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Pediatrics > Pediatric Oncology > Flashcards

Pediatric Oncology Flashcards

1
Q

Common Childhood Cancers (0-14)

A 
Leukemia
CNS
Lymphoma
Neuroblastoma
Soft tissue sarcomas
Kidney (Wilms)
Bone tumors
Germ-cell tumors
Retinoblastoma
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2
Q

Common Childhood Cancers (15-19)

A 
Lymphoma
Germ cell
Leukemia
CNS
Soft tissue sarcoma
Bone
Thyroid carcinoma
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3
Q

Which syndromes are associated with increased risk of cancer in children?

A

Down syndrome
Beckwith-Wiedeman
Li Fraumeni syndrome

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4
Q

Brain Tumors Associated with Genetic Syndromes

A 
Neurofibromatosis
Tuberous Sclerosis
Turcot Syndrome
Von Hipple Lindau
Gorlin
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5
Q

Kidney Tumors Associated with Genetic Syndromes

A 
Congenital aniridia
Hemihypertrophy
GU malformations
WAGR
Denys-Drash
Frasier
Beckwith-Wiedemann
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6
Q

Bone Tumors Associated with Genetic Syndromes

A 
Hereditary retinoblastoma
Paget's disease
Rothmund-Thompson
Li-Fraumeni syndrome
Poikiloderma, small stature, skeletal dysplasias
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7
Q

Liver Tumors Associated with Genetic Syndromes

A 
Polyposis
Gardner
Beckwith-Wiedeman
Hemi-hypertrophy
Tyrosinemia
Glucogen storage disease
alpha-1 anti-trypsin
Hemochromotosis
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8
Q

Ionizing Radiations can Cause

A

Leukemia

Brain tumors

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9
Q

Radiation Therapy can Cause

A

Bone tumors

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10
Q

Radium (high dose) can Cause

A

Bone tumors

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11
Q

Prior Chemotherapy can Cause

A

Bone tumors

Leukemia

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12
Q

Immunosuppression can Cause

A

Lymphoma

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13
Q

EBV Infection can Cause

A

Lymphoma (Burkitt’s)

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14
Q

Uncommon Symptoms for Possible CA and Possible CA

A

Recurrent fever & bone pain- leukemia
Morning headache with vomiting- CNS tumor
Neck mass not responding to antibiotics- lymphoma
chronic bone pain, swelling, limp- bone tumor
Progressive abdominal distension- abdominal tumor
Bleeding, bruising, pallor, fatigue-leukemia
Combined cytopenias-leukemia, marrow failure

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15
Q

Presenting Symptoms of Leukemia

A 
Bone pain
Anemia
Fatigue
Fevers
Infection
Petechiae
Bleeding
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16
Q

Symptoms of Brain Tumors for a Child

A

Morning headaches
Vomiting
Decreased academics
Personality changes

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17
Q

Symptoms of brain Tumors for an Infant

A 
Large head
Bulging fontenelle
Anorexia
FTT
Loss of milestones
Irritable
Shrill cry
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18
Q

Late Findings of Increased ICP

A

Cushings triad: hypertension, bradycardia, wide pulse pressure
Cheyne-Stokes Respirations

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19
Q

Management of Increased ICP

A 
Oxygenation
Steroids if edema
No prolonged hyperventilation
EVD: drain into lateral ventricle
Surgical decompression
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20
Q

Signs of Lymphomas

A 
Painless enlarged lymph nodes
Abdominal pain or mass
Compromise of vital structure
Fever
Night sweats
Weight loss
Fatigue
Pruritus
Pain with ETOH ingestion
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21
Q

What Mediastinal Masses are Medical Emergencies?

A

SVC

Superior Mediastinal syndromes

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22
Q

Mediastinal Mass

A

Depends on location
Fatal respiratory failure
Airway compression with sedation
Difficult to intubate with sedation

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23
Q

Emergency Management of a Mediastinal Mass

A

Steroids

Radiation

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24
Q

Signs of Abdominal Tumors

A 
Distension
Palpable mass
Nausea
Vomiting
Diarrhea
Constipation
Weight loss
Fever
Obstruction
pain
Jaundice
Hematuria
Renal failure
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25
Q

Signs of Bone Tumors

A 
Pain
Tenderness
Limp
Soft tissue mass
Night pain
"Growing pains"
History of minor trauma
Pathologic fracture
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26
Q

Types of ALL

A

Precursor B cell (B-ALL)
Burkitts (mature B-ALL)
T cell (T ALL)

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27
Q

WHO classification of AML

A

Marrow with 20+% blasts, prior therapy, Down syndrome, MDS, cytogenetics

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28
Q

Predisposing Conditions for Leukemia

A 
Li Fraumeni
Ataxia
Telangectasia
Neurofibromatosis
Bloom Syndrome
Klinefelter's
Ataxia telangectasia
Wiskott aldrich syndrome
Chronic immunosuppression
AIDS
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29
Q

Leukemia Presentation

A 
Bone pain
Adenopathy
Hepatosplenomegaly
Thymic expansion
CNS symptoms
Testicular involvement
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30
Q

Bone Pain in Leukemia Due to

A

Expansion of marrow cavity

May stop walking or favor the painful site

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31
Q

CNS Symptoms in Leukemia

A

Headache
Neck pain
CN palsy
Seizure

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32
Q

Testicular Involvement in Leukemia

A

Painless
Enlarged
Usually rock hard
Confirm with biopsy

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33
Q

Hematologic Findings of Leukemia

A 
WBC- high, normal, low
Decreased neutrophil #
Risk of tumor lysis syndrome
Hyperleukocytosis
Decreased platelets
Decreased RBCs
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34
Q

Differential Diagnosis of Pancytopenia

A 
Leukemia
Aplastic anemia
Metastatic solid tumor
Myelodysplastic syndrome
hemophagocytic lymphohistiocytosis
Infection, post infectious
Lupus
Hypersplenism
B12 or Folate deficiency
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35
Q

Differential Diagnosis of Heypatosplenomegaly and Pancytopenia

A 
Leukemia (AML, ALL)
Hepatitis associated aplastic anemia
Metastatic solid tumor
MDS
HLH
SLE
36
Q

Differential Diagnosis of Acute Lymphocytosis

A 
Infection
ALL
Thyrotoxicosis
Neutropenias
Addison's Disease
37
Q

Differential Diagnosis of Lymphadenopathy

A 
Infection
Metastatic disease
Leukemia
Lymphoma
Autoimmune disease
38
Q

Diagnostics of Leukemia

A 
CBC with diff
Peripheral smear
Bone marrow aspirate
LP
Flow cytometry
Morphology
Cytogenetics
Sanctuary Sites
Testicular exam
39
Q

Treatment for Standard Risk ALL

A 
4 weeks- 3 drugs
4 week- oral with IT
8 week  interim maintenance
8 week delayed intensifications
2nd interim maintenance
Maintenance (2+ years)
40
Q

Treatment for High Risk ALL and T ALL

A 
4 weeks- 4 drugs
8 weeks- IV consolidation
8 week interim maintenance
8 week delayed intensification
2nd interim maintenance
Maintenance (2+ years)
41
Q

Which type of ALL receives radiation regardless?

A

T ALL

42
Q

Relapse Information for ALL

A

Site of relapse important
Time to relapse important
Age at initial diagnosis
Genetic features

43
Q

Presentation of AML

A 
Fever
Bone pain
LAD
HSM
Extra medullary disease
Chloromas
Sepsis
Hyperleukocytosis
Anemia
Thrombocytopenia
Hemorrhage
DIC
44
Q

Risk Groups for AML

A

Based on cytogenetics

Down syndrome

45
Q

Treatment of AML

A

Remission induction- 2 courses intense chemo
Post remission consolidation- transplant high risk; 2 courses intense chemo
CNS prophylaxis- weekly IT chemo until cleared
No maintenance
No irradiation

46
Q

Presentation of Hodgkin Lymphoma

A

Painless lymphadenopathy, mediastinal mass, and/or constitutional symptoms

47
Q

B Symptoms in Hodgkin Lymphoma

A

Weight loss
Drenching night sweats
Unexplained fevers for 3+ days

48
Q

Other Symptoms of Hodgkin’s Lymphoma

A 
Fatigue
Anorexia
Mild weight loss
Pain following ETOH ingestion
Pruritis
49
Q

Lab Findings in Hodgkin’s Lymphoma

A

Elevated inflammatory markers
Anemia of chronic inflammation
Possible immune dysregulation

50
Q

Differential Diagnosis of Hodgkin’s Lymphoma

A 
Normal thymus
INfection
Lymphoproliferative disorder
Progressive transformation of germinal centers
NHL
Germ cell tumor
Soft tissue sarcoma
Metastasis
51
Q

Treatment for Hodgkin’s Lymphoma

A

Multimodal- chemoradiation

Risk adapted

52
Q

Who most often gets Non-Hodgkin’s Lymphoma

A

White male children

53
Q

Risk Factors for Non-Hodgkin’s Lymphoma

A

EBV
Immunodeficiency
Immunosuppression
Pesticides

54
Q

Emergency Presentations of Non-Hodgkin’s Lymphoma

A 
Compression of airway
Pulmonary effusions
SVC syndrome
Tamponade
Arrhythmia
Paraspinal/epidural mass
Electrolyte abnormalities
Organ failure
GI obstruction
Intussusception
Bleeding
Perforation
Jaundice
Pancreatitis
Cytopenias
55
Q

Presentation of Endemic Burkitt NHL

A 
Jaw swelling
Abdominal swelling
Orbital swelling
Paraspinal mass
CNS/marrow involvement
56
Q

Presentation of Sporadic Burkitt NHL

A 
Rapidly expanding abdominal mass
Spontaneous tumor lysis
Non-specific GI symptoms
CNS involvement
Marrow infiltration
57
Q

Presentation of Diffuse Large B-cell NHL

A

Extranodal involvement- bowel, mesentery, retroperitoneum

58
Q

Presentation of Lymphoblastic NHL

A 
Mediastinal mass
Pleural/pericardial effusion
Pain
Dysphagia
Dyspnea
59
Q

Presentation of Antiplastic Cell NHL

A

Slowly progressive
Systemic symptoms
Organs & skin can be involved

60
Q

Treatment of NHL

A

Depends on type
All receive chemo
Most DO NOT receive radiation

61
Q

Prognosis of NHL

A

Survival rate high

62
Q

What is the second most common solid neoplasm in childhood?

A

Neuroblastoma

63
Q

Presentation of Neuroblastoma

A 
Coincidental finding
Neck mass
GU symptoms
Neurologic abnormalities
Paraneoplastic syndromes
Malaise
Irritable
Weight loss
Anorexia
Pain
Abdominal distension
Proptosis
Raccoon eyes
Fever
Respiratory distress
64
Q

Diagnostics of Neuroblastoma

A 
CT spine
MRI spine
Bon marrow biopsy
Radiolabelled MIBG
Catecholamine metabolites
Tumor biopsy
65
Q

Prognostic criteria of Neuroblastoma

A 
Age >18 months
Advanced stage disease
Myc-N amplification
Poorly or undifferentiated tumor histology
Diploid DNA content
66
Q

Associated Malformations & Genetic Predisposition in Wilms Tumor

A

Aniridia
Hemi-hypertrophy
GU malformation
Malformation of any type
Genetic predisposition: WAGR, Beckwith Wiederman, Denys-Drash Syndrome,
Perlman syndrome, Sotos syndrome, Simpson-Golabi-Behmel

67
Q

Presentation of Wilms Tumor

A 
Asymptomatic upper abdominal mass
Abdominal pain
Fever
Anemia
Hematuria
Hypertension
Family hx
Congenital defects
68
Q

Labs for Wilms Tumor

A 
CBC
UA
BUN
Cr
Total bilirubin
Alkaline phosphatase
Albumin
SGPT
69
Q

Diagnostics of Wilms Tumor

A

Resection
CT chest
Abdominal ultrasound
CT abdomen

70
Q

Differential Diagnosis of Wilms Tumor

A

Clear cell sarcoma of the kidney
Rhabdoid tumor
Renal cell carcinoma
Congenital Mesoblastic nephroma

71
Q

Staging of Wilms Tumor

A 
Stage 1: confined to kidney
Stage 2: confined to renal fossa
Stage 3: gross residual disease
Stage 4: disseminated
Stage 5: bilateral tumors
72
Q

Prognostic Factors of Wilms Tumor

A 
Stage
Histology
Gene expression profile
Tumor size
Age >2 is worse
73
Q

Treatment of Wilms Tumor

A

Surgical resection
Multiagent chemo
Radiation for higher stages
Higher stages get more intense therapy

74
Q

Clinical Presentation of Retinoblastoma

A 
Leukocoria
Strabismus
Nystagmus
Buphthalos
Glaucoma
Periorbitalcellulitis
Proptosis + LN
Mets
75
Q

Diagnostics of Retinoblastoma

A 
Exam under anesthesia
Ocular ultrasound
MRI orbits & brain
Bone scan, bone marrow & CSF for advanced disease
Genetic counseling
76
Q

Differential Diagnosis of Retinoblastoma

A 
Congenital cataracts
Coats' disease
Persistent fetal vasculature
Retinitis
Medulloepithelioma
Astrocytic hamartoma
Choroidal osteoma
77
Q

Staging and Treatment of Retinoblastoma

A

Multiple staging systems

Treatment individualized

78
Q

Goals of Treatment of Retinoblastoma

A

Cure
Eye salvage
Vision preservation

79
Q

Prognostic Factors of Retinoblastoma

A 
High risk histology
Massive choroidal replacement
Ciliary body or iris involvement
Optic nerve extension
Extra CNS disease
CNS disease- dismal prognosis
No CNS disease- survival good
80
Q

Types of Childhood CNS Tumors

A 
Ependymoma
High grade glioma
Germ cell tumor
Medulloblastoma
Pilocytic astrocytoma
81
Q

Craniopharyngioma

A

Epithelial tumor
Arises from Rathke cleft
Cystic appearance with solid component
Treatment: surgery & radiation

82
Q

Presentation of Craniopharyngioma

A 
Hypothyroid
Obesity
DI
Amblyopia
Temporal hemianopsia
Blindness
Optic atrophy
Headache
N/V
Papilledema
83
Q

Presentation of Medulloblastoma

A

Headache
N/V
Papilledema

84
Q

Common Presentation of Ependymoma

A 
Headache
Ataxia
Nystagmus
Seizure
Increased head circumference
85
Q

What tumor consists of 50% of pediatric CNS tumors?

A

Pilocytic Astrocytoma

86
Q

Signs/Symptoms of Spinal Cord Tumors

A

Chronic back or neck pain
Scoliosis
Progressive weakness

Pediatrics (23 decks)

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