Oncology

Question 1

What is the most common type of cancer of childhood (< 15 years old)?

Answer 1

leukemia

Question 2

What is the single most common childhood malignancy?

Answer 2

• Acute Lymphoblastic Leukemia (ALL)

Question 3

What are some risk factors for Acute Lymphoblastic Leukemia?

Answer 3

• prenatal radiation exposure
• postnatal exposure to high doses of radiation
• down syndrome
• ataxia telangiectasia
• bloom syndrome
• fanconi anemia
• neurofibromatosis

Question 4

What are the signs and symptoms of ALL?

Answer 4

4 P’s

• pallor
• pyrexia
• purpura/petichiae - due to thrombocytopenia
• pain - bone pain w/ refusal to bear weight
• lymphadenopathy, fatigue, hepatosplenomegaly, anorexia

“limping 2 yo with pallor”

Question 5

What are the typical lab findings seen in ALL?

Answer 5

• 90% will have abnormal CBC - normocytic normochromic anemia and reticulocytopenia, either very low or very high WBCs, lymphoblasts on smear, severe neutropenia, thrombocytopenia
• elevated uric acid → renal dysfunction w/ hyperuricemia
• elevated LDH
• electrolyte abnormalities
• definitive diagnosis = bone marrow biopsy

Question 6

What is the most predictive factor for achieving a 2nd remission of ALL?

Answer 6

the length of time the first remission lasted

Question 7

What are side effects of ALL therapy?

Answer 7

• early and late CNS toxicity in patients receiving intrathecal and radiation therapy
• seizures, cerebral atrophy, necrotizing encephalopathy, microangiopathy
• cranial radiation → neruodevelopmental and neuroendocrine abnormalities (growth hormone deficiency)
• spinal radiation → growth restriction
• anthracyclines → cardiomyopathy
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