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Peds II Exam 1 > Oncology > Flashcards

Oncology Flashcards

1
Q

Leading cause of death in 1-19 YO

A

pediatric cancer

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2
Q

Warning signs for childhood cancer

A

Continued, unexplained weightloss
Headaches - oftening w/ vomiting- early night/ early morning
Increased swelling or pain in bones, back, legs,
Lumps/mass
Development of excessive bruising, bleeding rash

Constant infections
A whitish colour behind the pupil
Nausea which persists of vomiting w/o nausea
Constant tiredness or paleness
Eye or vision changes
Recurrent FUO
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3
Q

Most common malignancy in children

A

Acute lymphoblastic leukemia (ALL)

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4
Q

What causes ALL

A

uncontrolled proliferation of immature lymphocytes

B-precursor lineage (85%)

Peak incidence: 2-5 YO

Cause unknown; genetic factors (down syndrome); viral associations (viral infections, exposure to radiation)

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5
Q

Presentation of ALL

A 
intermittent fever, fatigue, pallor
bleeding (50%) - petechiae, purpura
BONE PAIN! (pelvis, vertebral bodies, legs)
hepatosplenomegaly
LAD
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6
Q

Lab finding

A

anemia/thrombocytopenia w/ normal or depressed WBC
Neutropenia in differential (ANC <1000)
Peripheral smear: lymphoblasts

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7
Q

Dx of ALL

A

bone marrow bx (leukemic blasts replacing normal marrow)

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8
Q

Tx for ALL

A

may take 2-3 years to complete
Chemo (1st line)
Hematopoietic stem cell transplant (HSCT) - best form matched sibling

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9
Q

Prognosis for ALL

A

> 85% survival rate

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10
Q

tumor lysis syndrome

A

oncologic emergency!
Hyperkalemia, hyperuricemia, hyperphosphatemia
acute renal failure

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11
Q

Acute myeloid leukemia cause

A

myeloblasts cant differentiate into mature cells

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12
Q

Predisposing factors for AML

A

no risk factors often
congenital: down syndrome, NF1
Environmental: radiation, benzene (smoking) and previous chemo

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13
Q

Clinical findings for AML

A 
fatigue, pallor, bleeding or infection (fever)
CNS INVOLVEMENT (5-15%) - h/a, lethargy, mental status change, cranial nerve palsies
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14
Q

Lab findings for AML

A

anemia, thrombocytopenia, neutropenia (ANC <1000)
WBC >100,000! (2%)

Hyperleukocytosis (>75,000) may be associated w/ life-threatening complications- Medical emergency

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15
Q

Hyperleukocytosis

A

AML

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16
Q

Dx of AML

A 
smear: myeloblasts >20%
Auer rods (pathognomoic)

Dx requires both:

  • bone marrow bx showing >20 blasts
  • leukemic cells must be of myeloid origin
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17
Q

Tx for AML

A

chemo

HSCT

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18
Q

Prognosis

A

65-75% survival

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19
Q

CML

A

myeloproliferative disorder - uncontrolled proliferation of mature and maturing granulocytes

rare (5% of child canger)

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20
Q

Philadelphia chromosome

A

CML; translocation between chromosome 9 and 22

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21
Q

Presentation of CML

A

chronic phase –> accelerated phase –> blast phase

most asymptomatic
bone pain
fever, NIGHT SWEATS, fatigue (B sx)
pallor, ecchymosis
MASSIVE SPLENOMEGALY, variable hepatomegaly
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22
Q

Lab findings for CML

A

anema, thrombocytosis, and marked leukocytosis
smear: myeloid cells in all stages of maturation, increased basophils and blasts

blast cells >20% = blast crisis

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23
Q

Dx for CML

A

smear w/ myeloid cells in all stages

confirmation: philadelphia chromosome

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24
Q

Tx for CML

A

TKI*

HSCT

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25
Q

TKI

A

TK allows for dysregulation cellular proliferation

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26
Q

50% of childhood lymphomas

A

Hodgkin Lymphoma

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27
Q

Etiology of hodgkins

A

4:1 male predominance
familial, EBC association
arises in lymph nodes and spreads to contiguous nodal groups

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28
Q

Diagnostic for hdogkins

A

Reed-sternberg cells (germinal center B cells that have undergone malignant transformation)

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29
Q

Response to to hodgkinds

A

children have better response that adults

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30
Q

Presentation of hodgkin lymphoma

A

painless cervical or supraclavicular adenopathy
Mediastinal mass (75%)
B symptoms

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31
Q

complication w/ hodgkin lymphoma

A

SVC syndrome- dyspnea, cough, orthopnea, facial/upper extremity edema

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32
Q

Dx of hodgkin lymphoma

A

tissue bx w/ reed-sternberg cells

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33
Q

Auer rods

A

AML

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34
Q

Staging of hodgkin lymphoma

A

CXR
CT scan (chest, abdomen, and pelvis)
bone marrow bx

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35
Q

Tx for hodgkins

A

chemo
radiation
HSCT

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36
Q

Prognosis for hodgkins

A

90% 5-10 survival rate

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37
Q

NHL epidemiology

A

5th most common pediatric cancer
3:1 male predominance
arises in lymphoid tissue and spreads to distant nodes

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38
Q

NHL is associated w/

A

congenital and acquired immunodeficiency syndromes

EBV

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39
Q

NHL children

A

worse than in adults; rapidly proliferating, high-grade, diffuse malignancies

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40
Q

Clinical findings for NHL

A

fast, 1-3 weeks
enlarging, non-tender LAD
ab pain, b symtoms
hepatomegaly/splenomegaly in advanced stage

41
Q

Dx of NHL

42
Q

Tx for NHL

A

chemo
HSCT for those that relapse

watch for tumor lysis

43
Q

Evaluation for brain tumor

A

measure head circumference

observe gait

44
Q

Most common solid tumor of childhood

A

brain tumors

45
Q

Presentation of brain tumor

A

AM h/a, vomiting, papilledema (optic nerve swelling)

younger children: vomiting, unsteadiness, lethary, irritability, macrocephaly, FTT, delayed development

Older: h/a, visual sx, seizure, focal neuro deficits, school failure and personality changes

46
Q

Imaging for brain tumor

A 
MRI (preferred)
CT scan (less time)
47
Q

Dx of brain tumor

48
Q

Types of brain tumors

A
  1. Glial - astrocytomas, ependymomas

2. Nonglial: medulloblastoma

49
Q

Tx for brain tumor

A
  1. surgical removal

2. radiation/chemo

50
Q

Prognosis for brain tumor

A

60-90% 5-10 year survival w/ low grade astrocytoma

51
Q

Most common abdominal tumor

A

neuroblastoma

52
Q

Most common solid neoplasm outside of the CNS

A

neuroblastoma

53
Q

Most common site for neuroblastoma

A

adrenal gland

54
Q

Clinical manifestation of neuroblastoma

A 
abdominal mass (firm, fixed and irregular shape; EXTENDS BEYOND MIDLINE)
bone pain from metastatic disease
fever, weight loss, irritability, ab pain, anorexia
55
Q

Lab findings for neuroblastoma

A 
anemia
URINARY CATECHOLAMINES (dopamine, Epi, NE)
56
Q

Tx for neuroblastoma

A

surgical resection coupled w/ chemo

surgery alone if low grade
radiation sometimes necessary

57
Q

Prognosis of neuroblastoma

A

<40% survival in chidlren w/ high-risk disease

58
Q

Wilms Tumor aka

A

Nephroblastoma

59
Q

Second most common abdominal tumor in children

A

Wilms tumor (nephroblastoma)

60
Q

Age nephroblastoma is common

61
Q

Clinical findings for wilms tumor

A

asymtomatic ab mass/swelling
RARELY CROSSES MIDLINE
smooth, firm, well demarcated
can extend inferiorly into pelvis

fever, hematuria, HTN

62
Q

Dx for wilms

A

U/S or CT of abdomen, CT of chest (can spread to lungs)

bx or surgical excision is diagnostic

63
Q

Tx for wilm’s tumor

A

surgical exploration
chemo
radiation

64
Q

Prognosis for wilm’s

A

90% overall 5 year survival

65
Q

Most common primary bone malignancy in peds

A

osteosarcoma

66
Q

Epidemiology of osteosarcoma

A

male predominance
13-16 yo
occurs in long bones (metaphysis) - distal femor (40%)

67
Q

Signs of bone tumor

A

bone pain at the site
mass formation
fracture through the area of cortical destruction
antalgic gait (due to pain)

68
Q

Dx of osteosarcoma

A

X-ray- destruction of normal trabecular pattern and irregular margins
MRI- eval of soft tissue involvement
Bonescan and CT of the chest (metastasis)

Imaging and bx

69
Q

Treatment of osteosarcoma

A

surgery

chemo

70
Q

Prognosis of osteosarcoma

A

70-75% long term survival w/ localized tumor

71
Q

Second most common primary bone tumor in peds

A

ewing sarcoma

72
Q

Epidemiology of ewing sarcoma

A

M>F in 2nd decade of life
long bones (diaphysis)
extremities/pelvis
rarely in soft tissue

73
Q

Clinical findings for ewing sarcoma

A

worsening localized pain +/- swelling
bone pain WORSE @ NIGHT
fatigue, fever, +/- weight loss

74
Q

Dx for ewing sarcoma

A

x-ray

CT/MRI of primary lesion

75
Q

Staging for ewing sarcoma

A

CT scan of chest
bone scan
bone marrow aspirates
biopsy

76
Q

Dx of ewing

77
Q

Tx for ewing

A

chemo
surgery
radiation
combination

78
Q

Prognosis of ewing sarcoma

A

70-75% long term survival if small localized tumor

79
Q

90% of tumors diagnosed before age 5 are

A

retinoblastoma

80
Q

Etiology of retinoblastoma

A

can be inherited (parent may be silent carrier)

usually unilateral

81
Q

Prognosis of retinoblastoma

A

metastasis rare

death w/i a year is typical

82
Q

Presentaiton of retinoblastoma

A

leukocoria (white pupillary reflex) <2 yo

strabisus, nystagmus and red inflamed eye possible

83
Q

Dx of retinoblastoma

A

opthalmolgic exam under anesthesia - chalky, off white retinal mass w/ soft, fraible consistency
ocular U/S
MRI of brain and orbits

84
Q

Tx of retinoblastoma

A

external beam irradiation

chemo if confined to globe

85
Q

Most common soft tissue sarcoma in childhood

A

rhabdomyosarcoma

86
Q

Epidemiology of rhabdomyosarcoma

A

most diagnosed by age 10
slight male predominance
can resemble fat, fibrous tissue and muscle
can effect any body part

87
Q

Most common sites for rhabdomyosarcoma

A

head and neck

88
Q

presentation of rhabdomyosarcoma

A

painless, progressively enlarging mass

89
Q

Orbital rhabdo

A

proptosis/exopthalmos

90
Q

Bladder rhabdo

A

hematuria
urinary obstruction
pelvic mass

91
Q

Dx for rhabdomyosarcoma

A

imaging: xray, CT, MRI

Chest CT and skeletal survey to r/o metastasis

92
Q

Tx for rhabdomyosarcoma

A

(any combo)
surgery
chemo
radiation

93
Q

Prognosis of rhabdomyosarcoma

A

70-75% 3 year survival

94
Q

Hepatic tumors stats

A

2/3 of liver masses are malignant

90% are either hepatoblastoma or hepatocellular carcinoma

95
Q

Lab for hepatic tumors

A

alpha-fetoprotein (AFP) elevated

***AFP is a good marker for response to tx

96
Q

Presentation of hepatic tumors

A

enlarging abdomen

97
Q

Imaging of hepatic tumors

A

abdominal U/S, CT or MRI

98
Q

Tx for hepatic tumors

A

surgery and chemo
complete resection essential for survival
liver transplantation when tumors are unresectable

99
Q

Prognosis of hepatic tumors

A

1/3 w/ complete resection have long term survival

Peds II Exam 1 (4 decks)

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