Pediatric Oncology

Question 1

Risk factors

Answer 1

Largely unknown (ALL)
Genetic abnormalities
AIDS
Ionizing radiation exposure
Chemo and radiation

Question 2

Leukemia

Answer 2

Most common cancer in children

Malignancy of WBCs

2-5 years

2 types - ALL, AML

Question 3

Leukemia name

Answer 3

Based on cell type

Question 4

Leukemia symptoms

Answer 4

Easy bruising
Pallor
Bone and/or joint pain
Lymphadenopathy

Question 5

Leukemia dx

Answer 5

Bone marrow aspiration/biopsy

Lumbar puncture

Peripheral blood smear

Question 6

Leukemia Prognosis

Answer 6

Based on…

WBC count
Age
Cytogenetics
Immunology
Response to initial treatment

Question 7

Leukemia tx

Answer 7

Chemo - three phases
Radiation
SCT

Question 8

Sanctuary sites

Answer 8

Where cancer can hang out dormant

CNS
Testicular involvement

Question 9

Leukemia chemo phases

Answer 9

Induction
Consolidation
Delayed Intensification
Maintenance

Question 10

Induction

Answer 10

Intense
Often admitted for induction
Pushes into remission

Question 11

Brain tumors

Answer 11

2nd most common pediatric cancer

Astrocytoma
Medulloblastoma
Ependymoma

Peak incidence 5 years old

Leading cause of childhood cancer related death

Question 12

Most common location of brain tumors

Answer 12

Posterior fossa

Cerebellum
4th ventricle

Question 13

Tentorium

Answer 13

layer of connective tissue that defines cerebellum below cerebrum

Question 14

Glioma/astrocytoma

Answer 14

Inoperable

Question 15

Ependymoma

Answer 15

Surgery through the nose

We usually don’t see full resections

Question 16

Brain tumor symptoms

Answer 16

Headache
Double vision
NV
Irritability
Sleep difficulties
Changes in personality/behavior
Impaired concentration
Memory loss
Problems with reasoning

Question 17

Cerebellum location specific

Answer 17

Clumsiness
Difficulty with coordination

Medulloblastoma

Question 18

Ventricle location specific

Answer 18

Increased head size before 2 years

Ependymoma

Question 19

Brainstem location specific

Answer 19

Facial droop
Difficulty swallowing
Slurred speech

Glioma
Astrocytoma

Question 20

Brain tumor dx

Answer 20

Imaging

Biopsy

Question 21

Brain tumor prognosis

Answer 21

Overall 70%

Brainstem no good
Medulloblastoma easily operable
A/M varies

Question 22

Brain tumor treatment

Answer 22

Chemo
Radiation
Surgery
Steroids
Anti-convulsants

Question 23

Anti-convulsants

Answer 23

Cause major swelling and steroid-induced myopathy

Question 24

Neuroblastoma

Answer 24

Most common solid, extracranial tumor in children

Children under 1 year

Comprises 15% all cancer related deaths

Question 25

Primary tumor location Neuroblastoma

Answer 25

Nerve root SC Anywhere in the sympathetic nervous system - Adrenal glands - Sympathetic ganglia Widely disseminated disease

Question 26

Neuroblastoma symptoms

Answer 26

Reflect location of tumor ``` Lump in abdomen, chest, neck Dark circles around eyes Bone pain Swollen stomach Labored breathing in infants Painless, bluish lumps under skin Weakness, paralysis ``` Increased catecholamine release Some may be asymptomatic

Question 27

Blueberry spots

Answer 27

You'll see them on the palms of the hands and soles of the feet

Question 28

Diagnosis Neuroblastoma

Answer 28

MIBG scan | 24-hour urine collection

Question 29

MIBG scan

Answer 29

Dx neuroblastomas Marker that binds to tumor and makes it light up

Question 30

Neuroblastoma low risk tx

Answer 30

Observation vs surgery only

Question 31

Neuroblastoma moderate risk tx

Answer 31

Surgery | Moderate intensity chemo

Question 32

Neuroblastoma high risk tx

Answer 32

``` Chemo Surgery High dose chemo Hematopoietic Stem Cell Rescue Radiation Clinical trials ```

Question 33

Sarcoma

Answer 33

Unclear etiology Rapid bone growth -Adolescent growth spurt Occurs at an earlier age in girls

Question 34

Sarcoma tumor location

Answer 34

Metaphyseal plate

Question 35

Osteosarcoma

Answer 35

Primary malignant bone tumor Most common bone cancer in children and adolescents 13-16 years of age

Question 36

Primary tumor location Osteosarcoma

Answer 36

Long bones... Distal femur Proximal tibia Proximal humerus Less common sites... Pelvis Jaw Fibula Ribs

Question 37

Ewing's sarcoma

Answer 37

Second most common primary bone tumor Peak incidence 10-15

Question 38

Primary tumor location Ewing Sarcoma

Answer 38

Can occur in flat and long bones Primary sites... ``` LE Pelvis Chest wall UE Spine Skull ```

Question 39

Bone cancer symptoms

Answer 39

Localized pain... Awakens at night Increases with WB Constant Swelling Palpable mass Fracture

Question 40

Bone cancer diagnosis

Answer 40

``` xray MRI CT scan Biopsy Bone marrow aspirate ```

Question 41

Bone cancer biopsy

Answer 41

CT guided core needle biopsy Open biopsy - taking out whole thing while we're in there

Question 42

Bone cancer prognosis

Answer 42

Based on... Site and size of primary tumor Presence of METs Response to initial therapy Age at dx

Question 43

Bone cancer tx

Answer 43

Chemo - before and after sx Radiation Surgery

Question 44

Neoadjuvant

Answer 44

Before surgery chemo in bone cancer

Question 45

Adjuvant

Answer 45

After surgery chemo in bone cancer

Question 46

Rotationplasty

Answer 46

Tumor resection Spared neurovascular bundle Use of ankle joint as knee joint with prosthesis

Question 47

Expandable Prosthesis

Answer 47

For kiddos in FIRST growth spurt Under high-powered magnet, they can expand the prosthesis Allows for continued limb growth

Question 48

Epiphysiodesis

Answer 48

Halting growth on the other side For kiddos in their LATER growth spurt

Question 49

Incidence of Childhood Cancer

Answer 49

Leukemia | Lymphoma