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Diagnosis and Management II > Pediatric Cancer > Flashcards

Pediatric Cancer Flashcards

1
Q

FMHx risk factors for retinoblastoma, osteosarcoma

A

1st degree familial retinoblastoma

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2
Q

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

A

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

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3
Q

FMHx risk factors for Leukemia, NHL

A

Family history of immunodeficiency disorders

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4
Q

Childhood Cancer Survivorship increases the risks for

A

AML, brain tumors, NHL, MDS

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5
Q

Early warning signs of Childhood Cancer (CHILDREN)

A

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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6
Q

CHILDREN - H

A

Headache or vomiting in the morning think CNS cancer

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7
Q

CHILDREN - L

A

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

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8
Q

CHILDREN - D

A

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

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9
Q

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

A

CBC and blood smear

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10
Q

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

A

CBC, blood smear, ESR, CXR

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11
Q

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

A

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

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12
Q

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

A

Ultrasound

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13
Q

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

A

Two view radiography, CRP, CBC, blood smear

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14
Q

Evaluate sudden persistent back pain in child

A

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

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15
Q

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

A

Ultrasonography or MRI

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16
Q

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

A

Leukemia (ALL, AML)

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17
Q

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

A

CNS tumors (brain, cranial nerves, spinal cord)

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18
Q

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

A

Lymphoma (Hodgkin, NHL)

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19
Q

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

A

Neuroblastoma

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20
Q

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

A

Soft tissue sarcoma (rhabdomyosarcoma)

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21
Q

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

A

Renal tumor (Wilms tumor)

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22
Q

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

A

Osteosarcoma

23
Q

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

A

Ewing Sarcoma

24
Q

B sypmtoms

A

Night sweats, fever, weight loss

25
Q

Blood stem cells become…

A

Myeloid or lymhoid stem cells

26
Q

Myeloid stem cells become….

A

RBC, WBC (first myeloblast) or platelet

27
Q

Lymphoid stem cells become….

A

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

28
Q

Jobs of Lymphocytes

A

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

29
Q

Risk groups for ALL

A

Standard Risk: Low WBC 50,000, 9 years, T-cell ALL

Very High Risk genetic associations with specific chromosome abnormalities

30
Q

Epidemiology of ALL (Peak, incidence, survival)

A

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

31
Q

Risk factor ALL

A

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

32
Q

ALL Labs

A

CBC w/diff, LFT, uric acid, LDH, ESR/CRP.

CBC will show pancytopenia and atypical lymphocytes. High Uric acid, high LDH

33
Q

ALL Imaging

A

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

34
Q

ALL Diagnostic

A

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

35
Q

ALL treatment

A

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

36
Q

ALL infiltration

A

CNS, testes, mediastinal mass particularly T-cell ALL

37
Q

AML Associated conditions

A

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

38
Q

AML Labs

A

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

39
Q

AML Diagnosis

A

BM aspiration and biopsy show blast cells

40
Q

AML Tx

A

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

41
Q

CML Pathophysiology

A

99% of Philidelphia chromosomal mutation

42
Q

CML Chronic Phase Pathophys

A

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

43
Q

CML Acute phase Pathyphys

A

Blast crisis similar to acute AML

44
Q

CML Presentation

A

Fatigue, fever, weight loss, splenomegaly

45
Q

CML Dx findings

A

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

46
Q

CML Treatment

A

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

47
Q

Neuroblastoma Pathophys

A

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

48
Q

Neuroblatoma Clinical Presentation - Abdomen

A

Swelling of abd, abd mass, abd pain, anorexia

49
Q

Neuroblatoma Clinical Presentation - Metastasis

A

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

50
Q

Neuroblatoma Clinical Presentation - Tumor releasing hormones

A

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

51
Q

Neuroblatoma Diagnosis

A

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

52
Q

Neuroblatoma Treatment

A

Chemo, radiation, surgery, immunotherapy, or combination

53
Q

Wilm’s Tumor Pathophys

A

Embryonal tumor of kidney

54
Q

Wilm’s Tumor Screening

A

Screen with abd US Q3 months until age 8

Diagnosis and Management II (3 decks)

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