Oncology Flashcards
Top three PEDs cancers?
- Leukemia
- CNS tumors
- Lymphoma
4th is neuroblastoma
Standout S/S of cancer?
FOU
Petechiae/bleeding
Pallor
Tumor lysis syndrome is?
Common to leukemia/lymphoma TXT
- rapid cellular lysis = K+, PO4, Uric acid released
Tumor lysis syndrome can cause?
Cardiac arrest or arrhythmias
Gout/uric acid
Nephropathy
MC childhood cancer?
Leukemia
Subtypes of leukemia?
Acute lymphocytic leukemia (ALL)
Acute myelogenous leukemia (AML)
Chronic myelogenous leukemia (CML)
MC subtypes of leukemia?
ALL (75%)
AML (15-20%)
ALL is most common in what gender?
Males
What ages is ALL MC in?
2-5yo
What leukemia subtype is MC in neonates and late adolescence?
AML
Leukemia standout S/S present?
LAD
Hepatosplenomegaly
LAB findings of leukemia?
Immature blasts, Anemia, Decreased PLTs
CBC - L, NL, H sometimes >50k WBC
BM = blasts
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Important lab to perform w/ leukemia is?
LP to eval if CNS is affected
Definitive Dx of leukemia is?
Flow cytometry and Cytochemical staining
MC mutation of ALL?
t(12:21) translocation - best prognosis
Poorest prognosis mutation of ALL?
t(9:22) translocation
Poorest prognostic indicators of leukemia?
<1yo or >9yo >50k WBC CNS or testicular Dz Genetic mutations t(4;11) or t(9;22) translocations No remission after 4wks of therapy
Lymphoma is?
Lymphoid tissie malignancy
3rd MC childhood cancer?
Lymphoma
What pathogen is ass/w lymphoma?
Epstein-Barr virus EBV
Major subtypes of lymphoma?
Hodgkin disease
Non-Hodgkin lymphoma
MC type of lymphoma?
Hodgkin’s lymphoma
MC population of hodgkins lymphoma?
Adolescents/young adult AND >50
MC population of NHL?
Whites > Blacks
Males > Females
Subtypes of NHL?
B-cell
T-cell
Large cell
B-cell NHL is AKA?
Burkitt lymphoma (sml noncleaved cell)
T-cell NHL is AKA?
Lymphoblastic
Two forms of Burkitt lymphoma?
Sporadic form - North America
Endemic form - Africa (EBV strongly ass/w)
Standout S/S of lymphoma?
Pruritis
B-Symptoms
SOB (Medialstinal LAD) / pleural effusion
Painless Cervical/supraclavicular LAD
B-symptoms are?
S/S ass/w lymphoma
- Fever for 3 consecutive days
- Night sweats
- Unintentional wgt loss
What gives lymphoma a poorer prognosis?
Presence of B-Symptoms
Lymphoma labs only w/u?
CBC = NL
BM = disease staging (>25% blasts= Acute leuemia)
Tissue Bx pleural/peritoneal BF=Reed Sternberg cells
Reed Sternberg cells is ass/w?
Hodgkins lymphoma (Owl eyes)
Lymphoma imaging w/u?
CXR - +-medialstinal mass
CT - Dx staging
Difference between ALL and Lymphoma Bone marrow?
> 25% blasts in Bone marrow = ALL
MC solid tumors in PEDs are located where?
CNS tumors
2nd MC childhood cancer?
CNS tumors
Inherited syndromes ass/w
Neurofibromatosis
Li-Fraumeni syndrome
Tuberous sclerosis
MC Location of CNS tumors in PEDS <2yo
MC - infratentorial (cerebellum/brainstem)
MC Location of CNS tumors in PEDS >2yo
MC - Spinal or supratentorial
S/S ass/w supratentorial lesion?
Visual S/S (field deficit)
Seizures
Foacl neuro
Personality changes
S/S ass/w infratentorial lesion?
Hydrocephalus
Increased ICP(papilledema)
Cranial nerve palsies
Ataxia
CNS tumor presents as?
Loss of developmental milestones
Poor school performance
Increased ICP - (HA, N/V, lethargy - 1st thing in AM)
— ICP increase > 6th nerve palsy
Cranial nerve deficits > brainstem involved
Sign of increased ICP?
Inability to abduct eye (6th nerve palsy)
6th nerve palsy affects what muscle?
Eye muscle - cant abduct (CN6)
CNS tumors affect pituitary fx?
Prolactinoma > glactorrhea
GH secreting > excess growth/precocious puberty
Cerebellar tumors S/S?
Ataxia, diminished coordination
MC type of Brain tumor?
Astrocytoma
2nd MC brain tumor?
Medulloblastomas
Where are Astrocytomas found mostly?
Posterior fossa of brain
Where are Medulloblastomas found mostly?
Cerebellar vermis
MC solid tumor outside of CNS?
Neuroblastoma
MC infant malignancy?
Neuroblastoma (20mo median age)
Where are neuroblastomas derived from?
MC - Neural crest cells that form adrenal medulla/SNS
but can form anywhere along SNS
MC presentation of Neuroblastoma?
Abd Pain/Mass (flank, hard, smooth, non-TTP) Fever, WGT loss Bone pain Horner syndrome Paraneoplastic syndromes
Horner syndrome is MC ass/w what malignancy?
Neuroblastoma
Paraneoblastic syndrome S/S?
Profuse sweating
Secretory diarrhea
Opsomyoclonus (Dancing eyes/feet)
W/U of neuroblastoma
Catecholamines (Urine- vanillylmandelic & homovanillic acid)
Tissue Bx
BM aspiration/Bx
CBC
Vanillylmandelic and homovanillic acid is ass/w what malignancy?
Neuroblastoma
Imaging ordered to w/u neuroblastoma?
XR - calcifications
CT
Bone scan
Nephroblastoma is AKA?
Wilms tumor
MC renal tumor of PEDs?
Nephroblastoma
Anomalies ass/w nephroblastoma?
WAGR syndrome W- Wilms tumor A- Aniridia G- GU malformation R- Retardation
Mutation ass/w WAGR syndrome anomalies?
Chromo 11p deletion
Avg Age of Nephroblastoma?
3-3.5y
Syndromes ass/w Nephroblastoma?
WAGR syndrome
Beckwith-Wiedemann syndrome
Beckwith-Wiedemann syndrome S/S?
Macroglossia
Umbilical Hernia
Omphalocele
Nephroblastoma Standout S/S?
Fever
HTN
Hematuria
Sarcoma is?
Tumors from bone or soft tissue
MC soft tissue sarcoma?
Rhabdomyosarcoma (skeletal muscle)
MC bone sarcoma(s)?
MC - Osteosarcoma
- Ewing sarcoma
Syndromes ass/w increased risk of soft tissue sarcomas?
Li-Fraumeni
Neurofibromatosis
Syndromes ass/w increased risk of Osteosarcoma?
Hereditary retinoblastoma
What TXT increases risk of osteosarcoma?
Radiation or Chemo (alkylating)
Microscopic characteristics of Rhabsomyosarcoma?
Small, Round, Blue cell tumors (Like Ewing)
Microscopic characteristics of Osteosarcoma?
Osteoid substance present
Osteosarcoma MC occurs where?
Epiphysis or metaphysis
- Distal Femur
- Proximal Tibia
- Proximal humerus
Osteosarcoma tends to follow what?
Trauma - (not dx due to S/S blamed on trauma)
XR of Osteosarcoma will show?
Starburst pattern
Standout S/S ass/w Ewing sarcoma?
Pain and fever
Ewing sarcoma is often misdx as?
Osteomyelitis
MC bone Ewing sarcoma occurs in?
MC - Femur or Pelvis
- but anywhere really
Ewing sarcoma microscopic characteristics?
Small round blue cell tumors
XR of Ewing sarcoma will show?
Onion-skin or Moth eaten characteristics
Dx of sarcomas?
Microscopy
Histology
Cytogenics
Microscopic findings that differentiae sarcomas?
Rhabo/Ewing = Small round blue cell tumors Osteosarcoma = Osteoid substance
Mutation ass/w Ewing sarcoma?
t(11;22) (95% of tumors)
Histologic variants of Rhabomyosarcoma?
Embryonal - Young PEDs w/ head, neck, GU tumors
vs
Alveolar - older w/ trunk or extremity tumors
Mutations ass/w Rhabomyosarcoma Alveolar variant?
t(2;13) or t(1;13)