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Lifespan > Ped Oncology > Flashcards

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
Q

What is a neuroblastoma? How common? Mean age of diagnosis?

A
  • 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
Q

Neuroblastoma Primary Tumor Location? (3) May not be?

A
  • Anywhere in the Sympathetic Nervous System
  • Adrenal glands
  • Sympathetic Ganglia
  • Primary tumor location may not be identifiable
27
Q

Neuroblastoma symptoms reflect? What are they? (8) Some may be?

A
  • 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
Q

Neuroblastoma diagnosis? (7)

A
  • 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
Q

Neuroblastoma tx for low risk? Moderate risk? (2)

A

Low Risk
Observation vs. Surgery only

Moderate Risk
Surgery
Moderate Intensity Chemo

30
Q

Neuroblastoma tx for high risk? (6)

A 
Chemo
Surgery
High Dose Chemo
Hematopoietic Stem Cell Rescue
Radiation
Clinical Trials
31
Q

Sarcoma pathogenesis? Usually where? Peak incidence during? Occurs when for girls, why?

A
  • 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
Q

Osteosarcoma - how common? (2)Incidence?

A
  • Primary malignant bone tumor

- Most common bone cancer in children & adolescents (56%)

33
Q

Osteosarcoma - Primary Tumor Location? (4) Less common sites? (4)

A

Long bones
Distal femur
Proximal tibia
Proximal humerus

Less common sites
Pelvis, jaw, fibula, ribs

34
Q

Ewing’s Sarcoma - how common? Peak incidence?

A
  • Second most common primary bone tumor seen in children & adolescents (35%)
  • Peak incidence is between 10-15 years of age
35
Q

Ewing’s Sarcoma - Primary Tumor Location? Primary sites? (6)

A
  • Can occur in both flat and long bones
Lower extremity 
Pelvis
Chest wall
Upper extremity
Spine 
Skull
36
Q

Symptoms of Bone Cancer? (7)

A
  • Localized pain
  • Awakens at night
  • Increases with weightbearing
  • Constant
  • Swelling
  • Palpable mass
  • Fracture
37
Q

Sarcoma diagnosis? (7)

A 
X-ray
MRI
CT scans
Biopsy 
CT guided core needle biopsy
*Open biopsy 
Bone marrow aspirate
38
Q

Sarcoma prognosis based on? (4)

A

Site and size of primary tumor
Presence of metastatic disease
Response to initial therapy
Age at diagnosis

39
Q

Sarcoma tx - (3)

A

Chemotherapy
Radiation
Surgery

40
Q

Sarcoma - types of chemo? (2) Why?

A
  • 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
Q

Limb salvage includes? (3) Purpose? (2) Requires? (2) Contraindications?

A
  • 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
Q

Amputation involves? (4) Benefit?

A
  • Involvement of neurovascular bundle
  • Tumor disruption
  • Infection
  • Pathological fractures

Return to sports

43
Q

Types of Surgical Procedures? (6)

A 
Tumor resection with joint replacement
TKR
THR
External/internal hemipelvectomy
Partial/total sacrectomy
Amputation (AKA, BKA, disarticulation, fore-quarter)
44
Q

What is a rotationplasty? (3)

A

Tumor resection
Spared neurovascular bundle *
Use of ankle joint as knee joint with prosthesis

45
Q

Expandable Prosthesis allows for? Types (2) Requires?

A
  • Allows for continued limb growth

Telescoping
Loaded spring

Epiphysiodesis: halting growth on either side on uninvolved side

46
Q

Potential Causes for Developmental Delay? (5)

A
  • Disease process and treatment
  • Environmental exploration
  • Parent/Caregiver interaction and bonding
  • Motivation for purposeful play
  • Interaction with age matched peers and siblings
47
Q

Potential Psychosocial Complications? (8)

A 
Depression
Anxiety
Low self-esteem
Loss of purpose
Social isolation
Behavioral issues
Learned helplessness
Regression
48
Q

Pediatric PT Intervention: Cardiovascular implications? (5) Tx? Monitor?

A 
Decreased Endurance
Prolonged isolation
Post-op activity limitations
Chemo Induced Cardiomyopathy
CHF

MOBILITY!
Monitor HR closely

49
Q

Pediatric PT Intervention: Neurological implications? (6) tx? (4)

A 
Primary tumor
Brain tumor
Nerve sheath tumors
Cord compression 
Peripheral neuropathy
Sensory processing

NDT handling techniques
Balance training
Orthotics
Sensory integration

50
Q

Pediatric PT Intervention: Pulmonary implications? (3) Tx? (5)

A

Post-op complications
Pulmonary metastases
Infection

Blowing activities
Bubbles
Pinwheels
Foamy mountain
Blo Pens
51
Q

Pediatric PT Intervention: Musculoskeletal implications? (4) Tx? (3)

A

Decreased strength
Postural deviation
Altered weight bearing
Post-op Rehabilitation

Purposeful play!
Gait Training
Neuromuscular Re-Education

Lifespan (3 decks)

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