Flashcards in CHildhood CA Deck (148):
How many children are diagnosed with CA each day?
What is the death rate of cancer in children?
What is the number 1 cause of disease related death for children?
What is the most common cause of death ages 104?
Congenital abnormalities (CA second)
What is the average age at diagnosis for childhood cancer?
What is the average years of life lost in an adult CA patient? Child?
15 in adult, 71 in children
What is the funding like for childhood cancer?
What is the odds of encountering a 20 year who survived childhood cancer?
What is the most common type of childhood cancer?
What is the second most common CA in children?
What is WIlm's tumor?
What are the two most common causes of cancer in adolescence?
What is happening to the mortality rate of childhood cancer?
Survival is greatest for what childhood cancer? Second?
What is the children's oncology group?
Cooperative of Drs that treat childhood CA
What are the causes of childhood cancer?
Largely Unknown--environmental causes have been difficult to identify
What is neurofibromatosis?
What is familial polyposis?
What is Li-Fraumeni syndrome?
What are the three categories of diseases linked with increased cancer risk?
-Disorders of chromosome stability
What are the ssx of childhood CA?
Nonspecific, and often mimic childhood problems
How many providers are seen before a diagnosis of childhood cancer is made?
What are the orders you want to make with HTN in children? What are the tumors associated with this?
Renal or abdominal tumors (NBL)
What are the orders you want to make with sudden onset weight loss in children? What are the tumors associated with this?
What are the orders you want to make with petechiae in children? What are the tumors associated with this?
CBC, manual diff
What are the orders you want to make with adenopathy unresponsive to ABs in children? What are the tumors associated with this?
CBC, manual diff
What are the orders you want to make with endocrine abnormalities (growth failure, electrolyte disturbances, sexual abnormalities, Cushings) in children? What are the tumors associated with this?
CT hypothalamic areas
What are the orders you want to make with (headache, CN palsy, ataxia, dilated pupils, afebrile szs, hallucinations, unilateral weakness) in children? What are the tumors associated with this?
What are the orders you want to make with (white spots on eyes, ptosis, wandering eye) in children? What are the tumors associated with this?
Rb, or metastatic neuroblastoma
What are the orders you want to make with bulging external ear mass, in children? What are the tumors associated with this?
CBC, diff, imaging
What are the orders you want to make with puffy face in children? What are the tumors associated with this?
What are the orders you want to make with pharyngeal masses in children? What are the tumors associated with this?
RSM, lymphoma, nasopharyngeal carcinomas
What are the orders you want to make with periodontal masses in children? What are the tumors associated with this?
LCH, burkitt's lymphoma
What are the orders you want to make with thoracic masses in children? What are the tumors associated with this?
Soft tissues tumors, mediastinal tumors
What are the orders you want to make with intra abdominal masses in children? What are the tumors associated with this?
abd US, CBC
What are the orders you want to make with testicular masses or masculinization/feminization in children? What are the tumors associated with this?
UA, CBC, US
Germ cell tumors
What are the orders you want to make with musculoskeletal issues in children? What are the tumors associated with this?
What is Ewing's sarcoma?
What are the ssx of leukemia? (6)
-fever 101F >7 days
-bone or joint pain
What are the ssx of brain tumors?
Szs, weakness, coordination difficulties
Headaches and vomiting
Why are headaches and vomiting common in childhood brain tumors?
Compression of CSF circulation
When are headaches concerning for brain tumors?
Regression of developmental milestones are concerning for what type of tumor?
What size are lymph nodes considered "large"?
> 10 mm except for epitrochlear nodes (>5 mm) or inguinal (>15 mm)
What are the two common bacterial causes of lymphadenopathy?
Cat scratch disease
Staph and strep
What are the common viruses that cause lymphadenopathy?
EBV and herpes
What are the two characteristics of lymph nodes that make them concerning for CA?
-Regional not involving the head to neck
What lymph nodes are particularly concerning for malignancy? (3)
When is a biopsy of a node recommended?
Enlarging after 2-3 weeks of abx
unchanged 6-8 weeks
True or false: any nodes associated with any abnormal CXR are concerning for CA
What are the masses that always require a CA work up?
Abdominal, thoracic soft tissue
True or false: bone pain is usually an early symptom of malignancy
Bone or joint pain is a presenting symptom of what percent of pts with ALL?
Ostalgia caused by CA is usually confused with what?
When is bone/joint pain particularly concerning?
Associated with swelling or mass
How do you differentiate ITP from malignancy?
Low platelets, ITP is usually preceded by a viral infection
What is the most common malignancy in childhood?
What is the peak age for ALL?
ALL accounts for what fraction of all childhood cancers?
In what race is ALL most common?
What sex has more cases of ALL?
What is the pathogenesis of ALL?
Lymphoid progenitor cells becomes genetically altered and undergo dysregulated proliferation and clonal expansion
What is the test to distinguish between what type of lymphoma it is?
Where does ALL arise from?
Bone marrow, but may present anywhere in the body
What are the ssx of ALL? (4)
What are the ssx of extramedullary leukemia? (lymph, respiratory, neuro, GU, skin, mouth)
-facial nerve palsy
What percent of ALL pts have leukocytosis?
What percent of ALL pts with have lymphoblasts on peripheral smear?
What percent of ALL pts have >2 cytopenias?
What percent of ALL pts will have 1 cytopenia?
What percent of ALL pts will have a normal CBC and diff?
Why do you want a manual differential when diagnosing ALL?
May mistake cells
What are the two infections and two diseases that mimic leukemia?
2. Parvovirus B19
3. Acute anemia
Incidence of ALL (specifically) is highest in what ethnicity?
Children with what disease have an increased risk of ALL?
The primary nongenetic risk factor for developing ALL is what?
prenatal exposure to x-rays
What type of cell is usually implicated in ALL?
What is the usual presentation of B-ALL?
BM involvement, but frequently CNS, gonads, lymph nodes
What percent of children have T-ALL?
Who is usually afflicted with T-ALL?
How does T-ALL usually present?
Looks like mumps with mediastinal mass and leukocytosis
What is the standard risk for ALL?
Age 1-10 yo
What is the high risk standard for ALL?
Age 10 yrs
What are the two cell types that are considered high risk ALL?
What is the greatest predictor of overall outcome of ALL?
Response to therapy in the first few days
What is the maintenance period for males? Females?
Males = 3.5 years
Females == 2.5 years
CNS prophylaxis is indicated in what types of ALL?
T cell or with CNS involvement
What are the f/u periods for ALL?
5 years after chemo, then every 10 years
What percent of ALL pts attain remission?
What is the infection that ALL pts are predisposed to?
What is the CA-free rate at 5 years in ALL?
What are the four late effects of ALL?
3. Neuropsychometric concerns
What is the side effect of vincristine use?
What is the MOA of vincristine?
Inhibits tubule formation/breakdown
What is the treatment for AML?
What are the three prognostic indicators for AML?
What is the cure for AML?
Bone marrow transplant
What are the side effects of daunorubicin?
What is the most common SOLID tumor of childhood?
Of the brain tumors, which type has the highest incidence in children?
Astrocytomas are usually associated with what genetic disorder?
What is the treatment for astrocytomas?
What are the ssx of increased intracrainial pressure?
Loss of vision
Bulging fontanelles/spreading sutures
What are the ssx of posterior fossa and brainstem?
What are the ssx of hemispheric tumors?
Hemiparesis or hemianopsia
What are the three ways to diagnose brain tumors?
Surgery, XRT, or chemo for: medulloblastoma?
surgery and chemo
Surgery, XRT, or chemo for: low grade astrocytoma?
surgery and focal XRT
Surgery, XRT, or chemo for: optic glioma?
Surgery, XRT, or chemo for: ependymomas?
Surgery XRT, and focal chemo
Surgery, XRT, or chemo for: germ cell tumors?
XRT and chemo
Surgery, XRT, or chemo for: high grade astro/GBM
What are the two exceptions of surgery for brain tumors?
What is the single best treatment for brain tumors?
What is neuroaxis prophylaxis?
treating neuro axis via CSF
True or false: chemo is usually an adjuvant therapy in brain CAs?
What is the limiting factor for chemo in brain tumor?
Blood brain barrier (maybe)
Astrocytomas are usually associated with what genetic disorder?
and Li-Fraumeni syndrome
Why are some childhood CA survivors usually present with astrocytomas?
Radiation to the head and neck
What is the genetic defect in Wilm's tumor?
WT1 tumor suppressor gene that is critical for normal renal development
What ethnicity has the highest incidence of Wilm's tumor?
What is the peak age incidence of Wilm tumor?
What are the ssx of wilm tumors? (4)
3. Large, palpable abdominal mass
4. HTN/gross hematuria
What are the two syndromes that are associated with wilm tumor?
What is the treatment for Wilm tumor?
What is stage I-V of Wilms tumor?
I = limited to kidney
II = extent beyond kidney
III = Residual tumor in abdo
IV = hematogenous spread
V= both kidneys
What are the orders for evaluating Wilms tumor?
What is the prognosis for Wilm's tumor?
When does retinoblastomas usually present?
What is the cause of retinoblastoma?
Loss of both alleles of the RB gene
What is the treatment for RB?
Radiation, chemo, enucleation of eye
What are neuroblastomas?
Anywhere there was neural crest cells in tissues
True or false: neuroblastomas are not usually metastatic
What are the ssx of metastatic neuroblastomas? (3)
-large abdo mass
-Lower extremity weakness (if spinal cord involved)
What is Horner's syndrome?
What is the most common extracranial solid tumor in children?
What are the three poor prognostic indicators in neuroblastomas?
How do you evaluate neuroblastomas?
What are rhabdomyosarcomas?
CAs from undifferentiated mesenchymal cells that differentiate into muscle
What are the ssx of rhabdomyosarcoma?
depend on age and site
What are the ssx of head/neck rhabdomyosarcomas?
What are the ssx of paramenigneal rhabdomyosarcomas?
What are the ssx of GU rhabdomyosarcomas?
What are the ages where rhabdomyosarcomas usually peak?
What are Ewing's sarcomas?
small, round blue cell tumors that present with pain, swelling,
What is the treatment for Ewing's sarcomas?
Are ewing's tumors radiosensitive?