Pediatric Oncology Flashcards Preview

Pediatrics > Pediatric Oncology > Flashcards

Flashcards in Pediatric Oncology Deck (20):
1

Initial Testing based on Presentation

  • CXR - mediastinal mass
  • US/CT of abdomen - abdominal tumor
  • Brain CT
  • CBC - pancytopenia or lymphocytosis
  • peripheral smear - immature forms (blasts)

2

MC Childhood Malignancies

  • ALL / AML (25%)*
  • CNS tumors (17%)
  • Neuroblastoma (7%)
  • Wilms
  • Non-Hodgkin lymphoma
  • Hodgkins
  • Rhabdomyosarcoma
  • Osteosarcoma
  • Ewing

3

Causes/Types of Leukemia

  • causes
    • unknown
    • predisposed- Downs, Wiskott Aldrich syndrome, neurofibromatosis
    • sibling w/ leukemia
    • radiation/chemotherapy
  • types
    • Acute Lymphoblastic (ALL) - 75%
    • Acute Myelogenous (AML) - 15%
    • Chronic Myelogenous (CML)

4

Classification of ALL

based on morphology of cancerous cells

  • B cell lineage
  • T cell lineage
  • Burkitts lymphoma

 

  • MC in boys than girls
  • peaks at age 2-5

5

Classification of AML

based cell types involved in proliferation

  • AML without maturation
  • AML with maturation
  • myelomonocytic
  • monoblastic and monocytic
  • erythroid
  • megakaryoblastic
  • basophylic
  • panmyelosis w/ myelofibrosis

6

Presentation of Leukemia*

  • fever
  • pallor
  • bruising or petechiae
  • lethargy or malaise
  • anorexia
  • bone or joint pain

7

Physical Findings in Leukemia

  • weight loss
  • ill appearance, fatigue
  • cough (secondary to mediastinal involvement)
  • pallor (secondary to anemia)
  • lymphadenopathy
  • abdominal mass, splenomegaly
  • testicular mass
  • various soft tissue tumors in AML

8

Evaluation of Leukemia

  • immature blasts on peripheral smear
  • urgent consultation
  • bone marrow aspiration (dx confirmation)
  • LP to determine CNS spread
  • cytogenetic analysis to begin tx planning

9

ALL Chemo

  • 3-4 agents
  • IV or intrathecally for CNS
  • 2-3 years

10

AML Chemo

  • intensive myelosuppressive therapy
  • may need stem cell transplant (HLA matched sibling)

11

ALL Prognosis

  • overall cure rate 80%
  • low, standard, high, very high
  • based on age, initial WBC count, genetics, response to induction therapy
  • relapse during tx poor prognostic sign
  • relapse can be bone marrow, CNS, testes, other site

12

AML Prognosis

  • 50% cure rate
  • improved with HLA matched stem cell transplantation from sibling

13

Hodgkin's Disease

S/s, Dx, Tx

  • bimodal distribution
    • adolescent/young adult and >50
  • S/s
    • firm, painless lymph node in 1-2 areas
      • usually supraclavicular, cervical
      • mediastinal w/ cough and SOB
      • abdominal w/ pain
    • suspected w/ EBV infection
  • Dx
    • CBC, ESR, electolytes, Ca+, phosphorous, LDH, uric acid, CXR
    • biopsy of affected tissue
    • Reed Sternberg cells*
  • Tx
    • combo chemo and irradiation
    • 90% overall 5 year survival

14

Non-Hodgkin Lymphoma

characteristics / subtypes

  • subtypes
    • lymphoblastic lymphoma
    • small noncleaved cell lymphoma
    • large cell lymphoma
  • characteristics
    • suspected assoc. w/ EBV - focal lymph nodes
    • typically systemic - bulky extramedullary disease

15

CNS Tumor Presentation

2nd MC tumor in children

  • HA (usually later)
  • altered mental status
  • ataxia
  • NAV, weight loss
  • gait disturbance
  • focal seizures
  • visual changes
  • speech deficits
  • focal sensory abnormalities

16

CNS Tumors

Characteristics, S/s, Dx, Tx

  • bimodal peak: age <10 and >70
  • S/s
    • papilledema
    • diplopia (6th n. compression)
    • Parinaud syndrome - impaired upward gaze (pineal tumors)
    • homonymous hemianopia (occipital tumors)
    • anosmia (frontal lobe tumors)
    • brainstem and cerebellar tumors- CN palsies, ataxia, sensory deficits, nystagmus, pyrimidal signs
  • Dx
    • must ID secondary tumors
    • MRI is study of choice (except subarachnoid space)
  • Tx
    • Dexamethasone - emerg. swelling
    • surgical excision/debulking
    • radiation/chemo

17

Neuroblastoma

Characteristics, S/s, Dx, Tx

(derived from neural crest cells that form medulla & SNS)

  • MC intraabdominal malignancy of infancy
  • MC before age 1, rare after 10
  • S/s
    • abdominal mass crosses midline  & bone pain
    • chest/neck mass w/ Horner syndrome, spinal cord compression
    • 50% w/ mets at time of dx
  • Dx
    • x-ray, US ab, bone scan, CT/MRI
    • CBC, LFT, ESR catecholamine by-products (HVA, VMA)
    • biopsy of mass essential
  • Tx
    • surgical excision
    • excision of bulk + chemo/radiation

18

Wilms Tumor

Characteristics, S/s, Dx, Tx

  • nephroblastoma (primitive kidney cells)
  • MC intraabdominal malignancy of childhood (avg age 3)
  • S/s
    • abdominal mass, pain, hematuria, hypertension
  • Dx
    • ab US, CT/MRI
  • Tx
    • nephrectomy with chemo
    • preserve some tissue if bilateral

19

Retinoblastoma

Characteristics, S/s, Dx, Tx

  • avg age 18mo, rare after 5
  • RB1 gene mutation - other malignancies
  • S/s
    • leukocoria (white pupillary reflex)
  • Tx
    • radiation, radioactive isotopes, chemo, surgical enucleation if no vision preserved

20

Sarcomas (solid tissue tumors)

Types, Dx, Tx

  • Types
    • Rhabdomyosarcoma (MC soft tissue kids)
      • 2-6: head/neck, genitourinary tumor
      • adolesc: extremities, trunk, male GU
    • Osteosarcoma
      • distal femur, proximal tibia/humorus
      • epi/metaphysis of max growth bone
    • Ewing sarcoma
      • any bone (femur/pelvis MC)
  • Dx
    • biopsy: small round blue cell tumors
    • Ewing- specific chromosomal transloc.
    • check for mets- bone scan, CT, marrow
  • Tx
    • depends on staging
    • surgery, chemo, radiation