Oncology Flashcards
Why is pediatric cancer difficult to diagnose in early stages?
Nonspecific associated sxs
Mimic other more common concerns
Clinicians lack the experience and reluctant to consider it
Warning signs for childhood cancer
Unexplained weight loss, HA often with vomiting, increased swelling/pain in bones, lumps/masses, excessive bruising/bleeding, constant infections, whitish color behind pupil, nausea, tiredness/paleness, eye/vision changes, recurrent fevers
What is the most common malignancy of childhood?
Acute lymphoblastic leukemia
How does ALL result?
Uncontrolled proliferation of immature lymphocytes (peak incidence at 2-5 yrs)
Genetic factors of ALL
Down Syndrome
Clinical presentation of ALL
Intermittent fever, fatigue, pallor Bleeding (petechiae) Bone pain (pelvis, legs etc) Hepatosplenomegaly LAD
Lab findings of ALL
Anemia and/or thrombocytopenia with normal or depressed WBC
Neutropenia
Lymphoblasts on peripheral smear
How to diagnose ALL
Bone marrow biopsy (aspirate)- leukemic blasts replacing normal marrow
Tx of ALL
Chemo (initial/first line)
Hematopoietic stem cell transplant
2-3 yrs
Tumor lysis syndrome
Oncologic emergency
Massive tumor lysis causing hyperkalemia, hyperuricemia, hyperphosphatemia and acute renal failure
Anticipate when tx started
Genetic factors of acute myeloid leukemia
Down syndrome and neurofibromatosis
Clinical findings of AML
Fatigue, pallor, bleeding or infection (fever)
CNS seen sometimes (mental status changes)
Lab findings of AML
Anemia, thrombocytopenia, neutropenia
WBC>100,000 in 20%
Hyperleukocytosis and AML
This may be associated with life-threatening complications (medical emergency)
What is seen on a peripheral smear in AML?
Circulating myeloblasts Auer rods (granular structures in cytoplasm)
How to diagnose AML
Bone marrow biopsy wth 20% or more blasts
Leukemic cells must be of myeloid origin
Tx of AML
Chemo or hematopoietic stem cell transplant
What is CML?
Myeloproliferative disorder with uncontrolled proliferation of mature and maturing granulocytes
Associated with philadelphia chromosome
Presentation of CML
Chronic phase-accelerated phase-blast phase
Bone pain, b sxs, pallor, ecchymosis
Lab findings in CML
Anemia, thrombocytosis and leukocytosis
Peripheral smear shows myeloid cells in stages of maturation, increased basophils and blast cells
Tx of CML
Tyrosine kinase inhibitor (allow for dysregulated cellular proliferation)
Cure: HSCT
What is diagnostic of Hodgkin lymphoma?
Reed-sternberg cells (germinal center B cells that have undergone malignant transformation)
Kids with hodgkin lymphoma
Have a better response to tx than adults
Presentation of hodgkin lymphoma
Painless cervical or supraclavicular adenopathy
Mediastinal mass (caution for superior vena cava syndrome)
B sxs
Tx of Hodgkin lymphoma
Chemo, radiation
Autologous HSCT
Description of all childhood non-hodgkin lymphomas
Rapidly proliferating, high grade, diffuse malignancies
Clinical findings of non-hodgkins lymphomas
Enlarging, non-tender LAD
Abdominal pain, fever, cough, dyspnea, night sweats
Maybe hepatosplenomegaly
Tx of non-hodgkin lymphoma
Chemo or HSCT (watch for tumor lysis syndrome)
Most common solid tumor of childhood
Brain tumor
How to evaluate for brain tumor
Measure head circumference and observe gait
Presentation of brain tumors
30% with triad: AM headache, vomiting and papilledema
Younger: vomiting, unsteady, lethargy, FTT, macrocephaly
Older: HA, visual sxs, seizure, school failure etc
Preferred diagnostic study of brain tumors
MRI (can use CT scan tho)
2 categories of brain tumors
Glial tumors and nonglial tumors
Brain tumor tx
Initial approach: surgical removal of as much tumor as possible
Radiation and chemo when indicated
Most common primary site of neuroblastomc
Adrenal gland
Clinical manifestations of neuroblastoma
Abdominal mass (often extends beyond midline- goes across belly button area) Bone pain from metastatic disease Fever, weight loss etc
Lab findings of neuroblastoma
Anemia and decreased WBCs in most
Urinary catecholamines elevated in 90% (of the ones that have adrenal gland)
Mainstay of tx for neuroblastoma
Surgical resection coupled with chemo (surgery alone if low grade)
Most common abdominal tumor in kids
Neuroblastoma
Clinical findings of nephroblastoma (Wilms tumor)
Asymptomatic abdominal mass/swelling (rarely crosses midline so just on 1 side)
Hematuria, HTN because of kidney probs
Tx of Wilms tumor
Surgical exploration, chemo and radiation
What is the most common primary bone malignancy in kids?
Osteosarcoma
Epidimiology of osteosarcoma
Male predominance
Time of rapid bone growth (10-19)
Where does osteosarcoma occur most?
Long bones (metaphysis)
Cardinal signs of bone tumor
Bone pain at site
Mass formation
Fracture through area of cortical destruction
Presentation of osteosarcoma
Bone pain over involved area (with or without swelling, antalgic gait)
Imaging for osteosarcoma
Xray shows destruction of normal trabecular pattern and irregular margins
MRI, bone scan and CT scan of chest
Tx of osteosarcome
Surgery, chemo
Where does Ewing’s sarcoma occur most?
Long bones (diaphysis)-rarely in soft tissue
Most common pt affected by Ewing Sarcoma
White males during second decade of life
Clinical findings at Ewing Sarcoma
Worsening localized pain/swelling
Bone pain worse at night
Fatigue, fever, weight loss
Tx for Ewing Sarcoma
Chemo, surgery, radiation or combo
Who tends to have bilateral retinoblastoma?
Preemies
Presentation of retinoblastoma
Leukocoria (white pupillary reflex under 2)- most common sign
Strabismus, nystagmus, red inflamed eye
What is diagnostic of retinoblastoma?
Chalky, off white retinal mass with soft, friable consistency
Tx for retinoblastoma
Some vision-sparing therapies
External beam irradiation
Chemo
Most common soft tissue sarcoma in childhood
Rhabdomyosarcoma
Where is rhabdomyosarcoma most common?
Head and neck
Presentation of rhabdomyosarcoma
Painless, progressively enlarging mass
Might be orbital or bladder too
Tx of rhabdomyosarcoma
Surgery, chemo radiation
What percent of liver masses found in childhood are malignant?
2/3rds
Types of hepatic malignancies
Hepatoblastoma or hepatocellular carcinoma
Presentation of hepatic tumors
Present usually because of enlarging abdomen
What is necessary for survival in hepatic tumors?
Complete resection
What is the most common solid neoplasm outside of the CNS?
Neuroblastoma
