid/ VMA , homovanillic acid / HVA)
36
Q

Paraneoplastic syndrome associated with neuroblastoma:

  • chorea
  • athetosis
  • diarrhea
  • HTN
  • hypercalcemia
A

Diarrhea

> Secretion of VIP (vasointestinal peptide)
= distend, diarrhea, low K

> Opsoclonus Myoclonus

37
Q

Opsoclonus seen in which:

  • AML
  • ALL
  • Neuroblastoma
  • Medulloblastoma
  • Rhabdomyosarcoma
A

Neuroblastoma (50% of pt)

“Dancing eyes and dancing feet”

38
Q

What is the most common malignancy associated with opsoclonus myoclonus syndrome

A

Neuroblastoma (50% of pt)

39
Q

T or F: 95% of opsoclonus myoclonus mis-dx as acute cerebellar ataxia as that comes before yes.

A

True.

Always have on DDx

40
Q

Another name for Wilm’s Tumour

A

Nephroblastoma

41
Q

Peak age for Wilm’s:

A

2-3 y.o.

42
Q

14 y.o. with leg pain. XR show distal femur with sunburst pattern. Dx?

A

osteosarcoma (aka osteogenic sarcoma)

43
Q

Poor prognosis for Langerhans Histiocytosis X associated with:

  • mastoiditis
  • pancytopenia
  • lymphadenopathy
  • chronic lung dx
  • vertebral body involvement (single bony)
A

Pancytopenia (Marrow is high risk)

44
Q

How does langerhan cell histiocytosis ppt?

A
  1. Bone (skull, other)
    * * bone pain
  2. Skin (papular seborrheic dermatitis, diaper +/- petechiae)
  3. lymph, HSM
45
Q

Birbeck Granule. Dx?

A

Langerhans Cell Histiocytosis

**tennis racket granule on cytoplasm of LCH dx

46
Q

What is the prognosis for langerhan cell histiocytosis?

A

Single-sys: usually benign

Multi-System: Chemo

47
Q

Child w/ Wilm’s Tumour. Associations:

A
  • Beckwith Weidemann
    (organomegaly w/ ++ insulin, macroglossia, omph, hemihypertrophy)
  • WAGR (Wilms, Aniridia, GU anomalies, MR)
  • Denys-Drash (RF, Pseudo hermaphroditism)
48
Q

T or F: most Wilm’s tumour are asymptomatic.

A

True.

If symptom
= 25%= HTN
OR abdo mass

49
Q

16 month old. B/L periorbital ecchymoses. Nystagmus. Palpable abdo mass. Dx?

A

Neuroblastoma

Note: periorbital bone mets= opsoclonus-myoclonus, periorbital ecchymosis, ptosis

50
Q

Teen w/ CA palliative. 10 y.o. brother starts ignoring. Parents concerned. What to say?

A

Norm for siblings to experience variety of feeling (depression, anxiety, guilt, fear) which may make them pull away or may feel neglected.

Include in conversation, brother’s care and offer support (SW, psychology, child-life)

51
Q

Describe the Human Body Pic for Chemo….

A

Human body- C look like Ear and Kidneys.
= Otoxotoxicty, Nephrotoxic

Bleomycin and Busulifan look like lungs. = Pul Fibrosis

Doxoruicin= Heart= Dilated cardiomyopathy.

CY= cyclophosphamide= Hemorrhagic cystitis

V= arm and leg = peripheral neuropathy

M= Methotrexate= Myelosuppression

52
Q

List three side effects for L-asparaginase:

A

Allergic Rxn
Pancreatitis
High BG
Plt dysfunction

53
Q

List 3 side effects Vincristine

A

Neuropathy
Constipation
Local cellulitis

54
Q

List 3 side effects with Prednisone

A 
HTN
Cushing
Cataract
Diabetes
Avascular necrosis
Peptic Ulceration
55
Q

Teen boy to get chemo + radiation. 2 factors that affect fertility:

A

High dose alkylating agent

High radiation Dose

Cigarette or MJ Use

56
Q

Give two options to deal with possible infertility linked with chemo:

A

Sperm banking (for M who have gone through puberty)

Shield testicle during radiation

Choose tx regimen w/ lowest chance of infertility

57
Q

List 3 tx for hyperuricemia:

A
  • **Allopurinol (prevent forming uric acid)
  • **Rasburicase (make uric acid water soluble so can pee)
  • **Dialysis
  • **Hyperhydration
58
Q

48h after chemo has hematuria + mild dysuria. Plt 90 pre-chemo. Likely x?

A

Cyclophosphamide induced hemorrhagic cystitis

59
Q

Neutropenic child with red central line. Abx?

A

Piperacillin-Tazobactam + Vancomycin

60
Q

List 6 long term effects of Radiation to neck + chest, cyclophosphamide and vincristine chemo:

A

General Long-Term:
Infertility

Radiation:

  • Growth retardation
  • Hypothyroidism
  • Cardiac or pul Toxicity
  • Delayed Puberty

Doxorubicin:
Cardiomyopathy

Bleomycin: Pulmonary fibrosis and interstitial pneumonitis

Vincristine:
Peripheral Neuropathy (sensory and motor)

Methotrexate: low BMD, neurocognitive deficits

61
Q

T or F: Vincristine is lethal if given intrathecal.

A

True.

= paralysis, coma, death

62
Q

What is lymphoma?

A

Solid tumour of lymphoid origin (NOT bone marrow or in circulation)

  • Teens
  • Hodgkin’s= Reed Sternberg cell
  • Non-Hodgkin’s= lymphoblastic, burkitt’s etc.

PPT: lymph, B symptom

Dx: Bx

63
Q

List 4 long term complication of curative therapy for CA:

A
  • infertility
  • hypothyroidism
  • cardiomyopathy
  • sensorineural hearing loss
64
Q

3 long term effect of cyclophosphamide

A
  • infertility
  • delayed puberty
  • bladder cancer
65
Q

4 principles of opioid in palliative patient:

A
  • individualized dosing for pt with titration as needed (no “right” dose for everyone)
  • goal: relieve pain and minimize side effect
  • basal level with breakthrough dose available
  • give in simplest, most effective route (i.e. PO versus PCA)
  • AE treated (i.e. constipation, itch, nausea)
  • consider adjuvant for opioid-sparing effect (i.e. antidepressant, steroids for bone pain, sedatives)
66
Q

What is tolerance in relationship to meds:

A

= decreasing drug effect w/ continued admin of a drug (need higher dose to get same effect)

67
Q

What is dependence in relationship to drugs?

A

= need for continued drug dosing to prevent abstinence syndrome if abruptly d/c

** usually seen if potent opioids > 5-7 d

68
Q

Teen with painless, firm rubbery cervical or supraclavicular node. Reed Sternberg cell

A

Hodgkin’s lymphoma

69
Q

4 y.o. abdo mass. Pancytopenia. List 3 test to help differentiate dx on ddx.

A 
Wilms
Neuroblastoma
Non-Hodgkin Lymphoma
Hepatoblastoma
Rhabdomyosarcoma

**U/S
**Urine HVA/VMA
(homovanillic aid and vanillylmandelic acid)
**alpha-fetoprotein
***CBC smear (lymphoma, rhabdo w/ bone marrow involved)
High serum Ca2+ more rhabdo

70
Q

Neuroblastoma. Which associated with improved outcome?

  • < 1 y.o. w/ met limited to liver, skin marrow
  • age > 18 mo
  • undifferentiated histology
  • N-myc gene amplication
A

< 1 y.o. w/ met limited to liver, skin, marrow

71
Q

Diabetes insipidus. MRI show two issue (pineal region, suprasellor region). beta HCG and alpha-fetoprotein negative. CNS Cytology negative for tumour. Lytic lesion on left humerus. Likely dx

  • germ cell
  • medulloblastoma
  • langerhans cell histiocytosis
  • ependymoma
A

LCH

72
Q

Define febrile neutropenia

A

Fever > 38.3 or > 38 x > 1hr
ANC < 0.5 (or expected to fall below that within next 72h)

Tx: Broad spectrum Abx

Common bugs: Viral, Gram (+) (viridian’s, staph), Gram (-) (pseudomonas, E coli, Klebsiella), Fungi

73
Q

Osteosarcoma vs. Ewing Sarcoma

A

Osteo:

  • most common primary bone overall; typically middle teen
  • Male
  • Predisposed if Retinoblastoma, Paget Dx
  • usually end of long bones + pelvis
  • SUNBURST
  • mets to lungs
  • Chemo + Sx. No radiotherapy.

Ewing Sarcoma:

  • < 10 or much older
  • middle of long bone, axial skeleton or chest wall
  • “onion skinning”
  • mets to bunch
  • Chemo +/- Sx +/- Radio

RC: Specialties Woo Hoo (31 decks)

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