Pediatric Oncology

Question 1

What is cancer, and how is it generally defined?

Answer 1

Cancer is defined as the uncontrolled growth of abnormal cells that can invade and destroy normal body tissues. It often spreads to other parts of the body (metastasis) through blood or lymphatic systems.

Question 2

What is the difference between primary and metastatic cancer?

Answer 2

Primary cancer originates in a specific organ or tissue, whereas metastatic cancer occurs when cancer cells spread to other parts of the body from the primary site.

Question 3

What are the most common types of pediatric cancer?

Answer 3

1. Leukemia (28% of pediatric cancers)
2. CNS tumors (26%)
3. Neuroblastic tumors (e.g., neuroblastoma)
4. Lymphomas (Hodgkin and Non-Hodgkin)
5. Sarcomas (bone and soft tissue cancers)
6. Retinoblastoma
7. Wilms tumor (kidney cancer).

Question 4

What is the incidence of pediatric cancer in the U.S.?

Answer 4

Approximately 11,000 children and adolescents are diagnosed with cancer annually in the U.S., with an 84% survival rate for those who receive treatment.

Question 5

What is leukemia, and why is it significant in pediatric oncology?

Answer 5

Leukemia is a cancer of the blood and bone marrow characterized by an overproduction of abnormal white blood cells. It is the most common pediatric cancer, accounting for 28% of cases.

Question 6

What are CNS tumors, and where are they commonly located in children?

Answer 6

CNS tumors are cancers that occur in the brain or spinal cord. In children, they are most commonly found in the posterior fossa (60%) or cerebral hemispheres (40%).

Question 7

Define neuroblastoma and its typical location in pediatric patients.

Answer 7

Neuroblastoma is a cancer of the sympathetic nervous system, often originating in the adrenal glands or along the spine. It typically affects children under 5 years old.

Question 8

What is the primary cancer staging system used for Wilms tumor?

Answer 8

Wilms tumor is staged using the COG (Children’s Oncology Group) system, which ranges from Stage I (tumor confined to the kidney) to Stage IV (tumor has metastasized to distant organs).

Question 9

What is retinoblastoma, and what is a hallmark sign of this cancer?

Answer 9

Retinoblastoma is a rare eye cancer in children, often characterized by leukocoria (absence of the red reflex in the pupil).

Question 10

What is the difference between Hodgkin and Non-Hodgkin lymphoma?

Answer 10

Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells and often presents with painless lymph node swelling. Non-Hodgkin lymphoma lacks these cells and can arise in various lymphatic tissues.

Question 11

What is the survival rate for children diagnosed with acute lymphoblastic leukemia (ALL)?

Answer 11

The survival rate for children diagnosed with ALL is over 90% with appropriate treatment.

Question 12

What are sarcomas, and what are the two most common types in pediatric patients?

Answer 12

Sarcomas are cancers of bone and soft tissue. The two most common types in pediatric patients are osteosarcoma (affecting long bones) and Ewing sarcoma (affecting bones and soft tissues).

Question 13

What is the significance of tumor grading in pediatric oncology?

Answer 13

Tumor grading provides information about the aggressiveness of the cancer, its likelihood of spreading, and helps guide treatment decisions.

Question 14

What are the common risk factors for pediatric cancer?

Answer 14

Common risk factors include genetic predisposition (e.g., Down syndrome, neurofibromatosis), exposure to radiation or toxic chemicals, and certain viral infections (e.g., Epstein-Barr virus).

Question 15

How does pediatric oncology differ from adult oncology in terms of common cancer types?

Answer 15

Pediatric oncology primarily includes cancers like leukemia, CNS tumors, and sarcomas, while adult oncology more commonly involves carcinomas (e.g., lung, breast, colon).

Question 16

What are the common signs and symptoms of leukemia in pediatric patients?

Answer 16

Symptoms include fatigue, pallor, frequent infections, easy bruising or bleeding, bone pain, fever, and enlarged lymph nodes, liver, or spleen.

Question 17

What neurological symptoms might indicate the presence of a CNS tumor in a child?

Answer 17

Symptoms include headaches (worse in the morning), vomiting, seizures, drowsiness, poor coordination, and impaired balance.

Question 18

What are the clinical presentations of neuroblastoma in children?

Answer 18

Symptoms depend on tumor location but may include abdominal mass, bone pain (if metastasized), fever, and, in some cases, Horner’s Syndrome (ptosis, miosis, anhidrosis).

Question 19

What is a typical clinical sign of Wilms tumor in children?

Answer 19

A painless abdominal mass is the most common sign, often discovered by parents or during a physical exam.

Question 20

What is the presentation of retinoblastoma, and what diagnostic test confirms it?

Answer 20

Retinoblastoma presents with leukocoria (absence of the red reflex). Diagnosis is confirmed by fundoscopic examination and imaging, such as MRI or CT.

Question 21

What are the hallmark signs of Hodgkin lymphoma in children?

Answer 21

Signs include painless swelling of lymph nodes (especially in the neck), fever, night sweats, weight loss, and itching.

Question 22

What diagnostic procedures are commonly used to confirm a pediatric cancer diagnosis?

Answer 22

Procedures include blood tests, imaging (e.g., MRI, CT, X-rays), biopsies, bone marrow aspiration, and lumbar punctures.

Question 23

What is the importance of staging in pediatric cancer diagnosis?

Answer 23

Staging determines the extent of the disease, guides treatment planning, and provides prognostic information.

Question 24

What imaging techniques are commonly used to evaluate CNS tumors in children?

Answer 24

MRI is the gold standard for evaluating CNS tumors, often supplemented by CT scans for additional anatomical detail.

Question 25

What are the systemic symptoms of Ewing sarcoma in children?

Answer 25

Symptoms include localized pain and swelling at the tumor site, fever, fatigue, and potential weight loss if metastasized.

Question 26

How is osteosarcoma commonly diagnosed in pediatric patients?

Answer 26

Diagnosis involves imaging (e.g., X-rays, MRI, CT) showing a ‘sunburst’ pattern, followed by a biopsy to confirm the cancer.

Question 27

What is the significance of lumbar puncture in leukemia diagnosis?

Answer 27

Lumbar puncture assesses CNS involvement by detecting cancer cells in cerebrospinal fluid, which influences treatment strategies.

Question 28

What lab findings are typical in leukemia?

Answer 28

Lab findings include anemia, thrombocytopenia, neutropenia, and elevated or decreased white blood cell counts with blasts present in the peripheral blood smear.

Question 29

What are the diagnostic signs of rhabdomyosarcoma?

Answer 29

Signs include a rapidly growing soft tissue mass, often in the head, neck, or genitourinary tract, with potential symptoms depending on the tumor’s location.

Question 30

What are the primary goals of a physical therapy examination for a child undergoing cancer treatment?

Answer 30

Goals include assessing ROM, strength, balance, coordination, functional mobility, and identifying any musculoskeletal or neurological impairments caused by the cancer or its treatment.

Question 31

What are the primary goals of chemotherapy in pediatric cancer treatment?

Answer 31

The primary goals are to destroy rapidly dividing cancer cells, shrink tumors before surgery, and eliminate microscopic disease after surgery or radiation.

Question 32

What are the common side effects of chemotherapy in pediatric patients?

Answer 32

Common side effects include nausea, vomiting, fatigue, alopecia (hair loss), myelosuppression (low blood cell counts), and peripheral neuropathy.

Question 33

What is the role of radiation therapy in pediatric oncology?

Answer 33

Radiation therapy targets and destroys cancer cells in a specific area, often used for CNS tumors, sarcomas, and as adjuvant therapy after surgery.

Question 34

Why is cranial radiation often avoided in children under 3 years old?

Answer 34

Cranial radiation is avoided due to its potential to severely impact brain development and cognitive function in young children.

Question 35

What are common surgical procedures used in pediatric cancer treatment?

Answer 35

Procedures include tumor resection, limb-sparing surgery for sarcomas, enucleation for retinoblastoma, and nephrectomy for Wilms tumor.

Question 36

What is the purpose of bone marrow transplantation in pediatric oncology?

Answer 36

Bone marrow transplantation replaces damaged or destroyed bone marrow with healthy cells, often used after high-dose chemotherapy for leukemia or lymphoma.

Question 37

How do physical therapy interventions address the needs of pediatric cancer patients?

Answer 37

PT focuses on maintaining ROM, strength, balance, and developmental skills while addressing cancer-related fatigue and neuropathy.

Question 38

What is the significance of monitoring blood counts in pediatric cancer patients undergoing chemotherapy?

Answer 38

Monitoring blood counts is crucial to manage and prevent complications such as infection, anemia, and bleeding due to myelosuppression.

Question 39

When are cranial orthoses used in pediatric oncology, and why?

Answer 39

Cranial orthoses may be used to manage deformities like plagiocephaly in children undergoing prolonged treatments that limit mobility or positioning.

Question 40

What is the role of immunotherapy in pediatric cancer treatment?

Answer 40

Immunotherapy enhances the body’s immune system to target and destroy cancer cells, often used in cases like neuroblastoma or relapsed cancers.

Question 41

How is pain managed in pediatric oncology patients?

Answer 41

Pain is managed through pharmacological methods (e.g., opioids, NSAIDs) and non-pharmacological approaches like relaxation techniques and PT interventions.

Question 42

What is the goal of adjuvant therapy in pediatric cancer treatment?

Answer 42

Adjuvant therapy aims to eliminate residual cancer cells after primary treatments like surgery or chemotherapy, reducing the risk of recurrence.

Question 43

How does limb-sparing surgery differ from amputation in pediatric sarcoma treatment?

Answer 43

Limb-sparing surgery removes the tumor while preserving as much of the limb’s structure and function as possible, whereas amputation removes the entire affected limb.

Question 44

What PT interventions are recommended for managing cancer-related fatigue in children?

Answer 44

Interventions include light aerobic exercises, stretching, strengthening activities, and graded activity programs to improve energy levels and function.

Question 45

What are the long-term considerations for pediatric cancer survivors in PT?

Answer 45

Long-term considerations include managing late effects of treatment such as cardiopulmonary issues, neuropathy, and musculoskeletal complications to optimize quality of life.

Question 46

A 6-year-old child presents with persistent bone pain, especially at night, and localized swelling in the distal femur. What type of cancer is likely, and what diagnostic test would confirm this?

Answer 46

The likely diagnosis is osteosarcoma. Diagnostic confirmation requires imaging (e.g., X-ray or MRI) and a biopsy of the affected area.

Question 47

A 3-year-old child is brought to the clinic with a palpable abdominal mass, hematuria, and hypertension. What is the likely diagnosis, and what staging system is used?

Answer 47

The likely diagnosis is Wilms tumor. The COG (Children’s Oncology Group) staging system is used to classify the severity.

Question 48

A 4-year-old child presents with fatigue, pallor, recurrent infections, and bruising. Blood tests reveal an elevated white blood cell count with immature blast cells. What is the most likely diagnosis?

Answer 48

The most likely diagnosis is acute lymphoblastic leukemia (ALL). Diagnosis is confirmed with blood tests and a bone marrow biopsy.

Question 49

A 2-year-old child has a firm, non-tender abdominal mass, raccoon eyes, and bone pain. What cancer is likely, and what is the primary site of origin?

Answer 49

The likely diagnosis is neuroblastoma, which commonly originates in the adrenal glands or sympathetic ganglia.

Question 50

A child with Hodgkin lymphoma presents with night sweats, unexplained weight loss, and fever. What do these symptoms indicate, and how do they affect prognosis?

Answer 50

These symptoms, known as B symptoms, indicate a more advanced stage of Hodgkin lymphoma and are associated with a poorer prognosis.

Question 51

A 7-year-old child undergoing chemotherapy reports numbness and tingling in the hands and feet. What condition does this suggest, and what intervention might PT provide?

Answer 51

This suggests chemotherapy-induced peripheral neuropathy. PT interventions include balance training, strengthening exercises, and education on safe movement strategies.

Question 52

An 18-month-old child with retinoblastoma is noted to have leukocoria during an eye exam. What does this finding suggest, and what is the first step in management?

Answer 52

Leukocoria suggests the presence of retinoblastoma. The first step in management is imaging (e.g., ultrasound or MRI) and referral to an ophthalmologist.

Question 53

A child with a CNS tumor develops nausea, vomiting, and ataxia. What is the likely tumor location, and what imaging would confirm this?

Answer 53

The likely tumor location is the posterior fossa. An MRI is the preferred imaging modality to confirm the diagnosis.

Question 54

A 10-year-old with leukemia develops a fever and low neutrophil count. What complication is likely, and what precautions should be taken?

Answer 54

The likely complication is febrile neutropenia. Precautions include isolation, monitoring for infection, and initiating antibiotics as needed.

Question 55

A 5-year-old child with a history of sarcoma is unable to fully extend their knee following limb-sparing surgery. What PT interventions could address this issue?

Answer 55

Interventions include stretching exercises, joint mobilizations, strengthening of surrounding muscles, and functional training to restore full ROM.