Exam 3 CHILDHOOD CANCERS

What is leukemia?

unrestricted proliferation of immature WBCs that infiltrate organs and tissues (depress normal blood cells in marrow)

What are the signs of leukemia?

marrow suppresion- infection, anemia, bleeding

tissue infiltration- pain, organomegaly

How do we classify leukemia?

Lymphocytic- ALL, CLL

Myelocytic- AML, CML

What is acute lymphoblastic leukemia (ALL)?

most common in childhood peaking at 2-5, B-call or T-cell

What are signs of ALL?

anemia bc decrease in RBCs= fatigue/pale, neutropenia= fevers/infections, thrombocytopenia= bruising/bleeding/petechiae, bone/joint pain, T-cell may lead to respiratory distress and enlarged thymus

How do we diagnose ALL?

H&P, blood smear, elevated WBC, bone marrow aspirate/biopsy, CXR, lumbar puncture

How do we treat ALL?

combination chemo, remissive induction, consolidation/intensification and maintenance (stem cell transplant reserved for refractory/relapsed disease)

What are lymphomas?

neoplastic disorders arising from lymph tissue

What is Hodgkin lymphoma?

affects B lymphocytes >90% 5-10 year survival and affects superficial lymph nodes

What are signs of Hodgkin lymphoma?

fever, night sweats, anorexia, nausea, pruritus, respiratory distress, 10% or more weight loss, liver failure, possible secondary cancer

How do we diagnose and treat hodgkin lymphoma?

H/P, CXR, CT, MRI, PET, biopsy of lymph nodes, presence of hodgkin/reed-sternberg cells

Treat- chemo, HSCT and possible radiation

What is non-hodgkin lymphomas?

more prevalent in children, it affects B/T lymphocytes with rapid onset before symptoms affecting deep lymph nodes

What are the symptoms of NHL?

similar to HL but had metastasis to bone marrow and CNS produces leukemia like symptoms

How do we treat NHL?

multi-agent chemo, induce remission then maintenance, radiation limited, CNS prophylaxis, autologous bone marrow transplant

What are signs of brain tumors?

related to location and size of tumor, headache upon awakening, vomiting not related to feeding, increase ICP, balance issues, visual disturbances, seizures, positive babinski

How do we treat brain tumors?

surgery by resection and trying to preserve neurological function, radiation if over 3 years old and chemo

What are sarcomas?

malignancy in bone and soft tissue, bone tumors in adolescence and soft tissue in younger children

What is osteosarcoma?

most common in long bones, associated with pubertal growth spurt, commonly metastasizes to the lungs, dull pain that progresses, swelling or lump around affected bone

What is Ewing sarcoma?

bone or soft tissue most commonly femur/pelvis/ribs, RARE affecting 10-20, intermittent pain that worsens, swelling/lump around cite, unexplained fracture with unexplained fever, fatigue, weight loss and anemia

How do we treat bone tumors?

CT/MRI/PET, surgery possible amputation, chemo pre and post op, radiation only for Ewing, stem cell rescue transplant for Ewing

What is Rhabdomyosarcoma?

soft tissue tumor develops in skeletal muscles like head/neck/GU tract/extremities

What are signs of rhabdomyosarcoma?

headache, diplopia, vomiting, strabismus, stuffy nose, pain in throat/nose, visible mass, nasal obstruction, facial paralysis, abd mass/GI obstruction, lymph node enlargement

How do we treat rhabdomyosarcoma?

chemo, plus surgery and radiation

What is neuroblastoma?

peripheral nervous system tumor arising along the sympathetic chain like adrenal glands

What are signs of neuroblastoma?

Spine tumor- stop crawling, walking, weakness, paralysis

Chest tumor- trouble breathing

Abdomen- pain, enlarged belly, constipation, vomiting, diarrhea, difficulty urinating, high BP

Metastasized- black eyes, bone pain, bruises, fever, paleness, limp, stop walking/crawling

How do we treat neuroblastoma?

multi-modal therapy, observation, surgery, chemo, stem cell transplant rescue if high risk, immunotherapy, radiation

What is nephroblastoma/wilms tumor?

malignant renal tumor, peak 2-3 years, most commonly presents asymptomatic abdominal mass (hematuria, malaise, hypertension, fever)

How do we treat nephroblastoma/wilms tumor?

surgery, NO PALPATE, kidney be removed on affected side, chemo, radiation if higher stage

What is retinoblastoma?

congenital caused by a gene mutation, risk if under 3 yrs with family hx (strabismus, white pupillary reflex/cats eye reflex, pain, decreased visual acuity, orbital edema, redness of eye)

How do we treat retinoblastoma?

brachytherapy, photocoagulation, cryotherapy, eye removal, chemo if spreads outside the eye

What does neoadjuvant treatment mean?

before primary treatment to reduce tumor size and kill the spreading cancer

What is adjuvant treatment?

given after primary treatment and destroys remaining cancer cells

What are chemotherapy dose-limiting toxicities?

myelosuppression, n/v, stomatitis, mucositis, end organ toxicities= heart, liver, lungs (call at first sign of fever)

What is myelosuppression?

decreased bone marrow activity- RBCs, WBCs, Plts (nadir= when blood counts are lowest)

What is good to know for a pt with neutropenia?

no flowers, no fresh fruits/veggies, avoid infection/sick ppl, good cleanliness, private room

What is radiation?

Ionization causes single/double strand breaks in DNA, causing inability of cells to divide or repair damage leading to cell death

What is biotherapy?

stimulates the body’s immune response using antibodies or segments of genetic material to target cells directly