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
Signs of Bone Tumors
``` Pain Tenderness Limp Soft tissue mass Night pain "Growing pains" History of minor trauma Pathologic fracture ```
26
Types of ALL
Precursor B cell (B-ALL) Burkitts (mature B-ALL) T cell (T ALL)
27
WHO classification of AML
Marrow with 20+% blasts, prior therapy, Down syndrome, MDS, cytogenetics
28
Predisposing Conditions for Leukemia
``` Li Fraumeni Ataxia Telangectasia Neurofibromatosis Bloom Syndrome Klinefelter's Ataxia telangectasia Wiskott aldrich syndrome Chronic immunosuppression AIDS ```
29
Leukemia Presentation
``` Bone pain Adenopathy Hepatosplenomegaly Thymic expansion CNS symptoms Testicular involvement ```
30
Bone Pain in Leukemia Due to
Expansion of marrow cavity | May stop walking or favor the painful site
31
CNS Symptoms in Leukemia
Headache Neck pain CN palsy Seizure
32
Testicular Involvement in Leukemia
Painless Enlarged Usually rock hard Confirm with biopsy
33
Hematologic Findings of Leukemia
``` WBC- high, normal, low Decreased neutrophil # Risk of tumor lysis syndrome Hyperleukocytosis Decreased platelets Decreased RBCs ```
34
Differential Diagnosis of Pancytopenia
``` Leukemia Aplastic anemia Metastatic solid tumor Myelodysplastic syndrome hemophagocytic lymphohistiocytosis Infection, post infectious Lupus Hypersplenism B12 or Folate deficiency ```
35
Differential Diagnosis of Heypatosplenomegaly and Pancytopenia
``` Leukemia (AML, ALL) Hepatitis associated aplastic anemia Metastatic solid tumor MDS HLH SLE ```
36
Differential Diagnosis of Acute Lymphocytosis
``` Infection ALL Thyrotoxicosis Neutropenias Addison's Disease ```
37
Differential Diagnosis of Lymphadenopathy
``` Infection Metastatic disease Leukemia Lymphoma Autoimmune disease ```
38
Diagnostics of Leukemia
``` CBC with diff Peripheral smear Bone marrow aspirate LP Flow cytometry Morphology Cytogenetics Sanctuary Sites Testicular exam ```
39
Treatment for Standard Risk ALL
``` 4 weeks- 3 drugs 4 week- oral with IT 8 week interim maintenance 8 week delayed intensifications 2nd interim maintenance Maintenance (2+ years) ```
40
Treatment for High Risk ALL and T ALL
``` 4 weeks- 4 drugs 8 weeks- IV consolidation 8 week interim maintenance 8 week delayed intensification 2nd interim maintenance Maintenance (2+ years) ```
41
Which type of ALL receives radiation regardless?
T ALL
42
Relapse Information for ALL
Site of relapse important Time to relapse important Age at initial diagnosis Genetic features
43
Presentation of AML
``` Fever Bone pain LAD HSM Extra medullary disease Chloromas Sepsis Hyperleukocytosis Anemia Thrombocytopenia Hemorrhage DIC ```
44
Risk Groups for AML
Based on cytogenetics | Down syndrome
45
Treatment of AML
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
Presentation of Hodgkin Lymphoma
Painless lymphadenopathy, mediastinal mass, and/or constitutional symptoms
47
B Symptoms in Hodgkin Lymphoma
Weight loss Drenching night sweats Unexplained fevers for 3+ days
48
Other Symptoms of Hodgkin's Lymphoma
``` Fatigue Anorexia Mild weight loss Pain following ETOH ingestion Pruritis ```
49
Lab Findings in Hodgkin's Lymphoma
Elevated inflammatory markers Anemia of chronic inflammation Possible immune dysregulation
50
Differential Diagnosis of Hodgkin's Lymphoma
``` Normal thymus INfection Lymphoproliferative disorder Progressive transformation of germinal centers NHL Germ cell tumor Soft tissue sarcoma Metastasis ```
51
Treatment for Hodgkin's Lymphoma
Multimodal- chemoradiation | Risk adapted
52
Who most often gets Non-Hodgkin's Lymphoma
White male children
53
Risk Factors for Non-Hodgkin's Lymphoma
EBV Immunodeficiency Immunosuppression Pesticides
54
Emergency Presentations of Non-Hodgkin's Lymphoma
``` 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
Presentation of Endemic Burkitt NHL
``` Jaw swelling Abdominal swelling Orbital swelling Paraspinal mass CNS/marrow involvement ```
56
Presentation of Sporadic Burkitt NHL
``` Rapidly expanding abdominal mass Spontaneous tumor lysis Non-specific GI symptoms CNS involvement Marrow infiltration ```
57
Presentation of Diffuse Large B-cell NHL
Extranodal involvement- bowel, mesentery, retroperitoneum
58
Presentation of Lymphoblastic NHL
``` Mediastinal mass Pleural/pericardial effusion Pain Dysphagia Dyspnea ```
59
Presentation of Antiplastic Cell NHL
Slowly progressive Systemic symptoms Organs & skin can be involved
60
Treatment of NHL
Depends on type All receive chemo Most DO NOT receive radiation
61
Prognosis of NHL
Survival rate high
62
What is the second most common solid neoplasm in childhood?
Neuroblastoma
63
Presentation of Neuroblastoma
``` 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
Diagnostics of Neuroblastoma
``` CT spine MRI spine Bon marrow biopsy Radiolabelled MIBG Catecholamine metabolites Tumor biopsy ```
65
Prognostic criteria of Neuroblastoma
``` Age >18 months Advanced stage disease Myc-N amplification Poorly or undifferentiated tumor histology Diploid DNA content ```
66
Associated Malformations & Genetic Predisposition in Wilms Tumor
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
Presentation of Wilms Tumor
``` Asymptomatic upper abdominal mass Abdominal pain Fever Anemia Hematuria Hypertension Family hx Congenital defects ```
68
Labs for Wilms Tumor
``` CBC UA BUN Cr Total bilirubin Alkaline phosphatase Albumin SGPT ```
69
Diagnostics of Wilms Tumor
Resection CT chest Abdominal ultrasound CT abdomen
70
Differential Diagnosis of Wilms Tumor
Clear cell sarcoma of the kidney Rhabdoid tumor Renal cell carcinoma Congenital Mesoblastic nephroma
71
Staging of Wilms Tumor
``` Stage 1: confined to kidney Stage 2: confined to renal fossa Stage 3: gross residual disease Stage 4: disseminated Stage 5: bilateral tumors ```
72
Prognostic Factors of Wilms Tumor
``` Stage Histology Gene expression profile Tumor size Age >2 is worse ```
73
Treatment of Wilms Tumor
Surgical resection Multiagent chemo Radiation for higher stages Higher stages get more intense therapy
74
Clinical Presentation of Retinoblastoma
``` Leukocoria Strabismus Nystagmus Buphthalos Glaucoma Periorbitalcellulitis Proptosis + LN Mets ```
75
Diagnostics of Retinoblastoma
``` Exam under anesthesia Ocular ultrasound MRI orbits & brain Bone scan, bone marrow & CSF for advanced disease Genetic counseling ```
76
Differential Diagnosis of Retinoblastoma
``` Congenital cataracts Coats' disease Persistent fetal vasculature Retinitis Medulloepithelioma Astrocytic hamartoma Choroidal osteoma ```
77
Staging and Treatment of Retinoblastoma
Multiple staging systems | Treatment individualized
78
Goals of Treatment of Retinoblastoma
Cure Eye salvage Vision preservation
79
Prognostic Factors of Retinoblastoma
``` 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
Types of Childhood CNS Tumors
``` Ependymoma High grade glioma Germ cell tumor Medulloblastoma Pilocytic astrocytoma ```
81
Craniopharyngioma
Epithelial tumor Arises from Rathke cleft Cystic appearance with solid component Treatment: surgery & radiation
82
Presentation of Craniopharyngioma
``` Hypothyroid Obesity DI Amblyopia Temporal hemianopsia Blindness Optic atrophy Headache N/V Papilledema ```
83
Presentation of Medulloblastoma
Headache N/V Papilledema
84
Common Presentation of Ependymoma
``` Headache Ataxia Nystagmus Seizure Increased head circumference ```
85
What tumor consists of 50% of pediatric CNS tumors?
Pilocytic Astrocytoma
86
Signs/Symptoms of Spinal Cord Tumors
Chronic back or neck pain Scoliosis Progressive weakness