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Med Conditions II > Pediatric Oncology > Flashcards

Pediatric Oncology Flashcards

1
Q

What are common symptoms for a child with ALL?

A 
Lymphadenopathy 
HSM
Petechiae
Purpura
Bleeding
Pallor
Fatigue
Fever
Joint/bone pains
Limping -> not walking
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2
Q

What are the secondary effects of bone marrow infiltration in ALL?

A

Anemia
Thrombocytopenia
Leukopenia or neutropenia
Bone or joint pain (often legs, back, pelvis)

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3
Q

What are the secondary effects of extramedullary infiltration in ALL?

A 
Hepatosplenomegaly
Lymphadenopathy
Stridor and orthopnea
Cranial nerve palsies
Retinal exudates
Testicular enlargement
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4
Q

Typical CBC presentation for children with ALL

A

95% with 2 or more cytopenias
4% with a single cytopenia
1% normal CBC

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5
Q

Typical lab findings for children with ALL

A

Low Hb, platelets, WBC

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6
Q

Common medical treatment timeline for children with ALL

A

Induction: “puts you in remission”- 4wks
Consolidation: “treatment to spine” - 4-8 wks
Interim Maintenance: “rest phase”- 6-8 wks
Delayed Intensification: “reduces # of hiding cells”- 8 wks
Maintenance: 2 years for females
3 years for males

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7
Q

Outcomes for children with ALL

A 
Standard Risk (younger kids with lower WBC)
~90% Event free survival (EFS)
High Risk (older kids or high WBC)
~80% EFS
Very High Risk
~40% EFS
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8
Q

Side Effects of Corticosteroids

A

Bone pain
Muscle weakness
Avascular Necrosis

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9
Q

Side effects of vincristine

A 
Peripheral neuropathy
“toe-walking”
“claw hands”
Vocal cord paralysis
ptosis
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10
Q

Top 3 pediatric cancers (>50% of combined cancers in kids)

A

Leukemia, CNS, Lymphoma

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11
Q

Leukemia typical presentation

A

3 year old with fussiness, mildly pale, occasional bruises (varying ages on inspection), complaining of leg pain/refuses to walk

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12
Q

Leukemia diff dx to consider - nonmalignant

A

Infections, rheumatologic cond, autoimmune cytopenias, aplastic anemia, leukemoid reaction and transient myloproliferative syndrome

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13
Q

Leukemia diff dx to consider - malignant

A

Neuroblastoma, rhabdomyosarcoma, retinoblastoma, non-Hodgkin’s lymphoma, MDS

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14
Q

Leukemia Diff Dx by history and PE - signs/symptoms

A

Fever,lymphadenopathy HSM; Petechiae, purpura, bleeding; Pallor, fatigue; Fever, joint/bone pains

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15
Q

Leukemia Diff Dx by history and PE - diff dx

A

EBV/CMV, stoarge diseases, lymphoma; ITP, HUS, meningococcemia; TEC, hemolytic anemia, aplastic anemia; JRA, Rheumatic fever, lupus, neuroblastoma

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16
Q

Issues secondary to marrow infiltration and decreased marrow production

A

anemia, thrombocytopenia, leukopenia or neutropenia, bone or joint pain

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17
Q

Down’s Syndrome and Leukemia

A

15-20x incidence, typically presenting 1-8 years of age

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18
Q

Leukemia bone pain

A

present in 30% of kids, may limp and progress to non walking

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19
Q

Issues secondary to extramedullary infiltration

A

Hepatosplenomegaly; Lymphadenopathy; Stridor and orthopnea; Cranial nerve palsies; Retinal exudates; Testicular enlargement

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20
Q

CBC at presentation of ALL

A

95% with 2 or more cytopenias; 4% with a single cytopenia; 1% normal CBC and differential; LDH usually elevated in acute leukemia with bone pain

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21
Q

ALL Lab Findings

A

low hemoglobin, high WBC count, low platelet count

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22
Q

ALL Facts

A

Peak incidenct 4 years old; 25% of all childhood leukemias; associated with trisomy 21 (age >3yr), Fanconi’s anemia, and congenital immunodeficiency syndromes

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23
Q

Induction treatment

A

“puts you in remission” - 4 wks

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24
Q

consolidation

A

“treatment to spine” - 4-8 wks

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25
Interim maintenance
"rest phase" - 6-8 wks
26
Delayed intensification
"reduces # of hiding cells" - 8 wks
27
Maintenance treatment
2 yrs for females, 3 ys for males
28
Standard risk outcomes
includes younger kids with lower WBC, ~90% event free survival
29
high risk outcomes
includes older kids or higher WBC, ~80% EFS
30
very high risk outcomes
~40% EFS
31
Risks of corticosteroid chemotherapy
bone pain, muscle weakness, avascular necrosis
32
risks of vincristine chemotherapy
peripheral neuropathy, "toe-walking", "claw hands", vocal cord paralysis, ptosis
33
Physical Deficits in ALL
decreased strength compared to age matched controls; slower timed 6 min test; more body fat; decreased ability to walk distance; underreported peripheral neuropathy
34
PT in ALLevals done
the Purdue Pegboard, the 6 Minute Walk, the PODCI parent-report instrument, and the PedsQL parent-report instrument; PT evals at 5 time points in therapy
35
Acute Myeloid Leukemia
1/4 as frequent as ALL; Predisposing Factors: -Trisomy 21(age<3); -Fanconi anemia; -Bloom syndrome; -Diamond Blackfan; -Neurofibromatosis; -Prior chemo; -MDS
36
AML treatment
Current treatmentInduction with AraC, dauno, etopIntensification AraC, mitoxantone, DaunoTo BMT after induction remission if 5/6 or 6/6 matched family donor, if intermediate or high risk50% incidence of serious bacterial infectionChemotherapy quite intense-prolonged hospitalizationsLess CNS prophylaxis (no XRT)
37
lymphadenopathy diff dx
infection, cyst, systemic disease (rheumatic), tumor
38
concerns in enlarged lymph nodes
size >1-2cm, increasing size over 2-4 weeks, supraclavicular LN, fevers for 2-4 weeks, constitutional symptoms
39
lymphomas
40% hodgkins, 60% non-hodgkins (large cell lymphoma s lymphoma 40-50%)
40
non-Hodgkin's lymphoma
3rd most common group of malignancies12% of newly diagnosed childhood malignancies500 new cases/year3:1 male to female ratiovincristine used
41
Hodgkin's Lymphoma
Bimodal peak- 1st peak in the mid 20’sM=F ratioAsymptomatic cervical or supraclavicular lymphadenopathy-most common presentation2/3 with mediastinal disease at diagnosisconstitutional symptoms in 33%-prognosis worseLong-term problems- pulmonary, cardiac, breast CA, ovarian failure, sterility
42
NHL and Hodgkin’s lymphoma
Chemotherapy is the mainstayVarious regimens usedDuration ~6-9 monthsRadiotherapy may be used with HD depending on the rapidity of responseSurgery not often indicatedNHL-can present with spinal cord compression and weakness
43
abdominal masses diff dx
kidney (hydronephrosis, polycystic kidney disease, malignancy); liver (storage disease, malignancy, AVM, CHF); spleen (infection, malignancy, hemeglobinopathy); other (neuroblastoma, lymphoma)
44
Wilms Tumor
Peak age 2-3 years, median age 3-4 yearsPresent most commonly with an asymptomatic abdominal massSpreads to contralateral kidney, lungs1% have affected relativesAfrican Americans- increased riskM=F ratio
45
Overgrowth syndromes
Beckwith-Wiedemann syndrome; Perlman; Simpson-Golabi-Behmel; Sporadic hemihypertrophy
46
Wilm's Tumor therapy and issues
TherapyLow stage/<18 months-surgery aloneLow stage-vincristine, actinomycin DHigher stage-vincristine, actinomycin D, doxorubicin, +/- radiation to abdomenIssues:Peripheral neuropathyscoliosis
47
Neuroblastoma
metastases seen in 70% of children >1 yr old at diagnosis; tumor of sympathetic nervous tissue (adrenal 40%, paraspinal 25%, cervical 15-20%, posterior mediastinal); median age at diagnosis is 22 months; presentation can be paraspinal as it is a midline process, usually in <1 year olds)
48
Neuroblastoma therapy
Low stageChemotherapy X 6 monthsDo very well, cure ~90%Likely to be < 2years of ageHigh stageIntensive chemotherapyHigh dose chemotherapy with autologous stem cell transplantSurgery, radiationBiologic therapy after transplantEvent free survival-35-40%
49
Bone pain info
leukemia (20-30% patients), neuroblastoma, rhabdomyosarcoma, primary bone tumor (osteosarcoma 79%, Ewings 89%, Langerhans Histiocytosis)
50
Bone pain - when to be concerned
persistent, progressive, night, associated with swelling/mass/limitation of movement
51
osteosarcoma info
Peak incidence in 2nd decade of lifeOccur earlier in females than males, associated with growth spurtOccur in the metaphyseal portion of the long tubular bonesPresent with pain, massAssociated with radiation, Li-Fraumeni syndrome, hereditary retinoblastoma
52
osteosarcoma vs ewings
osteosarcoma: majority occur in the distal femur, proximal tibia, and proximal humerus; Ewings: even split between extremities and axial skeleton, axial occur in pelvis, chest wall, spine, head, neck
53
Ewings Sarcoma info
Most commonly occur in the 2nd decade of life but can occur in young childrenOccur equally in the extremities and the central axisMore constitutional symptomsNo associations“Onion peel” on XRAY
54
OS Therapy
Chemotherapy for one yearSurgery at ~12 weeksNo role for radiationLocalized-72% EFS, metastatic 30% EFS
55
ES Therapy
Chemotherapy given every 2 weeksSurgery or radiation therapy at ~12 weeksLocalized-75% EFS, metastatic-20% EFS
56
Brain tumors
20-30% of childhood tumors - 2nd most common neoplasm of childhood; most occur <9 years old; M:F 1.3:1
57
top 3 pediatric brain cancers (>50% of combined brain cancers in kids)
supratentorial astrocytoma, cerebellar astrocytoma, medulloblastoma
58
clinical features of brain tumors
Increased intracranial Pressure irritability, lethargy early morning headache which improves vomiting-usually in the AM unexplained changes in personality or behavior papilledema
59
brain tumor therapy
Consists of multiple modalitiesSurgery, radiation-usualChemotherapy-medulloblastomas, germ cell tumors, low grade astroExperimental therapy- high grade gliomas, brain stem gliomas
60
brain tumor additional issues
#1 in terms of morbidityVincristine-used frequentlyHemiparesisGait changesGeneralized weaknessCognitive changesSpeech changes-quality, fluency, word findingWeight loss
61
brain tumors average delay in diagnosis
6 months
62
survivor use of therapies
chiropractic services chosen more frequently than PT, Grade 3-4 chronic conditions, CNS tumor/sarcoma associated with more use of PT

Med Conditions II (8 decks)

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