Pediatric Oncology Flashcards
What is the most common pediatric cancer
Leukemia
(A.L.L.)
what is the second most common cancer in kids
Brain/CNS
What are signs and symptoms of pediatric cancers
non-specific
fever, malaise
headache
lymphadenopathy
What are red flags for pediatric cancer
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
where does a neuroblastoma arise
adrenal medulla or less often sympathetic nervous system (Abdomen, chest, neck)
what cancer is most common in infants under age of 1
neuroblastoma
how is diagnosis confirmed with neuroblastoma
biopsy
what is the treatment of neuroblastomas
surgical resection
chemo
raditation
high-dose chemo with stem cell transplant
cis-retinoic acid
immunotherapy
what is the median age of diagnosis of neuroblastomas
17 months
What is the presentation of neuroblastomas
abdominal pain
discomfort
sense of fullness due to abdominal mass
mets: bone pain, periorbital ecchymosis and proptosis, abd distention
Whatis opsoclonus-myoclonus
dancing eyes and dancing feet (paraneoplastic syndrome)
what other tests need to be completed when there is concern for Neuroblastomas
Urinary vanillylmandelic acid (VMA) or Homovanillic acid (HVA) or both: elevated in >90% of patients
What is Stage IVS Neuroblastoma
localized primary tumor with dissemination limited to skin, liver and/or bone marrow in infant younger than 1 year of age
What are good prognositc factors with neuroblastomas
limited stage
younger age
4S disease
what is wilms tumor
AKA nephroblastoma
embryonal cancer of kidney composed of blastemal, stromal and epithelial elements
how is wilms tumor diagnosed
US, ABD CT/MRI
what is the treatment of Wilms tumor
surgical resection
chemo
radiation
when is wilms tumors most common
ages
< 15 years old
usually manifests age < 5 years
What is the presentation of wilms tumor
painless, palpable, abdominal mass
What are risk factors for CNS malignancies
cranial irradiation
genetic/familial syndromes (neurofibromatosis, tuberous sclerosis., etc)
When is imaging considered for CNS malignancy
persistent headache (> 4weeks)
persistent vomiting upon waking
visual finding
motor findings
What is the imaging of choice for CNS malignancies
MRI (best - requires sedation, takes longer)
CT -initial
what is a cancer arising from immature retina
retinoblastoma
what are signs/symptoms of retinoblastomas
common leukocoria, stabismus; less often, inflammation, impaired vision
What is leukocoria
white reflex in the pupil
How are retinoblastomas diagnosed
opthalmoscopic exam; US, CT or MRI
what is the treatment of retinoblastomas
small CA, bilat: photocoagulation, cryotherapy, radiation
Advanced, larger CA: Enucleation and occasioanl chemotherapy
when are retinoblastomas typically diagnosed
< 2 years of age
What is Rhabdomyosarcoma
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
how is rhabdomyosarcoma categorized
soft tissue sarcoma; most common cancer in this group
what populations are rhabdomyosarcoma more common in
whites > blacks
Boys > girls
Where is rhabdomyosarcoma found
can occur almost anywhere in the body:
Head and neck region, GU, Extremities, Trunk/Miscellaneous sites
what is the presentation of rhabdomyosarcoma
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
How is rhabdomyosarcoma diagnosed
CT; head and neck lesions better defined by MRI
confirmed with biopsy or excision
What is the treatment of rhabdomyosarcoma
surgery, chemo, sometimes radiation
when do osteosarcomas peak
Adolescence-growth spurt (may also occur in older adults)
what are risk factors for osteosarcoma
prior cancer or cancer treatments
What is the presentation of osteosarcomas
pain, limp swelling
where are osteosarcomas located
metaphysis of long bones
distal femur
proximal tibia
proximal humerus
what is the “sunburst pattern” on x-ray associated with
Osteosarcoma
what is the treatment of osteosarcoma
surgery and chemo
what is Ewing sarcoma
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
where are Ewing sarcomas likley located
Axial skeleton
pelvis
femur
What is the presentation of Ewing sarcoma
pain and swelling
can have systemic complaints:
fatigue, weight loss, fever, anemia
what is seen on x-ray with ewing sarcoma
“moth eaten”
“onion skinning”
What is the treatment of ewing sarcoma
chemo, radiation, surgery
what is the most common pediatric cancer
ALL
(acute lymphoblastic leukemia)
What are symptoms of ALL
fatigue, pallor, infection, bone pain, CNS symptoms , easy brusing, and bleeding
How is ALL diagnosed
Peripheral blood smear and bone marrow
What are the risk facotrs in children for ALL
exposure to Ionizing radiation
genetic syndromes (DOwns, neuofibromatosis)
What is the treatment of ALL
sysetmic chemo
prophylactic CNS chemo and sometimes CNS radiation
supportive care
maybe immunotherapy, targeted therapy, stem cells transplantation, and or radiation
What are the phases of chemotherapy for ALL
- remission induction
- post-remission consolidation
- interim mainenance and intensification
- maintenance
What is the goal of induction treatment for ALL
complete remission
how long is the induction phase of chemotherapy for ALL
4 weeks
how long is consolidation chemotherapy for ALL
4- 6 months
How long is maintenance chemotherapy for ALL
24-36 months
