Oncology

Question 1

• 77% of all childhood leukemias

* Onset brief and nonspecific (poor prognosis age <1 or >10 years at diagnosis

Answer 1

ALL

Question 2

MC SSx of ALL

Answer 2

− Common—bone and joint pain, especially lower extremities

− Then signs and symptoms of bone marrow failure

Question 3

CBC of ALL

Answer 3

° Anemia
° Thrombocytopenia
° Leukemic cells not often seen early

Question 4

Best Dxtic for ALL

Answer 4

− Best test is bone marrow aspirate → lymphoblasts

Question 5

PP factors for ALL

Answer 5

− If chromosomal abnormalities, poor prognosis

Question 6

1st phase of Tx ALL

Remission with induction meds

Answer 6

98% remission in 4–5 weeks

Question 7

2nd phase of Tx ALL

Answer 7

Second phase = central nervous system (CNS) treatment

Intensive systemic plus intrathecal chemotherapy

Question 8

% relapse after Tx

Answer 8

Majority is relapse (15–20%):

Question 9

Location of ALL relapse

Answer 9

° Increased intracranial pressure (ICP) or isolated cranial nerve palsies
° Testicular relapse in 1–2% of boys

Question 10

What Cx of ALL

result of initial chemotherapy (cell lysis): hyperuricemia, hyperkalemia, hypophosphatemia → hypocalcemia (tetany, arrhythmias, renal calcinosis

Answer 10

Tumor lysis syndrome

Question 11

Tumor lysis syndrome Tx

Answer 11

° Treat with hydration and alkalinization of urine; prevent uric acid formation
(allopurinol)

Question 12

Overall prognosis of ALL

Answer 12

Prognosis: >85% 5-year survival

Question 13

Most in 15- to 19-year-olds

• Ebstein-Barr virus may play a role; immunodeficiencies may predispose

Answer 13

Hodgkin Lymphoma (HL)

Question 14

HL Dxtic hallmark

Answer 14

Diagnostic hallmark—Reed-Sternberg cell (large cell with multiple or multilobulated
nuclei

Question 15

HL subtypes

Answer 15

− Lymphocytic predominant
− Nodular sclerosing
− Mixed cellularity
− Lymphocyte depleted

Question 16

now considered to be a high-grade non-Hodgkin lymphoma

Answer 16

Lymphocyte depleted

Question 17

MC Sign in HL

Answer 17

− Painless, firm cervical or supraclavicular nodes (most common presenting sign

Question 18

Dx of HL

Answer 18

− Excisional biopsy of node (preferred)

Question 19

Tx of HL determined by?

Answer 19

− Determined by disease stage, large masses, hilar nodes

Question 20

Prognosis of HL

Answer 20

Prognosis—overall cure of 90% with early stages and >70% with more advanced

Question 21

Malignant proliferation of lymphocytes of T-cell, B-cell, or intermediate-cell origin

Answer 21

NHL

Question 22

______major role in Burkitt lymphoma

Answer 22

Epstein-Barr virus—

Question 23

Sybtypes of NHL

Answer 23

− Lymphoblastic usually T cell, mostly mediastinal masses
− Small, noncleaved cell lymphoma—B cell
− Large cell—T cell, B cell, or indeterminate

Question 24

Tx of NHL

Answer 24

Surgical excision of abdominal tumors, chemotherapy, and monoclonal antibodies
± radiation

Question 25

• Second most common malignant abdominal tumor − Usual age 2–5 years − One or both kidneys (bilateral in 7

Answer 25

Nephroblastoma (Wilm’s tumor)

Question 26

Associations of Wilms

Answer 26

° Hemihypertrophy ° Aniridia ° Genitourinary anomalies ° WAGR

Question 27

SSx of Wilms

Answer 27

most are asymptomatic abdominal mass

Question 28

Why is there high BP in WIlms

Answer 28

↑ BP due to renal ischemia

Question 29

Dxtics for WIlms

Answer 29

− Best initial test–ultrasound | − Abdominal CT scan confirmatory test

Question 30

Tx for wilms

Answer 30

− Surgery − Then chemotherapy and radiation − Bilateral renal—unilateral nephrectomy and partial contralateral nephrectomy

Question 31

Prognosis of Wilms

Answer 31

Prognosis—54 to 97% have 4-year survival

Question 32

Other presentation of Neuroblastoma Patients with neuroblastoma can present with _____ or _____ (“dancing eyes and dancing feet”). These patients may also have Horner syndrome

Answer 32

ataxia or opsomyoclonus

Question 33

Neuroblastoma Firm, palpable mass in flank or midline; painful; with______ and ____

Answer 33

calcification and hemorrhage

Question 34

Best Dxtics for NB

Answer 34

− Plain x-ray, CT scan, MRI (overall best)

Question 35

Other Dxtics for NB

Answer 35

Elevated urine homovanillic acid (HVA) and vanillylmandelic acid (VMA) in 95% of cases

Question 36

• Catecholamine-secreting tumor from chromaffin cells

Answer 36

Pheochromocytoma

Question 37

asscn of Pheochromocytoma

Answer 37

Autosomal dominant; associated with neurofibromatosis, MEN-2A and MEN2B, tuberous sclerosis, Sturge-Weber syndrome, and ataxia-telangiectasia

Question 38

Dxtics of Pheochromocytoma

Answer 38

Can use I131 metaiodobenzylguanidine (MBIG) scan → taken up by chromaffin tissue anywhere in body

Question 39

What to do prior to Sx with Pheochromocytoma

Answer 39

• Treatment—removal, but high-risk | − Preoperative alpha and beta blockade and fluid administration

Question 40

Location of rhabdomyosarcoma

Answer 40

``` − Head and neck—40% − Genitourinary tract—20% − Extremities—20% − Trunk—10% − Retroperitoneal and other—10% ```

Question 41

rhabdomyosarcoma increased freq of what condition?

Answer 41

Increased frequency in neurofibromatosis

Question 42

Types of rhabdomyosarcoma ______—60%, Intermediate prognosis ______—vagina, uterus, bladder, nasopharynx, middle ear −______—15%, ° Very poor prognosis, ° Trunk and extremities − ______—adult form; very rare in children

Answer 42

− Embryonal − Botryoid (projects; grapelike) Alveolar Pleomorphic

Question 43

Tx of rhabdomyosarc

Answer 43

Treatment—best prognosis with completely resected tumors (but most are not completely resectable) − Chemotherapy pre- and postoperatively; radiation