Pediatric Oncology Flashcards
Risk factors
Largely unknown (ALL) Genetic abnormalities AIDS Ionizing radiation exposure Chemo and radiation
Leukemia
Most common cancer in children
Malignancy of WBCs
2-5 years
2 types - ALL, AML
Leukemia name
Based on cell type
Leukemia symptoms
Easy bruising
Pallor
Bone and/or joint pain
Lymphadenopathy
Leukemia dx
Bone marrow aspiration/biopsy
Lumbar puncture
Peripheral blood smear
Leukemia Prognosis
Based on…
WBC count Age Cytogenetics Immunology Response to initial treatment
Leukemia tx
Chemo - three phases
Radiation
SCT
Sanctuary sites
Where cancer can hang out dormant
CNS
Testicular involvement
Leukemia chemo phases
Induction
Consolidation
Delayed Intensification
Maintenance
Induction
Intense
Often admitted for induction
Pushes into remission
Brain tumors
2nd most common pediatric cancer
Astrocytoma
Medulloblastoma
Ependymoma
Peak incidence 5 years old
Leading cause of childhood cancer related death
Most common location of brain tumors
Posterior fossa
Cerebellum
4th ventricle
Tentorium
layer of connective tissue that defines cerebellum below cerebrum
Glioma/astrocytoma
Inoperable
Ependymoma
Surgery through the nose
We usually don’t see full resections
Brain tumor symptoms
Headache Double vision NV Irritability Sleep difficulties Changes in personality/behavior Impaired concentration Memory loss Problems with reasoning
Cerebellum location specific
Clumsiness
Difficulty with coordination
Medulloblastoma
Ventricle location specific
Increased head size before 2 years
Ependymoma
Brainstem location specific
Facial droop
Difficulty swallowing
Slurred speech
Glioma
Astrocytoma
Brain tumor dx
Imaging
Biopsy
Brain tumor prognosis
Overall 70%
Brainstem no good
Medulloblastoma easily operable
A/M varies
Brain tumor treatment
Chemo Radiation Surgery Steroids Anti-convulsants
Anti-convulsants
Cause major swelling and steroid-induced myopathy
Neuroblastoma
Most common solid, extracranial tumor in children
Children under 1 year
Comprises 15% all cancer related deaths
Primary tumor location Neuroblastoma
Nerve root
SC
Anywhere in the sympathetic nervous system
- Adrenal glands
- Sympathetic ganglia
Widely disseminated disease
Neuroblastoma symptoms
Reflect location of tumor
Lump in abdomen, chest, neck Dark circles around eyes Bone pain Swollen stomach Labored breathing in infants Painless, bluish lumps under skin Weakness, paralysis
Increased catecholamine release
Some may be asymptomatic
Blueberry spots
You’ll see them on the palms of the hands and soles of the feet
Diagnosis Neuroblastoma
MIBG scan
24-hour urine collection
MIBG scan
Dx neuroblastomas
Marker that binds to tumor and makes it light up
Neuroblastoma low risk tx
Observation vs surgery only
Neuroblastoma moderate risk tx
Surgery
Moderate intensity chemo
Neuroblastoma high risk tx
Chemo Surgery High dose chemo Hematopoietic Stem Cell Rescue Radiation Clinical trials
Sarcoma
Unclear etiology
Rapid bone growth
-Adolescent growth spurt
Occurs at an earlier age in girls
Sarcoma tumor location
Metaphyseal plate
Osteosarcoma
Primary malignant bone tumor
Most common bone cancer in children and adolescents
13-16 years of age
Primary tumor location Osteosarcoma
Long bones…
Distal femur
Proximal tibia
Proximal humerus
Less common sites…
Pelvis
Jaw
Fibula
Ribs
Ewing’s sarcoma
Second most common primary bone tumor
Peak incidence 10-15
Primary tumor location Ewing Sarcoma
Can occur in flat and long bones
Primary sites…
LE Pelvis Chest wall UE Spine Skull
Bone cancer symptoms
Localized pain…
Awakens at night
Increases with WB
Constant
Swelling
Palpable mass
Fracture
Bone cancer diagnosis
xray MRI CT scan Biopsy Bone marrow aspirate
Bone cancer biopsy
CT guided core needle biopsy
Open biopsy - taking out whole thing while we’re in there
Bone cancer prognosis
Based on…
Site and size of primary tumor
Presence of METs
Response to initial therapy
Age at dx
Bone cancer tx
Chemo - before and after sx
Radiation
Surgery
Neoadjuvant
Before surgery chemo in bone cancer
Adjuvant
After surgery chemo in bone cancer
Rotationplasty
Tumor resection
Spared neurovascular bundle
Use of ankle joint as knee joint with prosthesis
Expandable Prosthesis
For kiddos in FIRST growth spurt
Under high-powered magnet, they can expand the prosthesis
Allows for continued limb growth
Epiphysiodesis
Halting growth on the other side
For kiddos in their LATER growth spurt
Incidence of Childhood Cancer
Leukemia
Lymphoma
