Pediatric Cancer Flashcards by Johanna Valente

FMHx risk factors for retinoblastoma, osteosarcoma

1st degree familial retinoblastoma

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FMHx risk factors for GI cancer, colon cancer, hepatoblastoma, medulloblastoma

Familial history of gastrointestinal syndromes such as adenomatous polyposis, Gardner syndrome

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FMHx risk factors for Leukemia, NHL

Family history of immunodeficiency disorders

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Childhood Cancer Survivorship increases the risks for

AML, brain tumors, NHL, MDS

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Early warning signs of Childhood Cancer (CHILDREN)

Continued unexplained weight loss, Headaches with vomiting in the morning, Increased swelling or persistent pain in bones or joints accompanied by limping, Lump or mass in the abdomen neck or elsewhere, Development of whitish pupil or sudden changes in vision, Recurrent fevers not caused by infection, Excessive bruising or bleeding, Noticeable paleness or prolonged tiredness

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CHILDREN - H

Headache or vomiting in the morning think CNS cancer

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CHILDREN - L

Lump or mass in abdomen, neck or elsewhere think lymphoma or neuroblastoma

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CHILDREN - D

Development of whitish appearance in the pupil of the eye or sudden vision change think retinoblastoma

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Evaluate any combination of persistent or unexplained fever, recurrent or persistent infection, pallor, malaise, hemorrhagic manifestations, hepatosplenomegaly, or lymphadenoahy with…

CBC and blood smear

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Evaluate enlarged lymph nodes >2cm for >4-6 weeks with fever, night sweats, weight loss, hepatosplenomegaly or orthopnea with…

CBC, blood smear, ESR, CXR

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Evaluate headaches of new onset (persistent, occipital, morning, N/V, neurological deficits) by…

Rule out other causes like migraine, sinusitis, tension headaches, ocular abnormalities then take a history, neuro exam before neuro imaging

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Evaluate any abdominal mass or hepatosplenomegaly with anorexia, vomiting, fever, or pain with…

Ultrasound

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Evaluate persistent bone pain that awakens the child, doesn’t respond to NSAID, associated with swelling with…

Two view radiography, CRP, CBC, blood smear

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Evaluate sudden persistent back pain in child

CBC, blood smear, CRP, and radiography of the spine

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Evaluate any palpable, recent, nontender soft tissue mass >2 cm with…

Ultrasonography or MRI

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Pallor, fatigue, prolonged fever without cause, recurrent infections, anorexia, peticae, gingival bleeding, lymphadenopahy, hepatosplenomegaly, bone pain (generalized or joints), limp, irritability, neurological symptoms indicate…

Leukemia (ALL, AML)

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Persistent morning headaches, N/V, ataxia, visual disturbances, neurological deficits, seizures, developmental delay, unexplained deterioration in school performance, personality changes, torticollis, signs of increased ICP

CNS tumors (brain, cranial nerves, spinal cord)

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Lymphadenopathy, B symptoms, pallor, fatigue, petichae, abdominal mass, hepatosplenomegaly, N/V, constipation, abdominal pain

Lymphoma (Hodgkin, NHL)

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Palpable mass (abd or neck), anorexia, FTT, fever, bone pain, lymphadenopathy, pallor malaise, irritability, leg weakness, ocular symptoms, periorbital ecchymoses, back pain, subcutaneous nodules, obstructive symptoms of bowel and bladder, neurological defecits

Neuroblastoma

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Palpable mass, symptoms caused by pressure on adjacent structures, lymphadenoapthy, squint or proptosis, vaginal bleeding

Soft tissue sarcoma (rhabdomyosarcoma)

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Abd mass, abd pain, hematuria, vomiting, constipation, fever, HTN

Renal tumor (Wilms tumor)

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Localized bone pain, palpable mass, swelling or deformity, pathological fracture

Osteosarcoma

Localized bone pain, palpable mass, prolonged fever, fatigue, weight loss, compression of local structures, symptoms due to bone marrow

Ewing Sarcoma

B sypmtoms

Night sweats, fever, weight loss

Blood stem cells become...

Myeloid or lymhoid stem cells

Myeloid stem cells become....

RBC, WBC (first myeloblast) or platelet

Lymphoid stem cells become....

Lymphoblast and then lymphocyte (B lymphocyte, T lymphocyte, NK cell)

Jobs of Lymphocytes

B and T lymphocytes make antibodies, NK cells attack cancer cells and viruses

Risk groups for ALL

Standard Risk: Low WBC 50,000, 9 years, T-cell ALL | Very High Risk genetic associations with specific chromosome abnormalities

Epidemiology of ALL (Peak, incidence, survival)

Peak 2-4 years, males > females, good survival rate

Risk factor ALL

Downs syndrome 20x risk, immunodeficiency diseases, maybe parental smoking and paint exposure

ALL Labs

CBC w/diff, LFT, uric acid, LDH, ESR/CRP. | CBC will show pancytopenia and atypical lymphocytes. High Uric acid, high LDH

ALL Imaging

CXR, Abd US or CT, Lumbar puncture for staging. Lymphoblasts and elevated leukocyte count indicate CSF involvement

ALL Diagnostic

Bone marrow biopsy and aspirate shows infiltration of lymphoblasts replacing BM constitutents

ALL treatment

Chemo 3-4 years, cranial irradiation for CNS, Hematopoietic allogenic transplant for relapse or Philidelphia chromosome mutation

ALL infiltration

CNS, testes, mediastinal mass particularly T-cell ALL

AML Associated conditions

DIC, tumor lysis syndrome, leukostasis, extremely elevated WBC >100,000

AML Labs

CBC with diff, coagulation profile, LFTs, Uric Acid, ESR/CRP

AML Diagnosis

BM aspiration and biopsy show blast cells

AML Tx

Agressive multi-agent chemo, maybe CNS therapy, bone marrow or stem cell transplant with allogenic BM

CML Pathophysiology

99% of Philidelphia chromosomal mutation

CML Chronic Phase Pathophys

Chronic lasts 3-4 years with elevated WBC, high number mature cells, thrombocytopenia, anemia. Splenomegaly

CML Acute phase Pathyphys

Blast crisis similar to acute AML

CML Presentation

Fatigue, fever, weight loss, splenomegaly

CML Dx findings

High WBC with myeloid cells at all stages of development, Philadelphia Chromosome

CML Treatment

Gleevec first line, Sprycel (to control CML), chemo and transplant

Neuroblastoma Pathophys

Develops from sympathetic nerve cells in abdomen, either adrenal gland or sympathetic chain ganglia

Neuroblatoma Clinical Presentation - Abdomen

Swelling of abd, abd mass, abd pain, anorexia

Neuroblatoma Clinical Presentation - Metastasis

Lymphadenapthy, bone pain, raccoon eyes when in orbital bone, head or neck mass, respiratory symptoms

Neuroblatoma Clinical Presentation - Tumor releasing hormones

Sweating, flushing, tachycardia, blueberry muffin rash, Horner's Syndrome in the eye

Neuroblatoma Diagnosis

Biopsy, catecholamines in blood or urine, Abd US/CT/MRI, MBIG to tag neuroblastoma cells, bone marrow aspirate

Neuroblatoma Treatment

Chemo, radiation, surgery, immunotherapy, or combination

Wilm's Tumor Pathophys

Embryonal tumor of kidney

Wilm's Tumor Screening

Screen with abd US Q3 months until age 8