EXAM #3: CHILDHOOD CANCER

Question 1

What is the leading cause of mortality in children?

Answer 1

Cancer

Roughly 3,000 kids die per year from cancer

Question 2

What is the most common cancer of childhood?

Answer 2

ALL

Question 3

List the most common childhood cancers.

Answer 3

1) ALL
2) Brain and CNS
3) Neuroblastoma
4) Non-Hodgkin Lymphoma
5) AML

Question 4

What are the familial/ genetic diseases associated with increased childhood cancer?

Answer 4

1) Neurofibromatosis
2) Familial polyposis
3) Li-Fraumeni Syndrome

Question 5

What mutation is seen in Li-Fraumeni Syndrome?

Answer 5

p53

Question 6

What major categories of disease cause childhood cancer?

Answer 6

1) Immune deficiencies
2) Metabolic disorders
3) Disorders of chromosome stability

Question 7

What is the important clinical pearl to remember about the presentation of childhood cancer?

Answer 7

Signs and symptoms are non-specific and masquarade as common viral or bacterial infections

Question 8

What is the average time/ number of visits to initial neoplastic test for childhood cancer?

Answer 8

3-5 visits

Question 9

If a child presents with HTN, what imaging should be ordered?

Answer 9

CXR

Abd US

Question 10

What should you think if you see HTN in a child?

Answer 10

Something is wrong with the renal or cardiac system, most likely a renal/abdominal tumor e.g.

1) Wilm’s tumor
2) Neuroblastoma

Question 11

What should you order for a child with sudden onset weight loss?

Answer 11

Abdominal US

Question 12

What should you order for children with petechiae?

Answer 12

1) CBC

2) Manual diff.

Question 13

What are you concerned about when a child presents with petechiae?

Answer 13

1) Leukemia

2) Neuroblastoma

Question 14

What should you order if a child presents with lymphadenopathy unresponsive to antibiotics?

Answer 14

1) Surgical consultation
2) CXR
3) CBC
4) Manual diff.

Question 15

What causes lymphadenopathy unresponsive to antibiotics?

Answer 15

1) Leukemia

2) Lymphoma

Question 16

What should you generally be concerned about when you see endocrine anomalies?

Answer 16

• Pituitary tumors
• Hypothalamic tumors
• Gonadal tumors
• Adrenal tumors

Question 17

What should you order for a child with endocrine anomalies?

Answer 17

1) Hormonal assay
2) CT hypothalamic area
3) Abdominal CT
4) Endocrine consult

Question 18

What are some signs of a brain tumor?

Answer 18

• HA with early AM vomiting
• CN palsy
• Ataxia
• Afebrile seizure

….etc.

Question 19

What should you consider with leukocoria, proptosis, blindness, wandering eyes, or intraorbital hemorrhage? What should you do?

Answer 19

1) Retinoblastoma
2) Metastatic neuroblastoma
3) Rhabdomyosarcoma

Refer to ophthalmology

Question 20

What should you consider when a child presents with bulging masses in the external canal, mastoid tenderness, and swelling?

Answer 20

1) Langerhans Cell Histiocytosis

2) Rhabdomyosarcoma

Question 21

What should you consider when a child presents with a puffy neck and face? What should you do?

Answer 21

1) Mediastinal tumors/ SVC syndrome

Question 22

What should you consider when a child presents with a pharyngeal mass? What should you do?

Answer 22

1) Rhabdomyosarcoma
2) Lymphoma
3) Nasopharyngeal carcinoma

Question 23

What should you differential include for a child that presents with a periodontal mass or loose teeth?

Answer 23

LCH
Burkitt’s Lymphoma
Neuroblastoma
Osteosarcoma

Obtain imaging studies and refer for dental consultation

Question 24

What should you differential include for a child with an extrathoracic mass, or cough/dyspnea without fever, asthma, or allergies?

Answer 24

Soft tissue tumor
Mediastinal tumor
Metastatic tumor

Question 25

What types of tumors cause abdominal masses that may be found on abdominal exam?

Answer 25

1) Wilms tumor 2) Soft tissue sarcoma 3) Neuroblastoma 4) Hepatoblastoma 5) Hepatocellular carcinoma

Question 26

What should you suspect if a child presents with a GU mass?

Answer 26

1) Germ cell tumor | 2) Rhabdomyosarcoma

Question 27

What should you suspect if a child presents with masculinization or feminization?

Answer 27

Adrenal tumor

Question 28

What should you consider with a patient that has pelvic or long bone pain?

Answer 28

1) Osteosarcoma 2) Ewings Sarcoma 3) Leukemia 4) Neuroblastoma 5) Soft tissue sarcoma

Question 29

What are the signs and symptoms that are concerning for Leukemia?

Answer 29

1) Unexplained fever over 101 F for more than 7 days 2) Petechaie (especially in places of increased pressure i.e. waistline or socks) 3) Unexplained anemia or pallor 4) Generalized lymphadenopathy (LAD) 5) Hepatosplenomegaly 6) Bone or joint pain that wakes from sleep/ is not controlled with NSAIDs

Question 30

What are the signs and symptoms concerning for a CNS tumor?

Answer 30

1) Seizure 2) Weakness 3) Ataxia 4) Headache and vomiting

Question 31

When are lymph nodes considered "large?" What are the exceptions?

Answer 31

10mm - Epitrochlear nodes (5mm) - Inguinal nodes (15mm)

Question 32

What should be on the differential diagnosis for a child with LAD?

Answer 32

1) Bacterial infection 2) Atypical mycobacterium 3) Cat scratch disease 4) Viral illness i.e. EBV (mono) or herpes virus

Question 33

What type of LAD is more likely to be malignant?

Answer 33

Generalized and regional not involving the head or neck

Question 34

What are the characteristics of LAD that should be especially concerning for malignancy?

Answer 34

1) Hard/rubbery 2) Non-tender 3) Matted

Question 35

When should you order a lymph node biopsy?

Answer 35

- Enlarging node after treatment for 2-3 weeks - Nodes on CXR - LAD + concerning constitutional symptoms - Nodes in uncommon area

Question 36

What are the unusual locations for lymph nodes that warrant work-up?

Answer 36

1) Posterior auricular 2) Epitrochlear 3) Supraclavicular 4) Mediastinal

Question 37

What types of cancer does bone pain point to?

Answer 37

ALL Ewing's sarcoma Osteosarcoma

Question 38

When should bone pain be evaluated?

Answer 38

1) Persistent bone/joint pain with swelling or mass 2) Limited mobility 3) Wakes from sleep 4) Not relieved by NSAIDs

Question 39

What masses warrant workup in children?

Answer 39

Any mass unexplained by trauma