Pediatric Onco 1 Flashcards
most common malignancy in pediatric age
hematologic malignancy (leukemia)
most common solid tumor in pedia
brain and spinal tumor
outcome of pedia tumors
more aggressive, rapid progression, but greater response to treatment
t/f 80% of pediatric cases are diagnosed with metastasis
true, s/sx caused by systemic involvement
s/sx of childhood cancer mimicking normal illness
table 2
red flag signs
- lymphadenopathy >/= 2 cm
- morning symptoms
- rapid changes in vision +/- papilledema
- painless swelling
- fever associated with pallor +/- night sweats
- abdominal, bone, soft tissue masses
- scrotal masses that dont transilluminate
- urinary retention
tumor location and ddx
table 3
incidence of brain and spine tumors is highest in __
infants and children <5
brain tumors accg to cell origin
- neuroepithelium !!
- cranial nerves
- meninges and sella
- hematopoietic cells
- germ cells
brain tumors by age
1st year: supratentorial tumors (choroid plexus tumors and teratomas)
1-10 yo: infratentorial tumors (medulloblastoma and pilocytic astrocytoma)
> 10 yo: supratentorial tumors (diffuse astrocytoma!!)
most common malignant brain tumor of childhood, most common primary brain tumor age 0-4
medulloblastoma
most common location of brain tumors
infratentorial area
most common symptoms reported by children
headaches, but presence of headache alone should not be a red flag for diagnosis
red flag signs for headache
read
structures in the supratentorial region
- optic pathway
- pineal region
- suprasellar region
- third ventricular region
- hypothalamic or pituitary
presentation of supratentorial involvement
- focal motor weakness
- focal sensory changes
- language disorders
- focal seizures
- reflex asymmetry
- infants: premature hand preference
presentation of vetricular system involvement
neuroendocrine deficits
- galactorrhea
- precocious puberty
- hypothyroidism
- subacute development of obesity
- abnormal linear growth velocity
- diabetes insipidus
diencephalic syndrome
failure to thrive, emaciation despite normal caloric intake, inappropriately normal or happy affect
parinaud syndrome
- paresis of upward gaze
- pupillary caliber reactive to accomodation but not to light
- nystagmus to convergence
- eyelid retraction
classic symptoms of infratentorial tumor
headache, nausea, vomiting, papilledema
most common pediatric brain tumor
astrocytoma
pilocytic vs diffuse s pilomyxoid astrocytoma
read
management of low grade astrocytoma
main is surgical, rad/chemo if needed or recurrence
good outcome
types of high grade astrocytoma
anaplastic ang glioblastoma
location of ependymoma
infratentorial
subtypes of ependymoma
cellular !!
anaplastic
myxopapillary
management of ependymoma
surgery!, radiation, chemo
younger = poorer outcomes
posterior fossa or infratentorial = poorer outcomes
most common cns tumors in children <1 yo
choroid plexus tumors
clinical course of choroid plexus tumors
increased icp, macrocephaly, focal neurologic defects
subtypes of choroid plexus tumors
choroid plexus papilloma, atypical choroid plexus papilloma, choroid plexus carcinoma
t/f all variants of embryonal tumors are grade 4
true
- supratentorial pnet
- ependymoma
- medulloepithelioblastoma
- atypical teratoid or rhabdoid tumor
most common group of malignant cns tumors of childhood
embryonal tumors
what is craniophayngioma
read
- endocrinologic abnormalities
- visual changes
management of brainstem tumors
radiation therapy, chemo has no benefit
most important prognostic factor in brainstem tumors
- location of lesion
- structures being compressed
- infiltrates
- survival is 12 mos
subtypes of brainstem tumors
- focal brainstem tumor
- dorsal exophytic brainstem tumor
- cervicomedullary tumor
- diffuse intrinsic pontine glioma
most common site of origin of germ cell tumors
pineal gland
clinical course of germ cell tumors
- insidious course
- headache, parinaud syndrome, di, precocious puberty, ataxia, hemiparesis
subtypes of germ cell tumors
- secreting germinoma
- nongerminomatous tumors (tumor markers!! afp and bhcg)
subtypes of pineal parenchymal tumors
- pineoblastoma
- pineocytoma
multimodal approach
most common intraocular tumor in children
retinoblastoma, average age is 2 yo
histology in retinoblastoma
flexner winetsteiner rosettes, necrosis, calcification
clinical manifestation of retinoblastoma
- leukocoria
- strabismus
- dec visual acuity
- orbital inflammation
- hyphema
- vitreous hemorrhage
- pain
diagnosis of retinoblastoma
- directed opthalmoscopy
- ct/mri/uts
- clinical
BIOPSY CONTRAINDICATED - lumbar puncture
- bone scan
- bone marrow biopsy
t/f in retinoblastoma, primary goal is cure, secondary goal is preserving vision
true
