Pediatric Oncology Flashcards
What are common symptoms for a child with ALL?
Lymphadenopathy HSM Petechiae Purpura Bleeding Pallor Fatigue Fever Joint/bone pains Limping -> not walking
What are the secondary effects of bone marrow infiltration in ALL?
Anemia
Thrombocytopenia
Leukopenia or neutropenia
Bone or joint pain (often legs, back, pelvis)
What are the secondary effects of extramedullary infiltration in ALL?
Hepatosplenomegaly Lymphadenopathy Stridor and orthopnea Cranial nerve palsies Retinal exudates Testicular enlargement
Typical CBC presentation for children with ALL
95% with 2 or more cytopenias
4% with a single cytopenia
1% normal CBC
Typical lab findings for children with ALL
Low Hb, platelets, WBC
Common medical treatment timeline for children with ALL
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
Outcomes for children with ALL
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
Side Effects of Corticosteroids
Bone pain
Muscle weakness
Avascular Necrosis
Side effects of vincristine
Peripheral neuropathy “toe-walking” “claw hands” Vocal cord paralysis ptosis
Top 3 pediatric cancers (>50% of combined cancers in kids)
Leukemia, CNS, Lymphoma
Leukemia typical presentation
3 year old with fussiness, mildly pale, occasional bruises (varying ages on inspection), complaining of leg pain/refuses to walk
Leukemia diff dx to consider - nonmalignant
Infections, rheumatologic cond, autoimmune cytopenias, aplastic anemia, leukemoid reaction and transient myloproliferative syndrome
Leukemia diff dx to consider - malignant
Neuroblastoma, rhabdomyosarcoma, retinoblastoma, non-Hodgkin’s lymphoma, MDS
Leukemia Diff Dx by history and PE - signs/symptoms
Fever,lymphadenopathy HSM; Petechiae, purpura, bleeding; Pallor, fatigue; Fever, joint/bone pains
Leukemia Diff Dx by history and PE - diff dx
EBV/CMV, stoarge diseases, lymphoma; ITP, HUS, meningococcemia; TEC, hemolytic anemia, aplastic anemia; JRA, Rheumatic fever, lupus, neuroblastoma
Issues secondary to marrow infiltration and decreased marrow production
anemia, thrombocytopenia, leukopenia or neutropenia, bone or joint pain
Down’s Syndrome and Leukemia
15-20x incidence, typically presenting 1-8 years of age
Leukemia bone pain
present in 30% of kids, may limp and progress to non walking
Issues secondary to extramedullary infiltration
Hepatosplenomegaly; Lymphadenopathy; Stridor and orthopnea; Cranial nerve palsies; Retinal exudates; Testicular enlargement
CBC at presentation of ALL
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
ALL Lab Findings
low hemoglobin, high WBC count, low platelet count
ALL Facts
Peak incidenct 4 years old; 25% of all childhood leukemias; associated with trisomy 21 (age >3yr), Fanconi’s anemia, and congenital immunodeficiency syndromes
Induction treatment
“puts you in remission” - 4 wks
consolidation
“treatment to spine” - 4-8 wks