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Pediatric Oncology (Brain and Spinal Cord Tumors (Types (Medulloblastoma,…
Pediatric Oncology
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Neuroblastoma
Epi:
- 2nd most common
- neuroendocrine cnx from the neural crest
- Peaks before 2 yoa
Clinical:
- Abdominal mass or swelling
Diagnostic:
- CT scan
- MRI preferred if spinal inv
- nuclear med scan
- CMP & CBC
- Bone marrow studies
Management:
- surgery, full excision
- chemo and rad
- common recurrence
Retinoblastoma
- Epi:
- kids < 6, peak 2 yoa
- one or both eyes
- can be hereditary
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- Diagnostic:
- MRI of brain w/ contrast
- Eye exam w/ anesth
- Management:
- Remove the eye if vision can't be saved
- Chemo
Acute Leukemias
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Similarities
S&S:
- Fever, fatigue, wt loss, arthraligias
- CNS -> headache, stiff neck, visual, vomit
- Gingival hypertrophy
- Hyperleukocytosis --> emergent leukopheresis
PE:
- pallor, petechiae, ecchymosis
- Hepatosplenomegaly and Lymphadenopathy (ALL)
- Papilledema, retinal heme, focal neurologic deficits
Diagnosis:
- Bone Marrow Biopsy: hypercellular w/ 20% blasts
- CBC: anemia, thrombocytopenia, neutropenia
- WBC count: varies
- Hallmark of BOTH:Pancytopenia w/ circulating blast (lymphoid or myeloid)
- CXR: anterior mediastinal mass(T-cell ALL)
- Peripheral Blood Smear: Auer Rods (AML) Pathognomonic!!!
Treatment & Referral:
- Hematology Oncologist
- Induction chemotherapy
- intrathecal chemotherapy for CNS
- Allogenic stem cell repl
Lymphoma
Non-Hodgkins Lymphoma
- Epidemiology:
- several types
- median 50 yoa, but 7% of kid cnx
- increasing annually
- S&S:
- painless lymphadenopathy
- generalized (not local)
- 2/3 w/ retroperitoneal, mesenteric or pelvic nodal involvement
- mild fever, night sweats, wt loss
- Diagnosis:
- Tissue bx
- Peripheral bs normal
- bm bx: lymphoid aggregates w/ anaplastic changes
- Tx & Referral:
- Hem/onc
- Chemo, rad, based on stage
- 70-95% cured
Hodgkin's Lymphoma
- Epidemiology:
- bimodal age = 20 yoa & 50 yoa
- 85% of kids are male
- Pathophys:
- malignant Lymph Cancer
- Reed-sternberg cells
- EBV infx?
- starts local (cervical/supraclavicular) and spreads predictably
- S&S
- Painless lump in neck area
Excessive fatigue in kids
- pain with ETOH ingestion
- Pel-Ebstein pattern recurrent fever
- Diagnosis:
- Lymph node bx
- Labs: normo anemia, elev ESR, mild leukocytosis
- CXR: mediastinal lymphadenopathy
- CT chest/abd to stage
- Tx & Referral:
- Gen surgeon or ENT for bx
- Oncology
- Tx based on Ann Arbor staging
- chemo, rad, stem cell trans
- prognosis ok
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