Oncology- peds

Question 1

TNM staging

Answer 1

T= primary tumor 
TX= can't be measured 
T0= can't be found 
Tis= in situ
T1-4= size and spread into structures 

N= lymph nodes
NX= can't be evaluated
N0= no involvement 
N1-3= size, location, and/or number of lymph nodes affected 

M= metastasis 
M0= no distant met
M1= distant met

Question 2

Acute lymphocytic leukemia (ALL)- epidemiology

Answer 2

2-5yr

Most common

Question 3

Acute lymphocytic leukemia (ALL)- s/s

Answer 3

Lymphadenopathy
Fever
Hepatosplenomegaly (HSM)
Fatigue
Pallor
Bruising/bleeding
Bone pain/limp/tenderness
Painless testicular enlargement
Malaise

Question 4

Acute lymphocytic leukemia (ALL)- dx

Answer 4

BMB/A >20%

Question 5

Acute lymphocytic leukemia (ALL)- labs & imaging

Answer 5

CBC w diff and peripheral smear:
Anemia
Thrombocytopenia
Blasts

Question 6

Acute lymphocytic leukemia (ALL)- tx

Answer 6

Chemo- determined by phenotyping

Question 7

Acute lymphocytic leukemia (ALL)- prognosis

Answer 7

5 yr > 85%

Question 8

CNS tumors- epidemiology

Answer 8

2nd most common

Question 9

CNS tumors- s/s

Answer 9

HA
Irritable
N/V
Macrocephaly
Ataxia/impaired gait
Impaired vision
Seizure
Papilledema
Developmental delay

Question 10

CNS tumors- dx

Answer 10

8x- histologic

Question 11

CNS tumors- labs & imaging

Answer 11

MRI

Question 12

CNS tumors- tx

Answer 12

Open surgical procedure - get biopsy and remove as much as possible
Avoid radiation <3yo
Chemo
Anticonvulsants - seizures

Question 13

CNS tumors- prognosis

Answer 13

Depends on tumor type

5y >73%

Question 14

Retinoblastoma- epidemiology

Answer 14

0-2yr

50% heritable - increased chance of passing to kids, and bilateral issues

Question 15

Retinoblastoma- s/s

Answer 15

“Leukocoria

Strabismus, red inflamed eye, nystagmus”

Question 16

Retinoblastoma- tx

Answer 16

REFER TO OPTHO
Get genetic testing

Cryotherapy
Local/systemic Chemo
Laser photocoagulation 
Enucleation
Radiation

Question 17

Retinoblastoma- prognosis

Answer 17

> 95%

if untreated- deadly

Question 18

Osteosarcoma- epidemiology

Answer 18

Kids - sporadic
Radiation, chemo, genetics, Paget dx - bone breaks down and rebuilds weird
M>F

Question 19

Osteosarcoma- s/s

Answer 19

Localized pain - last months

Soft tissue mass on exam - large, TTP

Question 20

Osteosarcoma- dx

Answer 20

Biopsy

Question 21

Osteosarcoma- labs & imaging

Answer 21

Xray:

• Destructive lesion
• Codman triangle - lesion lifts periosteum from bone
• Sunburst appearance

Question 22

Osteosarcoma- tx

Answer 22

Chemo
Preop Chemo -> surgery -> postop chemo
RADIORESISTANT

Question 23

Osteosarcoma- prognosis

Answer 23

Depends on tumor response to chemo

Question 24

Ewing sarcoma- epidemiology

Answer 24

M>F

10-20yo

Question 25

Ewing sarcoma- s/s

Answer 25

Bony pain or swelling- localized months
Limp, fracture
In LONG BONES AND PELVIS

Question 26

Ewing sarcoma- dx

Answer 26

Biopsy

Question 27

Ewing sarcoma- labs & imaging

Answer 27

Xray:
- Onion peel- periosteal reaction

CT/MRI:

• show extent of involvement
• Met w/u

Question 28

Ewing sarcoma- tx

Answer 28

Chemo

Surgical resection + radiation

Question 29

Ewing sarcoma- prognosis

Answer 29

5y: non-met- 55%

Met- 21%

Question 30

Wilms tumor (Nephroblastoma)- epidemiology

Answer 30

Most common renal malignancy 
2-5yo
African
WAGR syndrome
Denys-Drash syndrome
Beckwith-Weidemann syndrome

Question 31

Wilms tumor (Nephroblastoma)- s/s

Answer 31

Abdominal mass or swelling- firm, smooth, nontender, unilateral mass
Abdominal pain, hematuria, fever, HTN

Question 32

Wilms tumor (Nephroblastoma)- dx

Answer 32

Biopsy

Question 33

Wilms tumor (Nephroblastoma)- labs & imaging

Answer 33

Abdominal u/s

Question 34

Wilms tumor (Nephroblastoma)- tx

Answer 34

Surgical resection- all
Chemo- some
Radiation- based on stage/ histology