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Peds II Exam 1 > Oncology > Flashcards

Oncology Flashcards

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1
Q

Leading cause of death in 1-19 YO

A

pediatric cancer

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2
Q

Warning signs for childhood cancer

A

Continued, unexplained weightloss
Headaches - oftening w/ vomiting- early night/ early morning
Increased swelling or pain in bones, back, legs,
Lumps/mass
Development of excessive bruising, bleeding rash

Constant infections
A whitish colour behind the pupil
Nausea which persists of vomiting w/o nausea
Constant tiredness or paleness
Eye or vision changes
Recurrent FUO
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3
Q

Most common malignancy in children

A

Acute lymphoblastic leukemia (ALL)

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4
Q

What causes ALL

A

uncontrolled proliferation of immature lymphocytes

B-precursor lineage (85%)

Peak incidence: 2-5 YO

Cause unknown; genetic factors (down syndrome); viral associations (viral infections, exposure to radiation)

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5
Q

Presentation of ALL

A 
intermittent fever, fatigue, pallor
bleeding (50%) - petechiae, purpura
BONE PAIN! (pelvis, vertebral bodies, legs)
hepatosplenomegaly
LAD
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6
Q

Lab finding

A

anemia/thrombocytopenia w/ normal or depressed WBC
Neutropenia in differential (ANC <1000)
Peripheral smear: lymphoblasts

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7
Q

Dx of ALL

A

bone marrow bx (leukemic blasts replacing normal marrow)

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8
Q

Tx for ALL

A

may take 2-3 years to complete
Chemo (1st line)
Hematopoietic stem cell transplant (HSCT) - best form matched sibling

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9
Q

Prognosis for ALL

A

> 85% survival rate

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10
Q

tumor lysis syndrome

A

oncologic emergency!
Hyperkalemia, hyperuricemia, hyperphosphatemia
acute renal failure

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11
Q

Acute myeloid leukemia cause

A

myeloblasts cant differentiate into mature cells

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12
Q

Predisposing factors for AML

A

no risk factors often
congenital: down syndrome, NF1
Environmental: radiation, benzene (smoking) and previous chemo

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13
Q

Clinical findings for AML

A 
fatigue, pallor, bleeding or infection (fever)
CNS INVOLVEMENT (5-15%) - h/a, lethargy, mental status change, cranial nerve palsies
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14
Q

Lab findings for AML

A

anemia, thrombocytopenia, neutropenia (ANC <1000)
WBC >100,000! (2%)

Hyperleukocytosis (>75,000) may be associated w/ life-threatening complications- Medical emergency

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15
Q

Hyperleukocytosis

A

AML

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16
Q

Dx of AML

A 
smear: myeloblasts >20%
Auer rods (pathognomoic)

Dx requires both:

  • bone marrow bx showing >20 blasts
  • leukemic cells must be of myeloid origin
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17
Q

Tx for AML

A

chemo

HSCT

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18
Q

Prognosis

A

65-75% survival

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19
Q

CML

A

myeloproliferative disorder - uncontrolled proliferation of mature and maturing granulocytes

rare (5% of child canger)

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20
Q

Philadelphia chromosome

A

CML; translocation between chromosome 9 and 22

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21
Q

Presentation of CML

A

chronic phase –> accelerated phase –> blast phase

most asymptomatic
bone pain
fever, NIGHT SWEATS, fatigue (B sx)
pallor, ecchymosis
MASSIVE SPLENOMEGALY, variable hepatomegaly
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22
Q

Lab findings for CML

A

anema, thrombocytosis, and marked leukocytosis
smear: myeloid cells in all stages of maturation, increased basophils and blasts

blast cells >20% = blast crisis

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23
Q

Dx for CML

A

smear w/ myeloid cells in all stages

confirmation: philadelphia chromosome

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24
Q

Tx for CML

A

TKI*

HSCT

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25
TKI
TK allows for dysregulation cellular proliferation
26
50% of childhood lymphomas
Hodgkin Lymphoma
27
Etiology of hodgkins
4:1 male predominance familial, EBC association arises in lymph nodes and spreads to contiguous nodal groups
28
Diagnostic for hdogkins
Reed-sternberg cells (germinal center B cells that have undergone malignant transformation)
29
Response to to hodgkinds
children have better response that adults
30
Presentation of hodgkin lymphoma
painless cervical or supraclavicular adenopathy Mediastinal mass (75%) B symptoms
31
complication w/ hodgkin lymphoma
SVC syndrome- dyspnea, cough, orthopnea, facial/upper extremity edema
32
Dx of hodgkin lymphoma
tissue bx w/ reed-sternberg cells
33
Auer rods
AML
34
Staging of hodgkin lymphoma
CXR CT scan (chest, abdomen, and pelvis) bone marrow bx
35
Tx for hodgkins
chemo radiation HSCT
36
Prognosis for hodgkins
90% 5-10 survival rate
37
NHL epidemiology
5th most common pediatric cancer 3:1 male predominance arises in lymphoid tissue and spreads to distant nodes
38
NHL is associated w/
congenital and acquired immunodeficiency syndromes | EBV
39
NHL children
worse than in adults; rapidly proliferating, high-grade, diffuse malignancies
40
Clinical findings for NHL
fast, 1-3 weeks enlarging, non-tender LAD ab pain, b symtoms hepatomegaly/splenomegaly in advanced stage
41
Dx of NHL
tissue bx
42
Tx for NHL
chemo HSCT for those that relapse watch for tumor lysis
43
Evaluation for brain tumor
measure head circumference | observe gait
44
Most common solid tumor of childhood
brain tumors
45
Presentation of brain tumor
AM h/a, vomiting, papilledema (optic nerve swelling) younger children: vomiting, unsteadiness, lethary, irritability, macrocephaly, FTT, delayed development Older: h/a, visual sx, seizure, focal neuro deficits, school failure and personality changes
46
Imaging for brain tumor
``` MRI (preferred) CT scan (less time) ```
47
Dx of brain tumor
tissue bx
48
Types of brain tumors
1. Glial - astrocytomas, ependymomas | 2. Nonglial: medulloblastoma
49
Tx for brain tumor
1. surgical removal | 2. radiation/chemo
50
Prognosis for brain tumor
60-90% 5-10 year survival w/ low grade astrocytoma
51
Most common abdominal tumor
neuroblastoma
52
Most common solid neoplasm outside of the CNS
neuroblastoma
53
Most common site for neuroblastoma
adrenal gland
54
Clinical manifestation of neuroblastoma
``` abdominal mass (firm, fixed and irregular shape; EXTENDS BEYOND MIDLINE) bone pain from metastatic disease fever, weight loss, irritability, ab pain, anorexia ```
55
Lab findings for neuroblastoma
``` anemia URINARY CATECHOLAMINES (dopamine, Epi, NE) ```
56
Tx for neuroblastoma
surgical resection coupled w/ chemo surgery alone if low grade radiation sometimes necessary
57
Prognosis of neuroblastoma
<40% survival in chidlren w/ high-risk disease
58
Wilms Tumor aka
Nephroblastoma
59
Second most common abdominal tumor in children
Wilms tumor (nephroblastoma)
60
Age nephroblastoma is common
2-5 yo
61
Clinical findings for wilms tumor
asymtomatic ab mass/swelling RARELY CROSSES MIDLINE smooth, firm, well demarcated can extend inferiorly into pelvis fever, hematuria, HTN
62
Dx for wilms
U/S or CT of abdomen, CT of chest (can spread to lungs) bx or surgical excision is diagnostic
63
Tx for wilm's tumor
surgical exploration chemo radiation
64
Prognosis for wilm's
90% overall 5 year survival
65
Most common primary bone malignancy in peds
osteosarcoma
66
Epidemiology of osteosarcoma
male predominance 13-16 yo occurs in long bones (metaphysis) - distal femor (40%)
67
Signs of bone tumor
bone pain at the site mass formation fracture through the area of cortical destruction antalgic gait (due to pain)
68
Dx of osteosarcoma
X-ray- destruction of normal trabecular pattern and irregular margins MRI- eval of soft tissue involvement Bonescan and CT of the chest (metastasis) Imaging and bx
69
Treatment of osteosarcoma
surgery | chemo
70
Prognosis of osteosarcoma
70-75% long term survival w/ localized tumor
71
Second most common primary bone tumor in peds
ewing sarcoma
72
Epidemiology of ewing sarcoma
M>F in 2nd decade of life long bones (diaphysis) extremities/pelvis rarely in soft tissue
73
Clinical findings for ewing sarcoma
worsening localized pain +/- swelling bone pain WORSE @ NIGHT fatigue, fever, +/- weight loss
74
Dx for ewing sarcoma
x-ray | CT/MRI of primary lesion
75
Staging for ewing sarcoma
CT scan of chest bone scan bone marrow aspirates biopsy
76
Dx of ewing
biopsy
77
Tx for ewing
chemo surgery radiation combination
78
Prognosis of ewing sarcoma
70-75% long term survival if small localized tumor
79
90% of tumors diagnosed before age 5 are
retinoblastoma
80
Etiology of retinoblastoma
can be inherited (parent may be silent carrier) | usually unilateral
81
Prognosis of retinoblastoma
metastasis rare | death w/i a year is typical
82
Presentaiton of retinoblastoma
leukocoria (white pupillary reflex) <2 yo | strabisus, nystagmus and red inflamed eye possible
83
Dx of retinoblastoma
opthalmolgic exam under anesthesia - chalky, off white retinal mass w/ soft, fraible consistency ocular U/S MRI of brain and orbits
84
Tx of retinoblastoma
external beam irradiation | chemo if confined to globe
85
Most common soft tissue sarcoma in childhood
rhabdomyosarcoma
86
Epidemiology of rhabdomyosarcoma
most diagnosed by age 10 slight male predominance can resemble fat, fibrous tissue and muscle can effect any body part
87
Most common sites for rhabdomyosarcoma
head and neck
88
presentation of rhabdomyosarcoma
painless, progressively enlarging mass
89
Orbital rhabdo
proptosis/exopthalmos
90
Bladder rhabdo
hematuria urinary obstruction pelvic mass
91
Dx for rhabdomyosarcoma
imaging: xray, CT, MRI | Chest CT and skeletal survey to r/o metastasis
92
Tx for rhabdomyosarcoma
(any combo) surgery chemo radiation
93
Prognosis of rhabdomyosarcoma
70-75% 3 year survival
94
Hepatic tumors stats
2/3 of liver masses are malignant | 90% are either hepatoblastoma or hepatocellular carcinoma
95
Lab for hepatic tumors
alpha-fetoprotein (AFP) elevated ***AFP is a good marker for response to tx
96
Presentation of hepatic tumors
enlarging abdomen
97
Imaging of hepatic tumors
abdominal U/S, CT or MRI
98
Tx for hepatic tumors
surgery and chemo complete resection essential for survival liver transplantation when tumors are unresectable
99
Prognosis of hepatic tumors
1/3 w/ complete resection have long term survival

Peds II Exam 1 (4 decks)

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