Peds Flashcards
S&S of ALL
Anemia, infx, hemorrhage, Fever, Malaise
S&S of Ewings Sarcoma
Pain, swelling, mass
MC site Ewings Sarcoma
Femur
S&S of Retinoblastoma
Leukochoria “cat eye”
S&S of Neuroblastoma
Pain! lethargic, ill appearing child <2yrs w/ abdo mass
blue skin lesions
70% present with metastatic disease–>orbital, bone, liver
MC site neuroblastoma
Adrenal Medulla
S&S Wilms Tumour
Painless abdo swelling–>smooth, firm, one sided
S&S Rhabdomyosarcoma
Asymptomatic mass
Favourable (Embryonal)–>Orbit
Unfavourable (Alveolar)–>Bladder
S&S Glioma Astrocytoma
Headaches & decrease in coordination
S&S Medullablastoma
Morning headaches & vomiting
45% spread beyond posterior fossa
invasion of 4th ventricle stopping flow of CSF
Epi/Eti ALL
MC childhood cancer
2-10 yrs boys
Epi/Eti Ewings sarcoma
MC bone tumour in children
10-20yrs, males
Epi/Eti Retinoblastoma
MC intraocular tumour in children
6mo-4yrs
inheritable, sporadic
Epi/Eti Neuroblastoma
2nd most common solid tumour
<2yrs, males
Epi/Eti Wilm’s
3-4yrs
10-15% are associated with WAGR
Epi/Eti Rhabdo
Before 10yrs
Males
Genetically inherited disorders
Epi/Eti Glioblastomas
MC solid tumours in children
<3yrs
Epi/Eti Medullabastoma
2-12yrs; males
INFRATENTORIAL
Prognostic Indicators for ALL, Ewings, Retino, Neuroblastoma, Wilm’s,
Rhabdo, Glioma, Medulla
ALL & Rhabdo= <1yr or >10yr
Ewings, wilms & Medulla=extent of disease
Neuro & Glioma= Age & stage
Routes of spread ALL
immature lymphoblast replace bone marrow
sanctuary sites: CNS, testis, optic/retina nerve
Routes of spread Ewings Sarcoma
LN involvement=RARE
Lungs
Routes of spread Retinoblastoma
Brain through the optic nerve invasion
Routes of spread Neuroblastoma
LN involvement is common.
70% of patients have metastatic disease
Routes of spread Wilm’s Tumour
Lungs and liver
Routes of spread Rhabdo
Lung, bone marrow, bone
Routes of spread Glioma Astrocytoma
No lymphatic spread
Routes of spread Medullablastoma
Extends locally; grow and fill 4th ventricle or involves brain stem. can met to bone
high risk of CSF seeding
Pathology ALL (2 ways to classify)
- morphologic
- Immunologic–>main system
a) pre-b cells 80-85%
b) T Cell 12-15%
Pathology Ewings
Small blue round cells; diffuse pattern
if spindle cells are present it becomes osteosarcoma
Pathology Retinoblastoma
small blue cell tumour originating from neuroectoderm
tumours usually grow out of their blood supple and cause necrosis and hemorrhage
Pathology Neuroblastoma (3 types of tumours & some staging)
1) Glaglioneuroma (benign)
2) Ganglioneuroblastoma
3) Neuroblastoma (small blue cell-undifferentiated)
Stage IVS- children <1yr; stage I or II; often disappears and becomes ganglioneuroma
Pathology Rhabdo
Arises from mesenchymal cells–> immature cells that develop to form muscle
embryonal (60%)–>good prognosis
Botryoid (6%)–> good prognosis
Alveolar (21%)–> poor prognosis
Pleomorphic (1%) Rare
Pathology Glioma Astrocytoma
MC-Gliomas
main types:
1) astrocytoma–>GBM
2) Ependymoma
3) Oligodendrocytes
4) Mixed
Pathology Wilm’s
Contains renal tubular
Favorable and unfavorable
Pathology Medullablastoma
Arises from neuroectodermal cells and arises in posterior fossa. small blue round cells
Disease Management ALL
Chemo-main tx
Induction–>given immediately
Consolidation–>After remission
Maintenance–>Daily chemo orally
Length:
3yrs for boys (disease harbored in testis)
2yrs for girls and adults
Disease Management Retinoblastoma
Surgery–> enucleation
Chemo
Disease Management Ewings
Small tumours in bones such as clavicle or fibula may be cured with RT & Sx
lg lesions will get sx if not responding to chemo
limb sparing–>bone graft or amputation
Disease Management Neuroblastoma
Low risk–>resectable; good prognosis; post-op use of adj chemo or RT
intermediate risk–> intensive tx
High risk–> BMT
–>combine induction chemo, sx, autologous (self) stem cell & RT to primary
Disease Management Wilms
Sx then chemo
RT post-op to involved flank, used for:
- All stage I unfavourable
- Stage II unfavourable
- Stage III fav and unfav
RT NOT used for stage I&II favorable
Whole abdo is used when:
- peritoneal seeding
- rupture
Disease Management Rhabdo
sx primary
chemo post-op (VAC)
Disease Management Glioastrocytoma
Low & high grade–>sx
Chemo low–>can delay or avoid RT
Chemo high–>Dex, chemoRT post-op= standard
Disease Management medullablastoma
Sx:
- initially for diagnosis & debulking
- posterior occipital craniotomy
- sx not alone due to seeding
- placement of shunt
Chemo:
-if <3yrs chemo used to delay RT to let brain mature
RT:
- used post-op
- CSI typically done in young children who fail to respond to chemo or RT to post fossa only
- Posterior fossa boost–HIGH risk of recurrence
Dose ALL
TBI- 1200-200 BID 3days
CSI-helmet: 2400/150 Spine: 1500/150
Cranial/helmet: 1200/180-200
Dose Ewings
Typically 45Gy
Total dose 60Gy
Dose Glioma Astrocytoma
Low grade: 50-54Gy
High grade: 60Gy
Dose Medullablastoma
CSI: 3600/150-180 followed by a boost to posterior fossa 54-55
- TD 5/5 of bone marrow
- Tolerance of cornea, lens, and optic nerve
- OARs for wilms tumour
- 250
- 50; 500; 60
- remaining kidney, liver, growth plates, bowel
ALL tx borders
Cranial field:
inf: include cribriform plate and temporal fossa (level C2). include retina and optic nerve
spine field Prone: chin tuck Sup: junction inf border of cranial field Inf: below S2 lat: cover vertebrae bodies
ALL treatment technique
CNS prophylaxis
-high risk; T cell diagnosis
TBI: prep for BMT
prescribed at umbilics
TLDs–> head, neck, shoulder, Axilla (no build up), umbilics, head of femur, b/w knees (no build up)
Tx of CNS
-CSI
Testicular irradiation
Ewings sarcoma tx technique
spare uninvolved epiphysis’s if is a growth plate shaping fields to maintain LN drainage (1cm strip) to avoid lymphedema
Tx to femur
-2/3 pt develop shortening; 1/3 fractures
Retinoblastoma tx technique
EBRT used for bilateral or inoperable unilateral
treat entire retina to avoid recurrence in ant eye
brachy-iodine 125
Wilms tumour prescribed dose borders and tx technique
Flank
Most FH tumours respond to RT
Stage I+II–> no RT
Stage III–>1080
UFH
Stage I&II–>1080
Stage III–>1980
Whole abdo and lung
- 1050 <12mo
- 2100/4 stage III
Borders:
Sup; dome of diaphragm
med: cross midline PA nodes
4-6MV APPA
Medullablastoma Tx borders
CSI-cranial
Inf: include cribriform plate (high risk of recurrence) and temp fossa C2 (POST ORBIT NOT INCLUDED LIKE ALL)
Sup: Flash to cover cranium
CSI-spine
Sup: jxn of inf border of cranium
inf; below S2 (Thecal sac)
lat: entire vertebrae w/ 1cm margin
Posterior fossa–>boost 54-55Gy
*again not necessary to include retina and optic nerve as done in ALL pts
