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X Pediatrics 2 > Oncology > Flashcards

Oncology Flashcards

1
Q

Why is pediatric cancer difficult to diagnose in early stages?

A

Nonspecific associated sxs
Mimic other more common concerns
Clinicians lack the experience and reluctant to consider it

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2
Q

Warning signs for childhood cancer

A

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

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3
Q

What is the most common malignancy of childhood?

A

Acute lymphoblastic leukemia

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4
Q

How does ALL result?

A

Uncontrolled proliferation of immature lymphocytes (peak incidence at 2-5 yrs)

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5
Q

Genetic factors of ALL

A

Down Syndrome

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6
Q

Clinical presentation of ALL

A 
Intermittent fever, fatigue, pallor
Bleeding (petechiae)
Bone pain (pelvis, legs etc)
Hepatosplenomegaly
LAD
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7
Q

Lab findings of ALL

A

Anemia and/or thrombocytopenia with normal or depressed WBC
Neutropenia
Lymphoblasts on peripheral smear

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8
Q

How to diagnose ALL

A

Bone marrow biopsy (aspirate)- leukemic blasts replacing normal marrow

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9
Q

Tx of ALL

A

Chemo (initial/first line)
Hematopoietic stem cell transplant
2-3 yrs

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10
Q

Tumor lysis syndrome

A

Oncologic emergency
Massive tumor lysis causing hyperkalemia, hyperuricemia, hyperphosphatemia and acute renal failure
Anticipate when tx started

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11
Q

Genetic factors of acute myeloid leukemia

A

Down syndrome and neurofibromatosis

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12
Q

Clinical findings of AML

A

Fatigue, pallor, bleeding or infection (fever)

CNS seen sometimes (mental status changes)

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13
Q

Lab findings of AML

A

Anemia, thrombocytopenia, neutropenia

WBC>100,000 in 20%

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14
Q

Hyperleukocytosis and AML

A

This may be associated with life-threatening complications (medical emergency)

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15
Q

What is seen on a peripheral smear in AML?

A 
Circulating myeloblasts
Auer rods (granular structures in cytoplasm)
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16
Q

How to diagnose AML

A

Bone marrow biopsy wth 20% or more blasts

Leukemic cells must be of myeloid origin

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17
Q

Tx of AML

A

Chemo or hematopoietic stem cell transplant

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18
Q

What is CML?

A

Myeloproliferative disorder with uncontrolled proliferation of mature and maturing granulocytes
Associated with philadelphia chromosome

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19
Q

Presentation of CML

A

Chronic phase-accelerated phase-blast phase

Bone pain, b sxs, pallor, ecchymosis

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20
Q

Lab findings in CML

A

Anemia, thrombocytosis and leukocytosis

Peripheral smear shows myeloid cells in stages of maturation, increased basophils and blast cells

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21
Q

Tx of CML

A

Tyrosine kinase inhibitor (allow for dysregulated cellular proliferation)
Cure: HSCT

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22
Q

What is diagnostic of Hodgkin lymphoma?

A

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

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23
Q

Kids with hodgkin lymphoma

A

Have a better response to tx than adults

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24
Q

Presentation of hodgkin lymphoma

A

Painless cervical or supraclavicular adenopathy
Mediastinal mass (caution for superior vena cava syndrome)
B sxs

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25
Q

Tx of Hodgkin lymphoma

A

Chemo, radiation

Autologous HSCT

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26
Q

Description of all childhood non-hodgkin lymphomas

A

Rapidly proliferating, high grade, diffuse malignancies

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27
Q

Clinical findings of non-hodgkins lymphomas

A

Enlarging, non-tender LAD
Abdominal pain, fever, cough, dyspnea, night sweats
Maybe hepatosplenomegaly

28
Q

Tx of non-hodgkin lymphoma

A

Chemo or HSCT (watch for tumor lysis syndrome)

29
Q

Most common solid tumor of childhood

A

Brain tumor

30
Q

How to evaluate for brain tumor

A

Measure head circumference and observe gait

31
Q

Presentation of brain tumors

A

30% with triad: AM headache, vomiting and papilledema
Younger: vomiting, unsteady, lethargy, FTT, macrocephaly
Older: HA, visual sxs, seizure, school failure etc

32
Q

Preferred diagnostic study of brain tumors

A

MRI (can use CT scan tho)

33
Q

2 categories of brain tumors

A

Glial tumors and nonglial tumors

34
Q

Brain tumor tx

A

Initial approach: surgical removal of as much tumor as possible
Radiation and chemo when indicated

35
Q

Most common primary site of neuroblastomc

A

Adrenal gland

36
Q

Clinical manifestations of neuroblastoma

A 
Abdominal mass (often extends beyond midline- goes across belly button area)
Bone pain from metastatic disease
Fever, weight loss etc
37
Q

Lab findings of neuroblastoma

A

Anemia and decreased WBCs in most

Urinary catecholamines elevated in 90% (of the ones that have adrenal gland)

38
Q

Mainstay of tx for neuroblastoma

A

Surgical resection coupled with chemo (surgery alone if low grade)

39
Q

Most common abdominal tumor in kids

A

Neuroblastoma

40
Q

Clinical findings of nephroblastoma (Wilms tumor)

A

Asymptomatic abdominal mass/swelling (rarely crosses midline so just on 1 side)
Hematuria, HTN because of kidney probs

41
Q

Tx of Wilms tumor

A

Surgical exploration, chemo and radiation

42
Q

What is the most common primary bone malignancy in kids?

A

Osteosarcoma

43
Q

Epidimiology of osteosarcoma

A

Male predominance

Time of rapid bone growth (10-19)

44
Q

Where does osteosarcoma occur most?

A

Long bones (metaphysis)

45
Q

Cardinal signs of bone tumor

A

Bone pain at site
Mass formation
Fracture through area of cortical destruction

46
Q

Presentation of osteosarcoma

A

Bone pain over involved area (with or without swelling, antalgic gait)

47
Q

Imaging for osteosarcoma

A

Xray shows destruction of normal trabecular pattern and irregular margins
MRI, bone scan and CT scan of chest

48
Q

Tx of osteosarcome

A

Surgery, chemo

49
Q

Where does Ewing’s sarcoma occur most?

A

Long bones (diaphysis)-rarely in soft tissue

50
Q

Most common pt affected by Ewing Sarcoma

A

White males during second decade of life

51
Q

Clinical findings at Ewing Sarcoma

A

Worsening localized pain/swelling
Bone pain worse at night
Fatigue, fever, weight loss

52
Q

Tx for Ewing Sarcoma

A

Chemo, surgery, radiation or combo

53
Q

Who tends to have bilateral retinoblastoma?

A

Preemies

54
Q

Presentation of retinoblastoma

A

Leukocoria (white pupillary reflex under 2)- most common sign
Strabismus, nystagmus, red inflamed eye

55
Q

What is diagnostic of retinoblastoma?

A

Chalky, off white retinal mass with soft, friable consistency

56
Q

Tx for retinoblastoma

A

Some vision-sparing therapies
External beam irradiation
Chemo

57
Q

Most common soft tissue sarcoma in childhood

A

Rhabdomyosarcoma

58
Q

Where is rhabdomyosarcoma most common?

A

Head and neck

59
Q

Presentation of rhabdomyosarcoma

A

Painless, progressively enlarging mass

Might be orbital or bladder too

60
Q

Tx of rhabdomyosarcoma

A

Surgery, chemo radiation

61
Q

What percent of liver masses found in childhood are malignant?

A

2/3rds

62
Q

Types of hepatic malignancies

A

Hepatoblastoma or hepatocellular carcinoma

63
Q

Presentation of hepatic tumors

A

Present usually because of enlarging abdomen

64
Q

What is necessary for survival in hepatic tumors?

A

Complete resection

65
Q

What is the most common solid neoplasm outside of the CNS?

A

Neuroblastoma

X Pediatrics 2 (10 decks)

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