Oncology Flashcards
(28 cards)
Fibroadenoma
Most common solid breast mass in teens
Typically in upper outer quadrant
From local exaggerated response to estrogen
Well circumscribed, rubbery, mobile, non tender
Can do US if unsure
Serial US every 6-12 months to check for malignant characterstics
Excision if suspicious, complex US, > 4-5 cm, anxiety
Tumor lysis labs
Hyperkalemia
Hyperphosphatemia
Hyperuricemia
Hypocalcemia
Allopurinol vs rasburicase
Allopurinol stops formation of uric acid = prevention
Rasburicase speeds breakdown of uric acid = treatment
Standard risk criteria for ALL (2)
Age 1-10 years
WBC count < 50
Specific findings that suggest AML > ALL
Blueberry muffin lesions (subcutaneous nodules)
Infiltration of the gingiva
Masses (chloromas or granulocytic sarcomas)
Infiltration of the gingiva
Ewing sarcoma
Present during puberty
Tumor of the long bones and pelvis
Diaphysis** mainly affected
XR: onion skin periosteal reaction, moth eaten appearance
Chemo and surgery
Osteosarcoma
Mainly in adolescence
Metaphyseal involvement of long bones
Deep bone pain with night time wakening
Most often around the knee
XR: sunburst pattern, Codman triangle
Chemo and surgery
Ewing vs osteosarcoma
OS: metaphysis, sunburst appearance
Ewing: diaphysis, axial pelvis, onion skinning on XR, may have soft tissue mass
Osteochondroma
Benign cartilage and bone forming tumor
Most in the metaphysis of long bones
Asymptomatic, bony mass, non painful
XR: Stalks or broad based projections, may have mushroom cap
Conservative management
Osteoid osteoma
Benign bone forming tumor
Increasing pain that is worse at night but is RELIEVED with nsaids (unlike osteosarcoma)
Usually lower limb
XR: round oval lucency surrounded by sclerotic bone
Surgery
Langerhans cell histiocytosis
Pathologic Langerhans cells
Lytic lesions of skull, rash in diaper or scalp area, can be on palms and soles (can look like seb derm), HSM, lymphadenopathy, exophthalmos, diarrhea, diabetes insipidus
Can use local control
May need systemic chemo if complicated
Hodgkin lymphoma
Reed Sternberg cells
Adolescents 15-19
Infections may be involved (EBV, CMV, HHV-6)
Cervical or supraclavicular lymphadenopathy, usually mediastinal involvement (need CXR), B symptoms
Excisional biopsy to diagnose
Treat with chemo and radiation
Non-hodgkin lymphoma
Can be secondary to immunodeficiencies (WAS, SCID), genetic syndromes, viruses
3 types: lymphoblastic lymphoma, mature B cell lymphoma (Burkitt, diffuse large B cell), anaplastic large cell lymphoma
Lymphadenopathy, mediastinal mass, tonsil enlargement
Chemo +/- immunotherapy
MS stage of neuroblastom
Children < 18 months
No bone marrow involvement
Tumor that would otherwise be stage 1 or 2 (localized, 1 compartment)
Can spontaneously regress, just follow with imaging
2 paraneoplastic syndromes with neuroblastoma
Opsoclonus-myoclonus-ataxia syndrome
Vasoactive intestinal peptide aka Kerner-Morrison (watery diarrhea, abdo distension, dehydration)
Neuroblastoma
Embryonal cancer of peripheral sympathetic nervous system
< 5 years, median 22 months
MYNC amplification and loss of heterozygosity are poor prognosticators
Most from adrenal glands but can be anywhere along chain
Periorbital ecchymoses
Elevated VMA and HVA
MIBG can find mets
2 chemo drugs with SIADH
Vincristine (also peripheral neuropathy, jaw pain)
Cyclophosphamide (also N/V, myelosuppression)
WAGR syndrome stands for
Wilms
Aniridia
GU anomalies
Retardation
Nephroblastoma (Wilms)
Unilateral or bilateral kidneys
Peak age 2-3 years
Asymptomatic mass, HTN, abdo pain, hematuria, constitutional sx
US and doppler initial, then CT to define extent
Radical nephrectomy, chemo
Why are NSAIDs not usually used for cancer pain
Because of their effect on platelet adhesiveness
Screening post
1. Bleomycin
2. Prednisone
3. Doxorubicin
4. Vincristine
- PFTs at baseline, repeat as needed
- DEXA at baseline, repeat as needed
- ECG at baseline, repeat as needed. Echo q2-5 years. Skin exam yearly
- Neuro exam yearly
Screening post
1. Etoposide
2. Methotrexate
3. Cisplatin
4. Cyclophosphamide
- Skin exam yearly
- Dexa and liver enzymes at baseline, repeat as needed. Neuro exam yearly
- Skin, neuro exam, and testicular volume yearly. Audiology q1-5 years.
- Tanner staging until mature, testicular volume yearly
Screening post head/neck/chest radiation
Thyroid exam and TSH/T4 yearly
Dental exam and cleaning q6 months
Eye exam annually
Tanner staging, breast exam
Audiology q1-5 years
Cortisol annually (head rad)
Mammogram/breast MRI at 8 years post or 25 (chest rad)
Pheochromocytoma
Catecholamine secreting tumor from chromaffin cells
Usually adrenal medulla
Right > left, can be bilateral
Von-Hippel-Lindau, MEN2
HTN, attacks, cachexia from increased met rate
Serum and urine metanephrines
Alpha, beta block then surgery
