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Peds 1 > Peds Oncology > Flashcards

Peds Oncology Flashcards

1
Q

What is the most common childhood cancer ages 0-14?

age 15-19?

A

leukemia (0-14)

Lymphoma (15-19)

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2
Q

Uncommon sx that might suggest cancer

A
  • recurrent fever and bone pain(leukemia)
  • mmorning headache with vomiting(cns tumor)
  • neck mass not responding to abx(lymphoma(
  • chronic bone pain, swelling, limp(bone tumor)
  • progressive abdominal distension(abd tumor)
  • bleeding, bruising, pallor, fatigue(leukemia)
  • combined cytopenias (leukemia)
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3
Q

Brain tumors

  • sx caused by what
  • sx
  • what is normal ICP?
A

Sx caused from increased pressure and location

Sx

  • HA
  • Vomiting
  • Decreased academics
  • personiality changes
  • large head, bulging fontanelle
  • anorexia
  • vision changes
  • seizure

Normal ICP is 10-18 mmHg

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4
Q

Lymphoma

  • localized sx
  • systemic sx
A

localized

  • painless enlarged lymph nodes
  • abd pain or mass
  • emergent: compromise of vital structure

Systemic

  • fevers, night sweats, weight loss, fatigue
  • pain with alcohol consumption
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5
Q

Superior vena cava syndrome and superior mediastinal syndrome are medical emergencies, true or false?

A

True

-emergency management may include steroids or radiation

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6
Q

Abdominal Tumor

sx

A

sx

  • distension, palpable mass
  • nausea, vomiting, diarrhea, constipation, weight loss, fever
  • obstruction, pain, jaundice, blood in urine
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7
Q

Bone tumor

sx

A
  • pain/tenderness/limp
  • soft tissue mass
  • night pain
  • growing pain
  • history or minor trauma
  • pathologic fracture
  • pain often present for 2-3 months
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8
Q

Leukemia
ALL types
AML type of dx (clinical/molecular)

A

ALL types

  • precursor B cell (80-85% of ALLs)
  • Burkitts
  • T cell

AML is a clinical AND molecular dx

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9
Q

Cancer Predisposition syndromes

A

Li Farumeni
Ataxia Telangectasia
Neurofibromatosis Type 1
Bloom Syndrome

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10
Q

Down Syndrome pts are 10-20x more likely to develop what type of cancer?

A

leukemia

-and they respond to chemo differently because they have different immune systems

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11
Q

AL Leukemia

  • presentation
  • heme findings
  • dx
A

Presentation-

  • Bone pain (35%)
  • adenopathy
  • hepatosplenomegaly
  • thymic expansion
  • CNS sx (HA, neck pain, CN palsy, seizures)
  • Testicular Involvement

Heme findings-

  • WBC can be high, normal, or low
  • decreased neutrophil number and function
  • hyperleukocytosis (WBC greater than 250-500K)
  • decreased platelets
  • decreased RBCs

Dx

  • CBC with diff, peripheral smear
  • bone marrow aspirate, LP
  • Flow cytometry, morphology, and cytogenetics
  • sanctuary sites (CNs and Testes): LP, testicular exam
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12
Q

Leukemia
Tx
What has a worse prognosis, aLL or AML?

A

Tx

  • 4 week 3 drug induction
  • 4 week oral consolidation with IT
  • 8 week Int maint
  • 8 week delayed intensification
  • 2nd int maint
  • maintenance (2yrs +)
  • this is for standard risk ALL

-CNS 3 disease and T ALL typically receives cranial irradiation

AML has a worse prognosis than ALL. AML 5yr survival is 50% compared to more than 90% in ALL

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13
Q

AML
presentation
smear findings
treatment

A

Presentation

  • fever
  • bone pain
  • LAD
  • hepatosplenomegaly
  • gingival hypertrophy
  • sepsis
  • anemia
  • thrombocytopenia
  • hemorrhage
  • DIC

Smear findings
-Auer Rod

Treatment

  • remission induction (two course intense chemo, very high risk of invasive infection)
  • post remission consolidation
  • CNS prophylaxis (lower rate of CNS relapse than ALL)
  • maintenance
  • no irradiation even with CNS disease
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14
Q 
Hodgkin Lymphoma
presentation
lab findings
Dx
Tx
A 
Presentation
-painless lymphadenopathy
-mediastinal mass
-constitutional sx
-B symptoms (weight loss, drenching night sweats, unexplained fevers for 3 consecutive days)
fatigue
-anorexia
-mild weight loss
-pain following alcohol ingestion

Lab findings
-elevated CRP, ESP, ferritin, copper, anemia of chronic inflammation

Dx

  • lymph node bx
  • Reed Sternberg cells**
  • CXR/CT/MRI/PET

Tx
-chemo and radiation

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15
Q 
Non-hodgkin lymphoma
common in who
presentation
Tx
Prognosis
A

Common in
-young while male children (less than 10)

Presentation
-Similar to HL
-different types have different presetation (ex. endemic burkitt has jaw swelling, abd or orbital swelling, paraspinal mass, CNS involvement...think Africa)
-painless lymphadenopathy
-mediastinal mass
-constitutional sx
-B symptoms (weight loss, drenching night sweats, unexplained fevers for 3 consecutive days)
fatigue
-anorexia
-mild weight loss
-pain following alcohol ingestion

Tx

  • depends on type and staging
  • all get chemo
  • most receive CNS ppx

Prognosis
-overall survival is high (burkitt is 90%)

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16
Q

Neuroblastoma

presentation

A

Presentation

  • Periorbital echymosis (think of the picture of the 2 year old with purple shiners on both eyes)
  • neck mass
  • GU sx
  • malaise, irritable, weight loss, anorexia
  • il defined pain
  • abd distension
  • fever
  • raccoon eyes

Dx

  • CT/MRI (spine)
  • bilateral bone marrow bx
  • radiolabelled MIBG
  • Tumor bx
17
Q

What is the most common renal tumor of childhood?

A

Wilms Tumor

18
Q 
Wilms tumor
Presentation
Dx
Staging
Tx
A

Presetation

  • usually an asymptomatic upper abd mass
  • abd pain
  • fever
  • anemia
  • hematuria
  • HTN
  • Hx of FMx

Dx

  • resection and bx
  • CT of chest/abdomen
  • Abd ultrasound

Staging

  1. confinded to kidney
  2. confined to renal fossa
  3. gross residual disease: unresectable primary, lymph node mets, positive, surgical margins, tumor spill
  4. disseminated
  5. bilateral tumors

Tx

  • surgical resection
  • chemo
  • radiation for higher stages
19
Q

Retinoblastoma
Presentation
Dx
Tx

A

Presentation

  • intraocular disease (strabismus, leukocoria=white reflex)
  • advanced intraocular disease (glaucoma)
  • extraocular disease(metastases)

Dx

  • exam under anestesia
  • ocular ultrasound
  • MRI of orbits and brain
  • genetic counseling-ALL pts

Tx

  • tx determined by staging, grouping, and laterality of disease
  • goals: cure, then eye salvage, then vision salvage
20
Q

Craniopharyngioma

  • what
  • presentation
  • 5 year survival
  • tx
A

What-

  • arises from the Rathke cleft
  • can occur anywhere along the course of the duct- pharynx to sella turcica and third ventricle

Presentation-
-interference with pituitary function (hypothyroid, obesity, diabetes insipidus)
-Interfere with visual function (amblyopia, blindness)
-mass effect (HA, n/v)
5 year survival: 80%

Tx
-surgery and radiation

21
Q

What is the most common malignant pediatric brain tumor?

A

Medulloblastoma

-papilledema is MC finding

22
Q

Ependymoma

  • glial tumors arise from what cells
  • common presentation
A

Glial tumors arise from ependymal cells

Common Presentation

  • increased ICP
  • HA, ataxia, nystagmus, sz
23
Q

50% of pediatric CNS tumors are…

A

Pilocytic Astrocytoma

24
Q

Spinal cord tumors
types
signs and sx
dx

A

Types: astrocytomas, ependymomas, neurofibromas, bone tumors

Signs and sx

  • chronic back or neck pain MC*
  • scoliosis
  • progressive weakness

Dx

  • PE for strength, sensation, reflexes)
  • MRI
25
Q

About what percent of U.S. children with cancer will be cured?

A

~80%

Peds 1 (12 decks)

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