Oncology

Question 1

Why is pediatric cancer difficult to diagnose in early stages?

Answer 1

Nonspecific associated sxs
Mimic other more common concerns
Clinicians lack the experience and reluctant to consider it

Question 2

Warning signs for childhood cancer

Answer 2

Unexplained weight loss, HA often with vomiting, increased swelling/pain in bones, lumps/masses, excessive bruising/bleeding, constant infections, whitish color behind pupil, nausea, tiredness/paleness, eye/vision changes, recurrent fevers

Question 3

What is the most common malignancy of childhood?

Answer 3

Acute lymphoblastic leukemia

Question 4

How does ALL result?

Answer 4

Uncontrolled proliferation of immature lymphocytes (peak incidence at 2-5 yrs)

Question 5

Genetic factors of ALL

Answer 5

Down Syndrome

Question 6

Clinical presentation of ALL

Answer 6

Intermittent fever, fatigue, pallor
Bleeding (petechiae)
Bone pain (pelvis, legs etc)
Hepatosplenomegaly
LAD

Question 7

Lab findings of ALL

Answer 7

Anemia and/or thrombocytopenia with normal or depressed WBC
Neutropenia
Lymphoblasts on peripheral smear

Question 8

How to diagnose ALL

Answer 8

Bone marrow biopsy (aspirate)- leukemic blasts replacing normal marrow

Question 9

Tx of ALL

Answer 9

Chemo (initial/first line)
Hematopoietic stem cell transplant
2-3 yrs

Question 10

Tumor lysis syndrome

Answer 10

Oncologic emergency
Massive tumor lysis causing hyperkalemia, hyperuricemia, hyperphosphatemia and acute renal failure
Anticipate when tx started

Question 11

Genetic factors of acute myeloid leukemia

Answer 11

Down syndrome and neurofibromatosis

Question 12

Clinical findings of AML

Answer 12

Fatigue, pallor, bleeding or infection (fever)

CNS seen sometimes (mental status changes)

Question 13

Lab findings of AML

Answer 13

Anemia, thrombocytopenia, neutropenia

WBC>100,000 in 20%

Question 14

Hyperleukocytosis and AML

Answer 14

This may be associated with life-threatening complications (medical emergency)

Question 15

What is seen on a peripheral smear in AML?

Answer 15

Circulating myeloblasts
Auer rods (granular structures in cytoplasm)

Question 16

How to diagnose AML

Answer 16

Bone marrow biopsy wth 20% or more blasts

Leukemic cells must be of myeloid origin

Question 17

Tx of AML

Answer 17

Chemo or hematopoietic stem cell transplant

Question 18

What is CML?

Answer 18

Myeloproliferative disorder with uncontrolled proliferation of mature and maturing granulocytes
Associated with philadelphia chromosome

Question 19

Presentation of CML

Answer 19

Chronic phase-accelerated phase-blast phase

Bone pain, b sxs, pallor, ecchymosis

Question 20

Lab findings in CML

Answer 20

Anemia, thrombocytosis and leukocytosis

Peripheral smear shows myeloid cells in stages of maturation, increased basophils and blast cells

Question 21

Tx of CML

Answer 21

Tyrosine kinase inhibitor (allow for dysregulated cellular proliferation)
Cure: HSCT

Question 22

What is diagnostic of Hodgkin lymphoma?

Answer 22

Reed-sternberg cells (germinal center B cells that have undergone malignant transformation)

Question 23

Kids with hodgkin lymphoma

Answer 23

Have a better response to tx than adults

Question 24

Presentation of hodgkin lymphoma

Answer 24

Painless cervical or supraclavicular adenopathy
Mediastinal mass (caution for superior vena cava syndrome)
B sxs

Question 25

Tx of Hodgkin lymphoma

Answer 25

Chemo, radiation | Autologous HSCT

Question 26

Description of all childhood non-hodgkin lymphomas

Answer 26

Rapidly proliferating, high grade, diffuse malignancies

Question 27

Clinical findings of non-hodgkins lymphomas

Answer 27

Enlarging, non-tender LAD Abdominal pain, fever, cough, dyspnea, night sweats Maybe hepatosplenomegaly

Question 28

Tx of non-hodgkin lymphoma

Answer 28

Chemo or HSCT (watch for tumor lysis syndrome)

Question 29

Most common solid tumor of childhood

Answer 29

Brain tumor

Question 30

How to evaluate for brain tumor

Answer 30

Measure head circumference and observe gait

Question 31

Presentation of brain tumors

Answer 31

30% with triad: AM headache, vomiting and papilledema Younger: vomiting, unsteady, lethargy, FTT, macrocephaly Older: HA, visual sxs, seizure, school failure etc

Question 32

Preferred diagnostic study of brain tumors

Answer 32

MRI (can use CT scan tho)

Question 33

2 categories of brain tumors

Answer 33

Glial tumors and nonglial tumors

Question 34

Brain tumor tx

Answer 34

Initial approach: surgical removal of as much tumor as possible Radiation and chemo when indicated

Question 35

Most common primary site of neuroblastomc

Answer 35

Adrenal gland

Question 36

Clinical manifestations of neuroblastoma

Answer 36

``` Abdominal mass (often extends beyond midline- goes across belly button area) Bone pain from metastatic disease Fever, weight loss etc ```

Question 37

Lab findings of neuroblastoma

Answer 37

Anemia and decreased WBCs in most | Urinary catecholamines elevated in 90% (of the ones that have adrenal gland)

Question 38

Mainstay of tx for neuroblastoma

Answer 38

Surgical resection coupled with chemo (surgery alone if low grade)

Question 39

Most common abdominal tumor in kids

Answer 39

Neuroblastoma

Question 40

Clinical findings of nephroblastoma (Wilms tumor)

Answer 40

Asymptomatic abdominal mass/swelling (rarely crosses midline so just on 1 side) Hematuria, HTN because of kidney probs

Question 41

Tx of Wilms tumor

Answer 41

Surgical exploration, chemo and radiation

Question 42

What is the most common primary bone malignancy in kids?

Answer 42

Osteosarcoma

Question 43

Epidimiology of osteosarcoma

Answer 43

Male predominance | Time of rapid bone growth (10-19)

Question 44

Where does osteosarcoma occur most?

Answer 44

Long bones (metaphysis)

Question 45

Cardinal signs of bone tumor

Answer 45

Bone pain at site Mass formation Fracture through area of cortical destruction

Question 46

Presentation of osteosarcoma

Answer 46

Bone pain over involved area (with or without swelling, antalgic gait)

Question 47

Imaging for osteosarcoma

Answer 47

Xray shows destruction of normal trabecular pattern and irregular margins MRI, bone scan and CT scan of chest

Question 48

Tx of osteosarcome

Answer 48

Surgery, chemo

Question 49

Where does Ewing's sarcoma occur most?

Answer 49

Long bones (diaphysis)-rarely in soft tissue

Question 50

Most common pt affected by Ewing Sarcoma

Answer 50

White males during second decade of life

Question 51

Clinical findings at Ewing Sarcoma

Answer 51

Worsening localized pain/swelling Bone pain worse at night Fatigue, fever, weight loss

Question 52

Tx for Ewing Sarcoma

Answer 52

Chemo, surgery, radiation or combo

Question 53

Who tends to have bilateral retinoblastoma?

Answer 53

Preemies

Question 54

Presentation of retinoblastoma

Answer 54

Leukocoria (white pupillary reflex under 2)- most common sign Strabismus, nystagmus, red inflamed eye

Question 55

What is diagnostic of retinoblastoma?

Answer 55

Chalky, off white retinal mass with soft, friable consistency

Question 56

Tx for retinoblastoma

Answer 56

Some vision-sparing therapies External beam irradiation Chemo

Question 57

Most common soft tissue sarcoma in childhood

Answer 57

Rhabdomyosarcoma

Question 58

Where is rhabdomyosarcoma most common?

Answer 58

Head and neck

Question 59

Presentation of rhabdomyosarcoma

Answer 59

Painless, progressively enlarging mass | Might be orbital or bladder too

Question 60

Tx of rhabdomyosarcoma

Answer 60

Surgery, chemo radiation

Question 61

What percent of liver masses found in childhood are malignant?

Answer 61

2/3rds

Question 62

Types of hepatic malignancies

Answer 62

Hepatoblastoma or hepatocellular carcinoma

Question 63

Presentation of hepatic tumors

Answer 63

Present usually because of enlarging abdomen

Question 64

What is necessary for survival in hepatic tumors?

Answer 64

Complete resection

Question 65

What is the most common solid neoplasm outside of the CNS?

Answer 65

Neuroblastoma