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Peds semester 2 > Peds Oncology > Flashcards

Peds Oncology Flashcards

1
Q

Calculate an ANC

A

you need WBC, Polys, Bands

  1. Polys + Bands
  2. Multiply total by WBC
  3. Multiply this product by 10 = ANC

ANC > 1000 is normal

ANC < 1000 is neutropenic

https://depts.washington.edu/registry/Calculate.ANC.pdf

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2
Q

List features of concerning LAD

A
  • Persistent >4-8 weeks
  • Progressive
  • > 2 cm
  • Generalized
  • Non-tender
  • Firm, rubbery, rock-hard
  • Matted (several nodes connected together)
  • Fixed
  • Axilla, infra or supraclavicular or inquinal areas
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3
Q

What is the MC cancer in kids (and the MC blood cancer)?

Which cell lines are down initially?

What will you see on a peripheral blood smear?

A

ALL (Acute lymphoblastic leukemia)

►WBC (leukopenia)

►platelets (thrombcytopenia)

lymphoblasts seen on peripheral smear

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4
Q

How long is the Tx for ALL (in girls vs boys)?

A

Tx lasts 2 years for girls and 3 years for boys

(risk of testicular reoccurrence)

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5
Q

What might be some CC of someone not yet diagnosed, but who has ALL?

A

CC: fever (persistent or recurrent), infections, easy bruising, obvious petechial/purpuric rashes

additional Sx at presentation may include: bone pain, new onset limp or joint pain, easily fatigued

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6
Q

How long does it take a child with lymphoblasts in bone marrow to become symptomatic?

A

lag time from onset of lymphoblasts in bone marrow→ Sx/clinical presentation is less than 1 month (therefore, don’t expect weight loss as see in adult cancer presentation)

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7
Q

What PE findings are common with ALL?

A

PE: generalized LAD (including concerning areas: axiallary, supra/infraclavicular, inguinal), hepatosplenomegaly (lymphoblasts infiltrate lymph nodes, spleen and liver)

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8
Q

Calculate an Absolute Neutrophil Count (ANC)

what defines neutropenia?

what is one consequnce (as far as wound infection goes) in someone with neutropenia?

A

ANC = WBC (in thousands) x (%neutrophils + %bands)

*neutropenia= ANC <500 or <1000 and still falling

**pts with neutropenia will not produce pus if sustain wound infection as have too few WBCs

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9
Q

List a DDx for LAD in kids.

A
  1. localized or systemic infxn (bacterial or viral)
  2. abscess/ lymphadenitis (would have erythema surrounding swollen nodes)
  3. EBV
  4. HIV
  5. cyst
  6. benign or malignant tumor
  7. systemic illness (eg JIA)
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10
Q

With regards to LAD, what are some of the concerning PE findings (for potential of cancer) ?

A
  1. persistent LAD (>4-8 weeks) or progressive LAD
  2. size >2cm
  3. generalized, non-tender, firm, rubbery (abscess), or rock hard or fixed nodes
  4. several nodes that appear to be connected together (matted)
  5. LAD outside cervical/ mandibular region (axiallary, supra/infraclavicular, inguinal)
    1. “shotty” LAD (small, pea-sized in cervical area) is not overly concerning in peds
  6. hepatosplenomegaly
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11
Q

What work-up would you do in a child with concerning LAD?

A
  1. CBC, ESR (acute-rises in 1-2 days)
  2. CRP (if greater than a week since onset)
  3. EBV titers (in young kids titer is better than monospot)
  4. PPD (if cough, fever, night sweats, or possible exposure→r/o TB)
  5. LDH + uric acid (high levels indicate high cell turnover, which indicates malignancy)
  6. Ultrasound helps evaluate for a cyst
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12
Q

What would you NOT due to work-up a child with concerning LAD?

A

Do NOT biopsy a node in primary care. Refer to oncology.

  1. risk of spreading cancer in process of Bx
  2. Bx indicated with:
    1. persistent, progressive or unusual LAD
    2. abnormal CXR
    3. systemic illness
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13
Q

What exam should be done on all children (regardless of CC)?

A

ABDOMINAL exam

ANY abdominal mass in a child is a malignancy until proven otherwise

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14
Q

Describe Wilm’s tumor (nephroblastoma).

A

A kidney cancer that is the MC abdominal malignancy found in kids (2-5yo) with an abdominal mass

Sx: none or abdominal mass/swelling/pain, fever, blood in urine

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15
Q

Describe a pediatric neuroblastoma.

A

Neuroblastoma= undifferentiated sympathetic nervous tissue

Presents in various ways →MC is at the adrenal gland (causes an abdominal mass)…could also be paraspinal, cervical or posterior mediastinal

Metastases are common (bone pain, liver/lymph node involvement, subQ nodule)

Sx: prolonged, severe watery diarrhea or catecholamine-induced HTN

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16
Q

Describe key signs and symptoms associated with osteosarcoma, Ewing sarcoma, retinoblastoma and rhabdomyosarcoma

A

osteosarcoma- long bones, peak incidence in teens, “sunburst patten on x-ray

Ewing sarcoma- pelvis or shoulder, “onion peel” pattern on x-ray

retinoblastoma- median age at presenation is ~2yo, leukocoria (white instead of “red light reflex”)

rhabdomyosarcoma- mass, hard on palpation, can occur anywhere–> MC site is head/neck, bimodal peak in young kids (2-5yo and teens)

17
Q

Osteosarcoma and Ewing sarcoma are primary bone cancers.

What types of bone pain are especially concerning for these pathologies?

A

Concerning bone pain includes:

  • persistent or progressive,
  • occurring at night,
  • associated with swelling, mass, or decreased ROM
18
Q

Both rhabdomyosarcoma and retinoblastoma can affect the eye region.

Distinguish the pathology of the two.

A

Rhabdomyosarcoma = malignancy of skeletal muscle

Retinoblastoma is a malignancy of embryonic retinal cells

→white “red eye reflex” is sign of retinoblastoma

19
Q

Understand the late effects of cancer treatment.

A
  1. Growth can be affected→ radiation for ALL, CNS tumors, head/ neck CA, so watch growth curves
  2. Learning problems, precocious or delayed puberty, hypothyroidism→ d/t previous cranial radiation
  3. Chemotherapy→ pulmonary fibrosis, fertility issues
  4. Second malignancies→ underlying genetic disorder with tissues in the field of previous radiation
  5. AML→ from various chemotherapy agents
20
Q

What are some oncologic emergencies?

A
  1. tumor lysis→ releases large amounts of K+, phosphates and nucleic acids into circulation→renal damage
  2. very high WBCs (>50K)→ impede circulation
  3. neurologic symptoms→ spinal cord compression, increased intercranial pressure (spinal cord damage or brain stem herniation)
  4. immunocompromised→fever (≥ 101F) and/or neutropenia may mean SBI
    1. send to ED or directly to oncology clinic ASAP
    2. need full septic w/u, including bacterial and fungal cultures of chemotherapy port and empiric broad spectrum abx until cultures return

Peds semester 2 (6 decks)

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