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Ped Oncology Flashcards

1
Q

Risk factors? (6)

A
  • Largely unknown
  • Down Syndrome
  • Genetic abnormalities
  • AIDS
  • Ionizing radiation exposure
  • Chemotherapy and radiation therapy
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2
Q

Two main types of leukemia? Peak incidence?

A
  • Acute lymphoblastic leukemia (ALL)
  • Acute myelogenous leukemia (AML)
  • Peak incidence is between 2-5 years of age
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3
Q

Pathogenesis is based on? (3)

A

Morphology
Immunotype
Cytogenetics

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4
Q

Leukemia Symptoms? (4)

A
  • Easy bruising bc of low platelets
  • Pallor bc of low HgB
  • Bone and/or joint pain bc of narrow canal
  • Lymphadenopathy (infection of WBC)
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5
Q

Leukemia Diagnosis? (3)

A

Bone marrow aspiration/biopsy
Lumbar puncture
Peripheral blood smear

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6
Q

Prognosis based on? (5)

A

Based on initial WBC count, age, cytogenetics, immonology, response to initial treatment

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7
Q

Most Leukemias are?

A

Low risk, then standard risk

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8
Q

Treatment for leukemia? (5)

A
  • chemo
  • Radiation
    » CNS, testicular involvement
  • Stem cell transplant (SCT): Indicated when induction fails or relapse
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9
Q

Why does radiation target CNS and testicles?

A

Disease tends to spend more time there

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10
Q

Phases of Chemotherapy Leukemia? (4)

A
  • Induction
  • Consolidation
  • Delayed Intensification
  • Maintenance
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11
Q

Describe induction (3)

A

Intense
Often admitted for induction
Pushes into remission

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12
Q

Stem Cell Transplant - types? (3) Sources? (3) Matching?

A

Types
Autogenic
Allogenic
Syngenic

Source
Peripheral Blood
Cord Blood
Bone Marrow

HLA typing

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13
Q

How common are brain tumors? What are the most common types? (3) Peak age of incidence?

A

2nd most common pediatric cancer

Astrocytoma: 52%
Medulloblastoma: 21%
Ependymoma: 9%

Peak age of incidence is 5 years old

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14
Q

Peak brain tumor incidence correlates with?

A

Peak neuroplasticity 2-5 yo

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15
Q

Where are medulloblastomas? Operable?

A

Tentorium - layer of connective tissue that defines cerebellum from cerebrum

Operable

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16
Q

Where are ependymomas? Operable?

A
  • Cerebellum and 4th ventricle

- hard but doable

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17
Q

Where are gliomas and astrocytomas? Operable?

A
  • BS

- inoperable

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18
Q

General symptoms of brain tumor? (8)

A 
Headaches
Double vision
Nausea & Vomiting
Irritability or sleep difficulties 
Changes in personality and behavior 
Impaired concentration 
Memory loss 
Problems with reasoning
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19
Q

Location specific symptoms - cerebellum? (2)

A

Clumsiness

Difficulty with coordination

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20
Q

Location specific symptoms - ventricles?

A

Increased head size before 2 years

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21
Q

Location specific symptoms - BS? (3)

A

Facial droop
Difficulty swallowing
Slurred speech

22
Q

Diagnosis? (2)

A

imaging

biopsy

23
Q

Brian tumor Prognosis? 5 yrears EFS for BS glioma, medulloblastoma, astrocytoma and ependymoma?

A
  • Overall survival is about 70%

Brainstem Glioma:

24
Q

Brain tumor tx? Kids might present how?

A 
Chemotherapy
Radiation
Surgery
Steroids
Anti-convulsants

Like CP

25
What is a neuroblastoma? How common? Mean age of diagnosis?
- Most common solid, extracranial tumor in children - Most commonly diagnosed tumor in children younger than 1 year - Mean age of diagnosis is 17.3 months
26
Neuroblastoma Primary Tumor Location? (3) May not be?
- Anywhere in the Sympathetic Nervous System - Adrenal glands - Sympathetic Ganglia - Primary tumor location may not be identifiable
27
Neuroblastoma symptoms reflect? What are they? (8) Some may be?
- Reflect location of the tumor - Lump in abdomen, chest, neck - Dark circles around eyes - Bone pain - Swollen stomach - Labored breathing in infants - Painless, bluish lumps under skin - Weakness, paralysis - Increased Catecholamine Release - Some may be asymptomatic
28
Neuroblastoma diagnosis? (7)
- Bone marrow aspirate - X-Ray - MIBG Scan (uses a marker that blinds to tumor) - Abdominal CT or MRI - Chest X-Ray - 24 hour urine collection (check for excess catecholamines) - Tumor biopsy
29
Neuroblastoma tx for low risk? Moderate risk? (2)
Low Risk Observation vs. Surgery only Moderate Risk Surgery Moderate Intensity Chemo
30
Neuroblastoma tx for high risk? (6)
``` Chemo Surgery High Dose Chemo Hematopoietic Stem Cell Rescue Radiation Clinical Trials ```
31
Sarcoma pathogenesis? Usually where? Peak incidence during? Occurs when for girls, why?
- Unclear etiology - Tumor location most frequently at metaphyseal plate - Peak incidence during adolescent growth spurt - Tumor location most frequently at metaphyseal plate - Occurs at an earlier age in girls bc they hit puberty earlier
32
Osteosarcoma - how common? (2)Incidence?
- Primary malignant bone tumor | - Most common bone cancer in children & adolescents (56%)
33
Osteosarcoma - Primary Tumor Location? (4) Less common sites? (4)
Long bones Distal femur Proximal tibia Proximal humerus Less common sites Pelvis, jaw, fibula, ribs
34
Ewing’s Sarcoma - how common? Peak incidence?
- Second most common primary bone tumor seen in children & adolescents (35%) - Peak incidence is between 10-15 years of age
35
Ewing’s Sarcoma - Primary Tumor Location? Primary sites? (6)
- Can occur in both flat and long bones ``` Lower extremity Pelvis Chest wall Upper extremity Spine Skull ```
36
Symptoms of Bone Cancer? (7)
- Localized pain - Awakens at night - Increases with weightbearing - Constant - Swelling - Palpable mass - Fracture
37
Sarcoma diagnosis? (7)
``` X-ray MRI CT scans Biopsy CT guided core needle biopsy *Open biopsy Bone marrow aspirate ```
38
Sarcoma prognosis based on? (4)
Site and size of primary tumor Presence of metastatic disease Response to initial therapy Age at diagnosis
39
Sarcoma tx - (3)
Chemotherapy Radiation Surgery
40
Sarcoma - types of chemo? (2) Why?
- Neoadjuvant - no chemo before surgery - Adjuvant - no chemo after - You get a break from chemo before/after surgery bc the cells are rapidly reproducing, impacting healing
41
Limb salvage includes? (3) Purpose? (2) Requires? (2) Contraindications?
- Tumor removal - Wide excision - Clean margins (negative) - Restoration of function & appearance - Prosthesis - Grafts (allo, auto, skin) - No high impact activities like jumping and running
42
Amputation involves? (4) Benefit?
- Involvement of neurovascular bundle - Tumor disruption - Infection - Pathological fractures Return to sports
43
Types of Surgical Procedures? (6)
``` Tumor resection with joint replacement TKR THR External/internal hemipelvectomy Partial/total sacrectomy Amputation (AKA, BKA, disarticulation, fore-quarter) ```
44
What is a rotationplasty? (3)
Tumor resection Spared neurovascular bundle * Use of ankle joint as knee joint with prosthesis
45
Expandable Prosthesis allows for? Types (2) Requires?
- Allows for continued limb growth Telescoping Loaded spring Epiphysiodesis: halting growth on either side on uninvolved side
46
Potential Causes for Developmental Delay? (5)
- Disease process and treatment - Environmental exploration - Parent/Caregiver interaction and bonding - Motivation for purposeful play - Interaction with age matched peers and siblings
47
Potential Psychosocial Complications? (8)
``` Depression Anxiety Low self-esteem Loss of purpose Social isolation Behavioral issues Learned helplessness Regression ```
48
Pediatric PT Intervention: Cardiovascular implications? (5) Tx? Monitor?
``` Decreased Endurance Prolonged isolation Post-op activity limitations Chemo Induced Cardiomyopathy CHF ``` MOBILITY! Monitor HR closely
49
Pediatric PT Intervention: Neurological implications? (6) tx? (4)
``` Primary tumor Brain tumor Nerve sheath tumors Cord compression Peripheral neuropathy Sensory processing ``` NDT handling techniques Balance training Orthotics Sensory integration
50
Pediatric PT Intervention: Pulmonary implications? (3) Tx? (5)
Post-op complications Pulmonary metastases Infection ``` Blowing activities Bubbles Pinwheels Foamy mountain Blo Pens ```
51
Pediatric PT Intervention: Musculoskeletal implications? (4) Tx? (3)
Decreased strength Postural deviation Altered weight bearing Post-op Rehabilitation Purposeful play! Gait Training Neuromuscular Re-Education

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