Primary Care CA survivors

Question 1

Pediatric survivors of which 2 types of CA are at highest risk for late term effects?

Answer 1

Bone tumors: these pts commonly experience disfigurement and functional limitations caused by amputations.

CNS tumors: most severely affected if received radiation, chemo, and surgery. Potential difficulties include cognitive impairment, short stature, hearing loss, problems with balance and coordination, hypothyroidism, thyroid nodules, kidney damage and secondary cancers.

Hodgkins lymphoma: may experience lung damage, abnormal skeletal growth and maturation, infertility, hypothyroidism.

Question 2

Growth complications in pediatric survivors

Answer 2

spinal radiation inhibits vertebral body growth

Asymmetric exposure of the spin may result in scoliosis

Chemotherapy alone may result in an attenuation of linear growth (this is usually temporary as a period of catch up occurs when the drugs are discontinued.)

Question 3

Endocrine Complications of pediatric survivors

Answer 3

prepubertal children given cranial radiation may experience early puberty 2ndry to premature activation of the Hypothalmic-pituitary-gonadal axis. This also results in premature closure of the epiphyses which translates to decreased growth and height.

Those receiving brain/neck radiation may have thyroid dysfunction, will have normal thyroxine levels with an abnormal TSH. (elevated TSH may predispose them to thyroid nodules and carcinomas)

gonadal radiation: azospermia, low testosterone, and delayed sexual development.

ovarian radiation: failure to undergo menarche, increased FSH and LH levels, low estrogen.

Question 4

Renal Complications of the Pediatric survivor

Answer 4

most long term renal complications stem from chemotherapy:

• cisplatin may cause abnormal GFR
• cyclophosphamide can cause hemorrhagic cystitis
• ifosfamide can cause fanconi syndrome (proteinuria, glycosuria, phosphaturia with hypophasphatemia) which may result in rickets.

Question 5

Neuropsychological complications of the pediatric survivor

Answer 5

pts who recieved cranial radiation for ALL or brain tumors are at highest risk for effects related to visual processing speed, visual motor integration, sequencing ability and short term memory.

Question 6

Psychosocial complications of the pediatric survivor

Answer 6

absence from school, frequent apts and hospitilzation lead to social isolation.

Question 7

Surveillance after breast CA & prostate CA, colorectal CA

Answer 7

monthly self breast exams, clinical breast exam q6mo for 5 years and then annually, mammography annually

Prostate:
-clinical evaluation, PSA q6mo for 5 years and then annually, digital rectal exam anually

Colorectal:
-CEA, clinical exam every 3 mo for 2 years, then every 6-12mo for 5 years, colonoscopy after one year and then at 3 years and 5 yrs.