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CAMRT Exam > Peds > Flashcards

Peds Flashcards

1
Q

S&S of ALL

A

Anemia, infx, hemorrhage, Fever, Malaise

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2
Q

S&S of Ewings Sarcoma

A

Pain, swelling, mass

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3
Q

MC site Ewings Sarcoma

A

Femur

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4
Q

S&S of Retinoblastoma

A

Leukochoria “cat eye”

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5
Q

S&S of Neuroblastoma

A

Pain! lethargic, ill appearing child <2yrs w/ abdo mass
blue skin lesions
70% present with metastatic disease–>orbital, bone, liver

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6
Q

MC site neuroblastoma

A

Adrenal Medulla

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7
Q

S&S Wilms Tumour

A

Painless abdo swelling–>smooth, firm, one sided

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8
Q

S&S Rhabdomyosarcoma

A

Asymptomatic mass
Favourable (Embryonal)–>Orbit
Unfavourable (Alveolar)–>Bladder

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9
Q

S&S Glioma Astrocytoma

A

Headaches & decrease in coordination

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10
Q

S&S Medullablastoma

A

Morning headaches & vomiting
45% spread beyond posterior fossa
invasion of 4th ventricle stopping flow of CSF

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11
Q

Epi/Eti ALL

A

MC childhood cancer

2-10 yrs boys

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12
Q

Epi/Eti Ewings sarcoma

A

MC bone tumour in children

10-20yrs, males

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13
Q

Epi/Eti Retinoblastoma

A

MC intraocular tumour in children
6mo-4yrs
inheritable, sporadic

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14
Q

Epi/Eti Neuroblastoma

A

2nd most common solid tumour

<2yrs, males

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15
Q

Epi/Eti Wilm’s

A

3-4yrs

10-15% are associated with WAGR

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16
Q

Epi/Eti Rhabdo

A

Before 10yrs
Males
Genetically inherited disorders

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17
Q

Epi/Eti Glioblastomas

A

MC solid tumours in children

<3yrs

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18
Q

Epi/Eti Medullabastoma

A

2-12yrs; males

INFRATENTORIAL

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19
Q

Prognostic Indicators for ALL, Ewings, Retino, Neuroblastoma, Wilm’s,
Rhabdo, Glioma, Medulla

A

ALL & Rhabdo= <1yr or >10yr
Ewings, wilms & Medulla=extent of disease
Neuro & Glioma= Age & stage

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20
Q

Routes of spread ALL

A

immature lymphoblast replace bone marrow

sanctuary sites: CNS, testis, optic/retina nerve

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21
Q

Routes of spread Ewings Sarcoma

A

LN involvement=RARE

Lungs

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22
Q

Routes of spread Retinoblastoma

A

Brain through the optic nerve invasion

23
Q

Routes of spread Neuroblastoma

A

LN involvement is common.

70% of patients have metastatic disease

24
Q

Routes of spread Wilm’s Tumour

A

Lungs and liver

25
Q

Routes of spread Rhabdo

A

Lung, bone marrow, bone

26
Q

Routes of spread Glioma Astrocytoma

A

No lymphatic spread

27
Q

Routes of spread Medullablastoma

A

Extends locally; grow and fill 4th ventricle or involves brain stem. can met to bone
high risk of CSF seeding

28
Q

Pathology ALL (2 ways to classify)

A
  1. morphologic
  2. Immunologic–>main system
    a) pre-b cells 80-85%
    b) T Cell 12-15%
29
Q

Pathology Ewings

A

Small blue round cells; diffuse pattern

if spindle cells are present it becomes osteosarcoma

30
Q

Pathology Retinoblastoma

A

small blue cell tumour originating from neuroectoderm

tumours usually grow out of their blood supple and cause necrosis and hemorrhage

31
Q

Pathology Neuroblastoma (3 types of tumours & some staging)

A

1) Glaglioneuroma (benign)
2) Ganglioneuroblastoma
3) Neuroblastoma (small blue cell-undifferentiated)

Stage IVS- children <1yr; stage I or II; often disappears and becomes ganglioneuroma

32
Q

Pathology Rhabdo

A

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

33
Q

Pathology Glioma Astrocytoma

A

MC-Gliomas

main types:

1) astrocytoma–>GBM
2) Ependymoma
3) Oligodendrocytes
4) Mixed

34
Q

Pathology Wilm’s

A

Contains renal tubular

Favorable and unfavorable

35
Q

Pathology Medullablastoma

A

Arises from neuroectodermal cells and arises in posterior fossa. small blue round cells

36
Q

Disease Management ALL

A

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

37
Q

Disease Management Retinoblastoma

A

Surgery–> enucleation

Chemo

38
Q

Disease Management Ewings

A

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

39
Q

Disease Management Neuroblastoma

A

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

40
Q

Disease Management Wilms

A

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
41
Q

Disease Management Rhabdo

A

sx primary

chemo post-op (VAC)

42
Q

Disease Management Glioastrocytoma

A

Low & high grade–>sx
Chemo low–>can delay or avoid RT
Chemo high–>Dex, chemoRT post-op= standard

43
Q

Disease Management medullablastoma

A

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
44
Q

Dose ALL

A

TBI- 1200-200 BID 3days
CSI-helmet: 2400/150 Spine: 1500/150
Cranial/helmet: 1200/180-200

45
Q

Dose Ewings

A

Typically 45Gy

Total dose 60Gy

46
Q

Dose Glioma Astrocytoma

A

Low grade: 50-54Gy

High grade: 60Gy

47
Q

Dose Medullablastoma

A

CSI: 3600/150-180 followed by a boost to posterior fossa 54-55

48
Q
  1. TD 5/5 of bone marrow
  2. Tolerance of cornea, lens, and optic nerve
  3. OARs for wilms tumour
A
  1. 250
  2. 50; 500; 60
  3. remaining kidney, liver, growth plates, bowel
49
Q

ALL tx borders

A

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
50
Q

ALL treatment technique

A

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

51
Q

Ewings sarcoma tx technique

A

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

52
Q

Retinoblastoma tx technique

A

EBRT used for bilateral or inoperable unilateral
treat entire retina to avoid recurrence in ant eye
brachy-iodine 125

53
Q

Wilms tumour prescribed dose borders and tx technique

A

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

54
Q

Medullablastoma Tx borders

A

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

CAMRT Exam (12 decks)

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