Oncology Flashcards by Rachel Longwell

Leukaemia
When does ALL normally present 
How does it present 
Are there any signs 
What should be looked at on bone marrow aspirate 
(4 things) 
What indicates high risk

Preschool- peaks 4 yrs
Quick 2-3 weeks pallor, fatigue, weight loss, low grade fevers, irritable
Enlarged testis, chloromas

Morphology- myeloid or lymphoid
Immunoflorescence-CD markers
Cytogenetics- translocations
Enzyme studies

Under 1 or over 10, Philadelphia chromosome, more mature phenotypes, high leukocyte count (>50)

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What translocation gives rise to the Philadelphia chromosome?
Which other translocation gives poor prognosis in ALL

9: 22
11: 23

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What syndromes are associated with leukaemias

Downs
Wiscott Aldrich
Ataxia teliengeictasia
Fanconi anaemia

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How long is the standard treatment of ALL?
Outline the phases
What is MRD?

2 yrs girls, 3 boys

Induction- weekly vincristine and IT Methotrexate, daily steroids, once PEG

Consolodstion- clearing cns disease

Intensification

Maintenance- daily mcp and daily mtx

Minimal residual disease- do a bone marrow after 28 days treatment to see if <5% blasts after induction

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What translocation gives good prognosis in ALL

Which trisomy “?

12:21

Trisomy 4 and 10

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What are the features of tumour lysis syndrome

What are risks for it

Hyperuricaemia phosphataemia and kalaemia
Hypo ca and mg

Leukaemia and lymphomas

Hyper hydrate
Allopurinol

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What is the association of Down’s syndrome and leukaemias (3 things)

Increased risk 20 times normal
Do better in AML
Can get myelodysplastic syndrome from infancy so high risk of aml in the future

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How does AML differ from ALL?

How does treatment differ?

Sicker, older, more likely to have signs (gum hypertrophy and blueberry muffin lesions)
Need to look for a bone marrow donor sooner

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What translocations show good prognosis in AML

Which monosomy is bad

8:21, 15:17

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Which subtype of AML has a specific treatment?

What is that treatment?

Juvenile APML

Retinoic acid

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What is juvenile myelomonocytic leukaemia
What is it associated with?
What is the prognosis
Is it associated with Philadelphia chromosome?

Juvenile cml
Noonans syndrome and nf1
Poor if not noonans
No!

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Lymphoma

Hodgkin and non Hodgkin- what are the features regarding:

number of nodes
how they spread
Extra nodal disease

Which subtype is more likely to involve mesenteric nodes

Hodgkin- single node, spread orderly, rare
NHL- multiple nodes, more sporadic spread, lots of extra nodal disease

NHL

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Hodgkin lymphoma

How does it present?
What type of cells are seen on biopsy? Are they pathogonomic?
What staging system is used? What does it look for?
What gives a poor prognosis?
What is the most common histiological subtype ?

Slow onset, painless rubbery lymphadenopathy, B cell symptoms

Reed sternberg cells. No!

Ann arbour- LN involvement above or below diaphragm

B cell symptoms, Hugh tumour bulk, High stage
Nodular sclerosing

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NHL

What is the most common subtype in children?
How do they present?
What abdominal pathology might make you think of it in an older child?
What is the classification staging?
What blood test monitors tumour burden?

Burkitts 
Faster, lymphadenopathy SVC obstruction 
Intussussecption 
St Jude 
LDH

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Brain tumours

What is the tentorium?
What are the most likely tumours 
-<1 
-1-10 yrs 
-over 10

Dura mater that separates the hemispheres and cerebellum

Supratentorial
Infratentorial
Supratentorial

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Brain tumours

What are signs of supra and infratentorial tumours?

What is diencephalic syndrome?

What might Torticollis suggest?

What is parinaud syndrome?

Signs of raised ICP- headache seizures weakness behaviour changes
Signs of brainstem- vomiting, incoordination, visual change, gait change, papilloedema

Tumours in thalamus or hypothalamus- increased appetite and irritable, cahexia and emaciated

Cerebellum herniating

Pineal tumour- paralysis of upward gaze

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Brain tumours
What is the most common histiological subtype?
What syndrome can it be associated with?
What is the prognosis?
Where is it found and what does it look like

Pilocytic astrocytoma (low grade glioma)
NF 1
Good- 80-90%
Cerebellar- cystic appearing

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Brain tumours
What is an ependynoma

What is a medulloblastoma
Where are they normally found?
When does they present 
What is seen on imaging and histology 
What are good signalling pathways

Tumour from the lining of the ventricles

Primitive Neuroendocrine tumour 
Cerebellum 
Primary school age 
Non calcified, contrast enhancing mass
Homer Wright rosettes 
WNT sonic hedgehog

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ATRT
What are they
How do they present
What is the prognosis
What is the youngest age you can have radiotherapy?
What genetic malformation are they associated with?

Germ cell tumours 
Rapid onset usually <2 years 
Poor
3 years 
IN11- complete peerage partial deletion of ch 22

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Neuroblastoma
What is it?
What 2 syndromes is it associated with
What gene shows bad prognosis

Tumour of the peripheral nervous system- neural crest cells
Beckwith wiedemann NF1
NNYC

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Neuroblastoma
What subtype can have a very good prognosis
How do they present

M4 s
Spontaneously regresses
Widespread nodes, massive liver

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Neuroblastoma

How do they typically present 
What is unique about the mass (2 things)
Where is the mass normally found 
What signs might be present 
How may a paraneoplastic syndrome present?

Large abdominal mass, weight loss, night sweats and fevers
Crosses the midline, hard craggy
Adrenal
Raccoon eyes and Horner syndrome, urinary or bowel obstruction
Opsomyoclonus, ataxia, diarrhoea and hypertension

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Neuroblastoma 
What is the best screening test 
What bloods monitor prognosis 
What is seen on ct 
What specialised imaging technique is used. What is needed to be given too

Vmas&HVAs
Ferritin and ldh
Calcification of the mass
MIBG scanning. Idodine

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Neuroblastoma

What immune therapy is given

Study These Flashcards

Anti GD 2 (glycoprotein)

Neuroblastoma | Does it cause renal calyceal dilatation

No!

Wilms What genetic mutation will outline a bad prognosis What is Denys Dash syndrome What gene is associated with Denys drash

P53 Wilms plus abnormal male genitalia and nephropathy WT1

``` Wilms How does it normally present Are they sick at diagnosis normally What is the best initial investigation. Where does it metastasise you Which renal tumours are more likely to met to the brain ```

Single smooth abdominal mass. Hypertensive No! Abdominal ultrasound Lungs and liver Clear cell and rhabdoid

``` Retinoblastoma What gene is mostly involved? which chromosome is it coded on? What is the pattern of inheritance? What is the difference between inherited and sporadic forms? ```

``` RET 1 13 AD Sporadic- usually unilateral Hereditary- bilateral- one gene hit from birth, second sporadic mutation ```

Retinoblastoma How does it present in the developed world How else can it present? What type of tumour is it?

Squint Leukocoria Pain, unequal pupils, mass, fevers, visual loss Small blue round cell

``` Rhabdomyosarcoma Where is the most common site? What are three other common sites? What type of tumour is it? Which syndrome is it associated with? How can it present What two translocations are common ```

``` Head and neck, trunk, limbs, GU tract Small round blue cell Li Frauneni syndrome Painful mass, longer than expected healing after an injury, bleeding or mass from vagina. Stridor and cough 1:13 2:13 ```

``` Bone tumours When are they most likely to happen Ewing’s and osteo: - location -X-ray findings - symptoms -genetics - Radiotherapy? ```

Adolescents Ewing’s- diaphysis- pelvis chest wallBones and soft tissues. Lytic. Systemic upset. Ch 22 translocations. Yes of large or not fully ressected Osteo- metaphysic, bone only- femur and tibia. Sunburst pattern. Pathological fractures or painful, slow to heal fractures. Retinoblastoma & li fraumeni. No

Osteosarcoma Where does it met to What gives the biggest prognostic indicator?

Chest Level of necrosis with pre op chemo

Liver tumours What is the most common type in children? Which lobe do they commonly involve? How do they present? Which blood test will show it? How might that test also be useful? Do they typically need chemo? Why?

``` Hepatoblastomas R lobe Large asymptomatic abdominal mass AFP. monitors response to chemo No >85% liver can be ressected with no complications ```

``` Germ cell tumours Are most gonadal or extra gonadal Where is the most common site What is the most likely histiological type? What will raised alpha FP show What type of chemo is used ```

``` Extra (gonadal in teens) Sacrococcygeal Teratomas If it’s malignant Platinum based ```

What are the three most common cancers to have secondary malignancies?

Hereditary retinoblastoma Hodgkin lymphoma Soft tissue sarcoma

What are 5 small blue round cell to tumours?

``` Ewing’s Rhabdomyosarcoma PNET Neuroblastoma NHL ```

What are the 5 points of the cell cycle? | Where does the p53 gene work

G0 G1 S G2 M | G1

Which drugs work in M phase Where in the cell cycle does asparginase work? What works in the S phase What acts in the G phase

Vincristine and vinblastane G1 Methotrexate and 6MCP. Ara C Bleomycin and etoposide

Chemo side effects | Methotrexate

Bone marrow suppression | Nephro/hepato toxic

Chemo side effects | Cytarabine

Cns side effects and fevers

Chemo side effects | Vincristine

Peripheral neuropathy Constipation Fatal if given IT

Chemo side effects | Asparginase

Anaphylaxis

Chemo side effects Cyclo/ifosfamide What might help prevent it?

Renal tubulopathy ifos also encephalopathy | MENSA

Chemo side effects | Carboplatin/ cisplatin

Hearing and neuro | Renal impairment

Chemo side effects | Bleomycin

Pulmonary fibrosis

What is a common side effect of etoposide

Allergy

Chemo side effects | Cisplatin

Vomiting ++

What stain on blood film may help identify blasts

MPO- myeloperoxidase

Which chemo has high risk for secondary malignancies | What is the cancer type

Etoposide | AML

How is Philadelphia chromosome positive leukaemia treated

Imatinib or dasatinib- tyrosine kinase inhibitors

When will screening for beckwith wiedemann abdo tumours stop? When is the highest risk period?

1st decade | 1st year of life

Phenotypically what is seen in Bloom syndrome | What tumours are likely

Short, photosensitive rash and T2dm | Leukaemia and lymphoma

What tumours do inactivated p16 and 19 cause

T cell and pre B ALL

How does rasburicase work

Enzyme oxidation to HPO and allantoin

How does carT therapy work What is the main side effect What is it used for currently

Engineered T cells to kill cd19 cells Cytokine storm Relapsed ALL or primary refractory ALL

Febrile neutropenia How low do the neuts have to be What is given for fungal cover What is given for AML

<0.5 Ambisome Taz and vanc

Which 2 chemos cause mucositis | What is used to treat it

Doxyrubicin and methotrexate | Fluids and leukovorin rescue

In tumour lysis syndrome, what precipitates in the tubules | “ if urine is alkaline

Uric acid | Calcium phosphate

What is the most common cause of secondary HLH

Ebv

Oncology Flashcards

(59 cards)