Pediatric Oncology

Question 1

What is the most common pediatric cancer

Answer 1

Leukemia
(A.L.L.)

Question 2

what is the second most common cancer in kids

Answer 2

Brain/CNS

Question 3

What are signs and symptoms of pediatric cancers

Answer 3

non-specific
fever, malaise
headache
lymphadenopathy

Question 4

What are red flags for pediatric cancer

Answer 4

unexplained weight loss
HTN
persistent adenopathy
HA with vomiting in AM
Abnormal neuro exam
afebrile seizure
dilated pupil, white spot in the pupil
sudden onset of excessive bruising/bleeding
persistent swelling/pain in a limb

Question 5

where does a neuroblastoma arise

Answer 5

adrenal medulla or less often sympathetic nervous system (Abdomen, chest, neck)

Question 6

what cancer is most common in infants under age of 1

Answer 6

neuroblastoma

Question 7

how is diagnosis confirmed with neuroblastoma

Answer 7

biopsy

Question 8

what is the treatment of neuroblastomas

Answer 8

surgical resection
chemo
raditation
high-dose chemo with stem cell transplant
cis-retinoic acid
immunotherapy

Question 9

what is the median age of diagnosis of neuroblastomas

Answer 9

17 months

Question 10

What is the presentation of neuroblastomas

Answer 10

abdominal pain
discomfort
sense of fullness due to abdominal mass
mets: bone pain, periorbital ecchymosis and proptosis, abd distention

Question 11

Whatis opsoclonus-myoclonus

Answer 11

dancing eyes and dancing feet (paraneoplastic syndrome)

Question 12

what other tests need to be completed when there is concern for Neuroblastomas

Answer 12

Urinary vanillylmandelic acid (VMA) or Homovanillic acid (HVA) or both: elevated in >90% of patients

Question 13

What is Stage IVS Neuroblastoma

Answer 13

localized primary tumor with dissemination limited to skin, liver and/or bone marrow in infant younger than 1 year of age

Question 14

What are good prognositc factors with neuroblastomas

Answer 14

limited stage
younger age
4S disease

Question 15

what is wilms tumor

Answer 15

AKA nephroblastoma
embryonal cancer of kidney composed of blastemal, stromal and epithelial elements

Question 16

how is wilms tumor diagnosed

Answer 16

US, ABD CT/MRI

Question 17

what is the treatment of Wilms tumor

Answer 17

surgical resection
chemo
radiation

Question 18

when is wilms tumors most common

ages

Answer 18

< 15 years old
usually manifests age < 5 years

Question 19

What is the presentation of wilms tumor

Answer 19

painless, palpable, abdominal mass

Question 20

What are risk factors for CNS malignancies

Answer 20

cranial irradiation
genetic/familial syndromes (neurofibromatosis, tuberous sclerosis., etc)

Question 21

When is imaging considered for CNS malignancy

Answer 21

persistent headache (> 4weeks)
persistent vomiting upon waking
visual finding
motor findings

Question 22

What is the imaging of choice for CNS malignancies

Answer 22

MRI (best - requires sedation, takes longer)
CT -initial

Question 23

what is a cancer arising from immature retina

Answer 23

retinoblastoma

Question 24

what are signs/symptoms of retinoblastomas

Answer 24

common leukocoria, stabismus; less often, inflammation, impaired vision

Question 25

What is leukocoria

Answer 25

white reflex in the pupil

Question 26

How are retinoblastomas diagnosed

Answer 26

opthalmoscopic exam; US, CT or MRI

Question 27

what is the treatment of retinoblastomas

Answer 27

small CA, bilat: photocoagulation, cryotherapy, radiation Advanced, larger CA: Enucleation and occasioanl chemotherapy

Question 28

when are retinoblastomas typically diagnosed

Answer 28

< 2 years of age

Question 29

What is Rhabdomyosarcoma

Answer 29

Childhood cancer that arises from embryonal mesenchymal cells that have potential to differentiate into skeletal muscle cells can arise from almost any type of muscle tissues in any location. resulting in highly variable clinical manifestations

Question 30

how is rhabdomyosarcoma categorized

Answer 30

soft tissue sarcoma; most common cancer in this group

Question 31

what populations are rhabdomyosarcoma more common in

Answer 31

whites > blacks Boys > girls

Question 32

Where is rhabdomyosarcoma found

Answer 32

can occur almost anywhere in the body: Head and neck region, GU, Extremities, Trunk/Miscellaneous sites

Question 33

what is the presentation of rhabdomyosarcoma

Answer 33

firm, palpable mass OR with organ dysfunctiond ue to impingement on organ by cancer orbital and nasopharyngeal: tearing, eye pain, proptosis GU: abdominal pain, mass, difficulty urinating, heaturia

Question 34

How is rhabdomyosarcoma diagnosed

Answer 34

CT; head and neck lesions better defined by MRI confirmed with biopsy or excision

Question 35

What is the treatment of rhabdomyosarcoma

Answer 35

surgery, chemo, sometimes radiation

Question 36

when do osteosarcomas peak

Answer 36

Adolescence-growth spurt (may also occur in older adults)

Question 38

what are risk factors for osteosarcoma

Answer 38

prior cancer or cancer treatments

Question 39

What is the presentation of osteosarcomas

Answer 39

pain, limp swelling

Question 40

where are osteosarcomas located

Answer 40

metaphysis of long bones distal femur proximal tibia proximal humerus

Question 41

what is the "sunburst pattern" on x-ray associated with

Answer 41

Osteosarcoma

Question 42

what is the treatment of osteosarcoma

Answer 42

surgery and chemo

Question 43

what is Ewing sarcoma

Answer 43

believed to be neural crest cells in origin mostly occur in bone, but can be extra-osseous peak in adolescent; dose not occur in older adults

Question 44

where are Ewing sarcomas likley located

Answer 44

Axial skeleton pelvis femur

Question 45

What is the presentation of Ewing sarcoma

Answer 45

pain and swelling can have systemic complaints: fatigue, weight loss, fever, anemia

Question 46

what is seen on x-ray with ewing sarcoma

Answer 46

"moth eaten" "onion skinning"

Question 47

What is the treatment of ewing sarcoma

Answer 47

chemo, radiation, surgery

Question 48

what is the most common pediatric cancer

Answer 48

ALL (acute lymphoblastic leukemia)

Question 49

What are symptoms of ALL

Answer 49

fatigue, pallor, infection, bone pain, CNS symptoms , easy brusing, and bleeding

Question 50

How is ALL diagnosed

Answer 50

Peripheral blood smear and bone marrow

Question 51

What are the risk facotrs in children for ALL

Answer 51

exposure to Ionizing radiation genetic syndromes (DOwns, neuofibromatosis)

Question 52

What is the treatment of ALL

Answer 52

sysetmic chemo prophylactic CNS chemo and sometimes CNS radiation supportive care maybe immunotherapy, targeted therapy, stem cells transplantation, and or radiation

Question 53

What are the phases of chemotherapy for ALL

Answer 53

1. remission induction 2. post-remission consolidation 3. interim mainenance and intensification 4. maintenance

Question 54

What is the goal of induction treatment for ALL

Answer 54

complete remission

Question 55

how long is the induction phase of chemotherapy for ALL

Answer 55

4 weeks

Question 56

how long is consolidation chemotherapy for ALL

Answer 56

4- 6 months

Question 57

How long is maintenance chemotherapy for ALL

Answer 57

24-36 months