Flashcards in Pediatric oncology II Deck (38)
what is the most common malignancy in childhood?
what is the pathogenesis of ALL?
1. lymphoid progenitor cell undergoes clonal expansion
2. altered expression of genes whose products contribute to normal development of B and T cells
what are the three main signs of leukemia?
1. bone marrow infiltration
2. extramedullary disease
3. fever of malignancy
what are the manifestations of bone marrow infiltration in leukemia?
2. low platelets
4. bone pain
what are the manifestations of extramedullary disease in leukemia?
3. orthopnea, cough
4. gingival hypertrophy
orthopnea could alert physican to what type of mass?
what is the most helpful test in the diagnosis of ALL?
what % of ALL cases will show elevated WBC?
what % of ALL patients will have 2 or more cytopenias?
what are the primary accepted nongenetic risk factors for ALL?
prenatal exposure to x rays and high dose radiation
what is the presentation for precursor B cell ALL?
1. bone marrow involvement
2. frequently also extramedullary - CNS, skin, gonads, lymph nodes, liver, spleen
what is the presentation for precursor T cell ALL?
1. mediastinal mass
2. high WBC
3. prominent lymphadenopathy
what are the main prognostic factors in B cell leukemia?
1. WBC count
what is the greatest predictor of outcome for ALL?
response of induction therapy in bone marrow within 28 days
what are the late effects of treatment for ALL?
1. osteonecrosis, osteopenia
3. neuropsychometric concerns
what are the prognostic indicators for AML?
what is the most common brain tumor in children?
what are the signs of posterior fossa tumors?
ataxia, tremors, dysarthria, stiff neck, papilledema
what are the signs of brainstem tumors?
1. extremity weakness
2. cranical nerve signs
what are the signs of hemispheric tumors?
what is generally needed for brain tumor diagnosis?
what has the greatest impact on brain tumor outcome?
what is the treatment for a tumor that disseminates via CSF?
neuro-axis radiation prophylaxis
what role does chemotherapy have in childhood cancer cases?
astrocytomas are associated with what mutation in 50-80% of cases?
what is the leading cause of morbidity and mortality among pediatric cancers?
what is the gene mutation associated with wilms tumor?
what are the anomalies and syndromes associated with wilms tumor?
3. denys-drash syndrome
4. beckwith-widemann syndrome
what are the main history symptoms associated with wilms tumor?
2. gross hematuria
what tests are used to evaluate for wilms tumor?
2. CT abdomen
3. CT chest
5. abdominal US
what is the cause of retinoblastoma?
loss of both alleles of RB gene
where do neuroblastomas occur?
any neural crest tissue - adrenal, paraspinal sympathetic tissue
what is the clinical presentation for neuroblastoma?
1. large abdominal mass crossing midline
2. lower extremity weakness
3. cervical, high thoracic mass - horner's syndrome
what is the most common extracranial solid tumor in children?
what is the average age of diagnosis for neuroblastoma?
what are the poor prognositc indicators for neuroblastoma?
1. age over 18 months
2. myc-n amplification
3. unfavorable histology
what are the tests to evaluate for neuroblastoma?
1. urine catecholamines
2. imaging - CT, bone scan
3. BM biopsy
4. lymph node evaluation