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59 Cards in this Set
- Front
- Back
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note: general distinctions between childhood cancers and adult cancers |
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d |
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note: etiologies of childrens cancer role of the environment/ predisposing syndromes? |
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PRESENTATION |
some symptoms more acute.. eg masses, bruises/petichiae, neurological signs |
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general prognosis of some childhood cancers |
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s |
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___% will survive at least 5 y from treatment |
82% |
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general prognosis of childhood cancers is pretty good.. |
50% is in middle of graph |
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concept in childhood cancer: is cure enough? |
i.e., the quality of the cure is important as the cure itself: need to think about late effects as well. |
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define late effect |
side effects related to tx for cancer that start during treatmetn and persist or occur 5 or more years after treatment for cancer |
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prevalence of late effects |
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note: late effects can be related to medical issue, or emotional/psychosocial issue |
d |
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general approach to medical complications of cure |
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models of survivorship care...3 |
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late effects 1. what causes auditory impairment 2. what type of hearing loss |
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risk factors for auditory hearing loss |
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recommended followup in possible ototoxicity |
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late effects: manifestations of cardiotoxicity |
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causes of cardiotoxicity? 2 |
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mechanism of anthracycline mediated cardiotoxicity |
loss of myocytes during anthracyclinetherapy impairs myocardial growth leading to gradual increase in LV afterload anddecreased contractility |
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predisposing risk factors for cardiotoxicity 7 |
1. increasing cumulative dose 2. time since treatment 3. mediastinal radiation 4. presence of other cardiac risk factors 5. younger age at treatment 6. pregnancy/new weight lifting: increased load on heart 7. female sex. |
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RT induced cardiotoxicity |
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surveillance in cardiotoxicity |
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causes of infertility as a late effect? 3 mech |
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how does chemo alter fertility? |
damages germinal epithelium |
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fertility and chemo: damage depends on: |
1. age
2. agent 3. dose 4. synergistic toxicity of agents |
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note: chemo and leydig cells |
generally spared: therefore secondary sex char. develop normally |
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some gonadotoxic agents |
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effects of testicular and pituitary gland RT |
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Female infertility: can be due to effects of cancer therapy on....3 |
1. ovary 2. uterus 3. brain |
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how does chemo cause ovarian failure |
•Resultsfrom cytotoxic insult depleting ova pool or quickening its decline |
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chemotherapy and female fertility: notes 1. susceptibility compared to males 2. DRR 3. age of tx 4. agents? 5. presentation in females ? |
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RT and primary ovarian failure note: effects on teenagers vs. younger girls note dose that reliably produces ovarian failure at any age |
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RT and 2ndary ovarian failure? |
-dueto radiation therapy to the brain -doses of > 3000cGy damage pituitarycausing decreased LH/FSH |
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different modalities of RT that lead to ovarian therapy: summary |
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Uterine radiation effects |
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gonadal function surveillance |
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2º malignancies in childhood cancer survivors risk increase from general pop? |
incidence of SMN >20% at 30 years post diagnosis primary 6x increased risk |
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risk factors for SMN 5 |
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2 types of 2º malignancies |
1. therapy related leukemia (eg myelodysplasia, AML) 2. radiation related solid tumors (breast, skin, thyroid) |
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secondary MDS and AML: 1. which agents 2. when does this occur? 3. when does risk plateau? 4. prognosis |
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2º solid tumors: relationship with RT |
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Most common SMN? which patients get this? |
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surveillance: skin |
annual physical exam of skin and soft tissue within radiation field |
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surveillance: Leukemias: |
annual CBC |
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surveillance:females with chest radiation |
-monthly breast exams at puberty -yearly mammograms / Breast MRI 8 yearspost radiation or at age 25 whichever is later |
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surveillance: RT >25Gy to pelvis, spine, abdomen |
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surveillance: other notes |
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thryoid abnormalities: 3 |
primary/central hypothryoid benign/malignant thyroid tumors hyperthyroidism can be seen in survivors with radiation to head and neck, spinal, total body |
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surveillance: thyroid |
screen annually |
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neurocognitive issues: causes 2 |
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risk factors for neurocognitive sequellae |
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surveillance for children receiving therapy potentially affecting their neurocog status |
•Baseline neuropsychological evaluationprior to treatment •Repeat as clinically indicated and at keytransition points •Annualassessments of vocational or educational progress |
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Other medical late effects 1. growth 2. endocrine 3. lungs 3. osteo 5. dental |
5. osteonecrosis/osteopenia: steroids in ALL 6. dental effects: head and neck cancer, radiation to oropharynx, surgeries involving head and neck region |
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3 categories of psychosocial morbidity among cancer survivors |
1. physical 2. psycholgocial 3. re-entry |
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physical |
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psychological |
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re-entry problems |
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