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222 Cards in this Set

  • Front
  • Back
The estimated number of cancer survivors between the ages of 14-45 years old is 1 in _____ , but it is estimated that in 2010 it will be 1 in ______
900
250
Late effects are a result of (5)
1. surgery
2. radiation therapy
3. chemo
4. effects of infections
5. supportive care ( ex. aminoglycosides admin or immunesuppression)
Four factors associated with development of late effects:
1. initial dx: location and extent of the primary disease
2. age and developmental stage
3. type and intensity of treatment
4. genetic and familial predisposition
Categories of Late effects are: (5)
1. physical
2. psychological
3. cognitive
4. economic
5. social/emotional
_______ therapy is the tx most commonly associated with late CNS toxicity.
Radiation
What are the structural changes associated with irradiation of the whole brain? (3)
1. dystrophic calcification
2. mineralizing microangiopathy
3. cerebral atrophy
At what age is associated with increase risk from CNS related toxicity?
6 year olds

<2 years old are most vulnerable
After 1,8000 centrigrays to the whole brain is associated with the following:
Leukoencephalopathy
T/F

There is synergistic relationship between Methotrexate and radiation.
True

radiation disrupts the BBB > increased methotrexate in the CNS > increases chances of leukoencephalopathy
T/F

Hyperfractionated radiotherapy is more damaging to normal CNS
False
Neuropsychological deficits are effects by which factors:
- type and location of disease
- age
- tx implemented: surgery, chemo, corticosteriods
- starting IQ / academic performance
Factors which influence cognitive performance:
- integrity of visual and motor fxn
- memory
- attention
- processing speed
- motor skills
The two most common long term neurological abnormalities are:
1. atrophy
2. decrease subcortical white matter
Platinum based chemo is associated with which CNS symptoms:
hearing loss
HD MTX is associated with which CNS symptoms:
neuroanatomic pathology and neurocognitive deficits
What chemotherapies are associated with peripheral neuropathy?
Vinca alkaloids, cinblastine, etoposide, cisplatin
What chemotherapies are associated with leukoencephalopathy?
IV methotrexate
IV cytarabine
What are the s/s of leukoencephalopathy?
dementia, dysarthria, dysphagia, ataxia, spasticity, seizures, or coma
rare (blindness)
What are the s/s of peripheral neuropathy?
foot drop, paranthesis, or numbness of hands and feet
How to work up long term CNS findings?
CT scan of head for calcification
Possible MRI
Neuropsych testing @ baseline then periodically as indicated
Behavioral and neurocognitive rehabilitation includes:
- appr. school placement
- counseling
- training in behavioral management
- psych drugs if needed
Abnormalities of the HPA are commonly seen after radiation to the ____, ____, and _____
head
neck
face
Injury to the HPA axis can cause alterations in the following hormones:
Growth hormones
throtropin
gonadotropin
adrenocorticotropin (ACTH)
prolactin
antidiuretic (ADH)
vasopressin
Injuries from radiation therapy can happen between _____ to ______ cGy
1800
5000
Growth abnormalities can occur between :________ cGy
1800-2000
Precious Puberty can occur between :________ cGy
1800-2000
Gonadotropin can occur between :________ cGy
3000-4000
TSH deficiency can occur between :________ cGy
> 3000 cGy
ACTH deficiency can occur between :________ cGy
> 3000 - 4000 cGy
hyperprolactinemia can occur between :________ cGy
> 4000 - 5000 cGy
T/F
Children with tumors in the HPA region have a 50% chance of developing an ADH deficiency before surgery and 25% chance after surgery.
False

actually 30 % and 16 %
what is the most common abnormality of the HPA axis?
GH deficiency
Deficiency of growth hormone presents clinical with:
- reduced growth velocity
- decrease in muscle mass
- increased adipose tissue
- high cholesterol levels
- hypertension
- early onset arthrosclerosis
Precious puberty presents clinical with:
- early breast development ( girls < 8 y/o)
- early genital development (boys < 9 y/o )
- accelerated bone maturation
- premature epiphyseal fusion
- reduced final height
Deficiency of gonadotropin presents clinical with:
- failure to progress through puberty
- arrested puberty
- amenorrhea
- if public and axillary hair develop w/o breast development
Deficiency of ACTH presents clinical with:
- decreased stamina
- lethargy
- fasting
- hypoglycemia
- dilutional hyponatremia
Hyperprolactinemia presents clinical with:
- failure to proceed through puberty
- arrested puberty
- galactorrhea
- amenorrhea
- decreased libido
- impotence
What is the diagnostic work up for GHD?
- assess growth velocity, tanner stage, bone age
- thyroid fxn
- Insulin growth factors (IGF1, IGFBP3)
- Formal GH stimulation testing
- frequent serum sampling of GH over a 12-24 hour period
What is the diagnostic work up for Gonadotropin Def?
- LH
- FSH
- Testerone
- Estradiol
- GnRh
What is the diagnostic work up for precious puberty?
- Tanner stage
- bone age
- testing for GnRh
- GH testing
What is the diagnostic work up for TSH deficiency?
- basla conc of thyroxine and TSH
What is the diagnostic work up for ACTH deficiency?
- random serum cortisol level (first thing in the am)
- if abnormal then do a 1 hour ACTH stimulation test
What is the diagnostic work up for hyperprolactinemia?
- random samples of serum plasma prolactin
- should be referred to an endocrinologist
What is the diagnostic work up for diabetes insipidus?
- ADH def
- UA
- serum electrolytes and
What is the medical treatment for GHD?
- GH therapy should not be done until at least a year after cancer treatment
- GH therapy
What is the medical treatment for precocious puberty?
- gonadotropin releasing hormone analog is used to suppress puberty
- GH with gonadotropin releasing hormone increased overall height in studies
What is the medical treatment for gonadotropin deficiency ?
- replace hormone - estrogen (female) and testerone (males)
- should be overseen by an endocrinologist
What is the medical treatment for TSH deficiency?
- thryroxine replacement therapy (levothyroxine/ Synthroid)
-- should be overseen by an endocrinologist
What is the medical treatment for Adenocorticotropin Deficiency?
- hydrocortisone
- stress dose during times of stress
- mineralocorticoids may also need to be replaced
-- should be overseen by an endocrinologist
What is the medical treatment for hyperprolactinemia?
- bromocriptine or related dopaminergic agents
- endocrinologist
What is the medical treatment for dibetes insipidus?
- demopressin (to treat antidiuretic hormone deficiency)
- endocrinologist
Nursing Assessment or HPA axis:
- height and weight ( including sitting height)
- s/s of hormone def
- tanner stages of development
The most common thyroid dysfunction related to late effects is :
hypothyroidism
The peak incidence of thyroid abnormalities is ____ - _____ years s/p treatment.
2-5
What are the risk factors for thyroid complications as late effects of treatment?
- radiation > 1000 cGY to the head, neck, chest, or spinal axis
- single dose or total body irradiation > 750 cGy
- use of busulfan/cyclophosphamide
- treated in puberty increase chance of problems
- lymphangiograms done at time of dx have been associated with late effects
- thyriodectomy
- radiolabeled antibodies used in dx and tx of neuroblastoma
- allogeneic bone marrow transplant
what are the clinical presentations of hypothyroidism ?
- intolerance to temperature
- constipation
- weight gain
- dry skin
- generalized weakness
- muscle and joint aches
- hoarseness
- bradycardia
- hypotension
- puffy and round face
- brittle nails and hair
- periorbital edema
- amenorrhea and arrested pubertal development
- problems concentrating and depression
- high cholesterol level
- elevated TSH and decreased T4
what are the clinical presentations of compensated hypothyroidism ?
- asymptomatic
- labs elevate TSH with normal T4
what are the clinical presentations of Graves disease?
- tachycardia
- excitability, anxiety, nervousness
- heat intolerance
- increased sweating
- wt loss
- increased appetite
- muscle weakness
- fatigue
- diarrhea
- moist skin
- tremors of the hands
- irregular menstrual period
- exophthalmos
- decreased TSH and elevate T4
what are the clinical presentations of thyroiditis?
- s/s of hypothyroidism
- elevated serum thyroid antibodies
what are the clinical presentations of benign or malignant tumor?
- palpable nodules or enlargement of the thyroid
- endocrinologist
what are the clinical presentations of mixed hypothyroidism?
- s/s of central hypothyroidism
- mildly elevated TSH level
What is the diagnostic workup for thyroid complications?
- palpation of the pt thyroid
- Thyroid panel
T/F

Pt who received craniospinal radiation and/ or taking birth control should be evaluated for thyroid function based on free T4 rather than T4.
True
What is the medical treatment of hypothyroidism?
Synthroid
What is the medical treatment of compensatory hypothyroidism?
Synthroid
What is the medical treatment of Graves Disease?
- surgical removal of part or all
thyroid
- thyroid ablation with radioactive iodine
- antithyroid drugs
What is the medical treatment of thyroiditis?
- can be self limiting
- monitor serum thyroid studies
- may involved hormone replacement
What is the medical treatment of benign or malignant tumor?
- tumors are surgically resected
- see endocrinologist
High dose radiation + the following factors effect hearing s/p treatment:
- younger age
- otosclerosis
- tympanosclerosis
- conductive hearing loss
- eustachian tube dysfunction
What type of chemotherapy is known for causing ototoxicity?
platinum
At what cumulative dose of cisplatin is correlated with hearing problems?
360 mg/m2
Ocular complications are associated with:
- direct orbital/ eye radiation
- higher dose cranial radiation
Reduced visual acuity and orbital hypoplasia is caused by doses greater than:
30 Gy

also @ 30 Gy : lacrimal duct atrophy and xerophthalmia, retinopathy
Cataracts can occur at doses greater than
10 Gy
Radiation combined with _____ and _____ increase the risk for cataract development.
- steroids
- busulfan
Keratitis and keratoconjunctivitis are cause by doses greater than
50 Gy
Optic chiasm neuropathy can be caused at 30-65 Gy, and are exacerbated by the following comorbid conditions?
- diabetes mellitus
- hypertension
How does glaucoma present?
- eye pain
- headache
- nausea/ vomiting
- decreased peripheral vision
Radiation can lead to vascular injury that leads to ______ in the vessel wall and perivascular interstitial spaces.
fibrosis
Cranial radiation puts people at risk for ( @ 30cGy)
- vasculopathies in the larger vessels of the brain
- TIA, strokes, focal seizures
- accelerated arthrosclerosis -- rare: hemorrhage
True or False

Currently there is little evidence that links chemotherapy exposure to vasculature changes in the head and neck.
True
What effects can radiation have on mucosal linings long term?
- chronic sinusitis
- altered sinus drainage
What effects can radiation have on skin long term?
- telangiectasia
- atrophy
- hyperpigmentation
- alopecia
- accelerated aging
- 2ndary cancers
What effects can chemotherapy have on skin long term?
- bleomycin : increase size of melanocytes
- busulfasn: permanent alopecia
What effects can radiation have on bones long term greater than 3000 cGy?
- hypoplasia
- craniofacial abnormalities
- fractures
- necrosis
T/F

Children older than 5 years at time of radiation are at higher risk for bone and connective tissue damage.
False
What effects can radiation have on connective tissue long term?
- fibrosis
- hypoplasia
Atrophy of salivary glands resulting in decreased salivation may occur with doses greater than ______ . cGY. This may also leads to altered _______ _______.
4000
Taste buds
Dental abnormalities related to radiation (greater than 1000 cGY) are:
- tooth and root agenesis
- enamel dysplasia
- caries
- malocclusion
- microdontia
- arrested/ altered root development
- periodontal disease
Who is at greatest risk in developing dental complications long term?
- children under 5
- Total Body Irradiation
- greater than 1000 cGY
What three chemo agents are known for disrupting dental development?
- cyclophosphamide
- vincristine
- vinblastine
What complications are associated with chemotherapy in dental development?
- malocclusion
- enamel hypoplasia
- opacities
-hypodontia
- microdontia
- supernumerary teeth
- enlarged pulp chamber
- altered root development
- marked shortening of premolar root
- thickening and constricting of roots
What are the common dental finding in patient who undergo BMT?
- v shaped roots
- premature apical closure
- microdontia
- enamel disturbances
- aplasia
What are the kind of cerebrovascular complications you can see as late effects?
stroke, premature carotid artery disease, Moyamoya disease, occlusive cerebral vasculopathy.
What are the kind of presenting symptoms accompany cerebrovascular complications late effects?
change in mental status, headaches, weakness, hemiparesis, numbness, or tingling, aphasia
What are the kind of subclavian-artery disease you can see as late effects?
diminished brachial and radial pulses, pallor of upper extremities, coolness of the skin or unequal blood pressure measurements
What are the late effects on skin?
pale, thinning, loss of pliability, submucosal induration, chronic ulcerations
What are the late effects on nasal mucosa?
intranasal scarring, changes in normal production of mucus and sinus drainage, possible chronic sinusitis, chronic nasal discharge, postnasal drip, nasal obstruction, facial pain, and headache
Late effects as skin can appear as:
hyper or hypo pigmentation, telangiectasias, atrophy, dryness, lockjaw, xerostomia.
Hair loss occurs at what dose cGY?
4,500 - 5,000 cGy

also hair color and texture changes
Late effects on the bones and connective tissue appear as:
deformities, muscle hypoplasia, loss of elasticity, constricting fibrosis, osteoradionecrosis, and necrosis or ulcers of the soft tissue
Late effects on salivary glands and taste buds appear as:
xerostomia, dental caries, and decay
Dental late effects appear as:
root and crown abnormalities, root agenesis, premature apical closure, enamel hypoplasia, and microdontia, gingival hyperplasia
What is the potential medical treatment of vasculature changes?
stroke- revascularization surgery
hyperlipidemia - diet, lipid lowering agent, antiplatelet agents
What is the potential medical treatment of skin and mucous membranes?
removal of suspicious moles and dysplastic nevi
Chronic sinusitis- aggressive for infections, re: to ENT
ABCD is assessing moles:
a- ASYMMETRY
b- BORDERS
c- COLOR
d- DIAMETER
Cardiotoxicity in long term effects most commonly takes form of:
cardiomyopathy
pericarditis
valvular or coronary artery disease
T/F
Males and young children have a higher incidence of late cardiovascular effects.
False

females and younger children
T/F
Myocardial impairment increases as the survivor ages.
True
Cardiomyopathy increase with _____ chemotherapy agents at the following dose _____ m2.
anthracycline
>300m2
Other chemotherapies responsible for cardiomyopathy are:
cytoxan, dactinomycin, mitomycin, decarbazine, vincristine, bleomycin, methotrexate
T/F
Mediastinal radiation enhance anthracycline toxicities.
True
What are factors that enhance the possibility of myocardial toxicity?
underlying cardiac abnormalities
primary tumor of the chest
pregnancy
recreational drug use
health behaviors
uncontrolled HTN
What are the clinical s/s of pericarditis?
fatigue, cyanosis, ascites, peripheral edema, hypotension, chest pain, dyspnea, fever, venous distention, pulsus paradoxus, muffled heart sounds, effusion, and friction rub.
What are the clinical s/s of cardiomyopathy?
tachycardia, tachypnea, SOB, dyspnea, edema, heptomegaly, fatigue, cough, HTN, suncope, arrhythmias, cardiomegaly, gallop rhythms, palpitations, congestive heart failure, pleural effusion
What are the clinical s/s of valvular damage?
weakness, cough, dyspnea, new murmur, pulsating liver
What are the clinical s/s of coronary artery disease?
chest pain, pain on exertion, dyspnuea, diaphoresis, pallor, hypotension, arrhythmias
What is the medical tx of pericarditis?
if tamponade> pericardiocentesis
Effusion 1-10 months usually resolves
if chronic then pericardiectomy
What is the medical tx for cardiomyopathy?
afterloading reducing agents
digoxin
diuretics
possible cardiac transplant
What is the medical tx for valvular damage?
penicillin proph before surgery or dental procedures
surgical replacement of damaged valves
What is the medical tx for coronary artery disease?
diuretics
cardiac medications
dietary restrictions
balloon dilatations angioplasty or bypass surgery
What are the general considerations for long term effects on the respiratory system?
combination of therapies, younger age at exposure, higher cumulative doses, concurrent infection and baseline dysfunction
Ankylosing spondylitis

clinical findings
Chronic inflammatory disease of spine and sacroiliac joints → ankylosis (stiff spine), uveitis, and
aortic regurgitation.

Bamboo spine.
what chemo agent most commonly associated with pulmonary toxicity?
Bleomycin
Increased @ > 400 m2
but seen @ 60- 100 units/m2
Busulfan and Nitrosureas (carmustine, lomustine) are linked to what late effects ?
fibrosis
pneumonitis
Bulsulfan > 500 mg/m2 increase risk
Cumulative doses to lung tissue greater than ____ Gy, TBI greater than ____ Gy in a single fraction, or fractioned TBI greater than ___ Gy present the highest risk.
10-15
6
12
Indirect effects of radiation of the lungs are:
impair normal growth
development of the thoracic cage, airways, and lung parenchyma
What is the pathophysiology of treatment induced long term lung damage?
DNA damage
free radical formation
allergic and inflammatory response to chemo or radiation
Long term effects possible with cytosine arabinoside or interleukin 2:
non cardiac pulmonary edema involving endothelial inflammation and vascular leak
Tx of pulmonary edema is:
1. oxygen therapy
2. diuresis
What is the clinical presentation of pneumonitis?
1-3 months after radiation therapy or chemotherapy

low grade fever, congestion, cough, fullness of chest, dyspnea, dry cough, pinkish sputum, pleuritic chest pain, can lead to gradual development of pulmonary fibrosis
What is the clinical presentation of fibrosis?
months or years after tx
changes occur over 1-2 years then stabilize
chronic respiratory failure: dyspnea on exertion, fatigue, cough, decreased exercise tolerance, orthopnea, cyanosis, oxygen dependence, chronic cor pulmonale.
What are the preventive measures for respiratory long term effects?
Monitor PFTs, CXR
Early detection of changes
Pneumococcal Vaccine/ FLU
Prevent infections
Cessation of smoking
TX of long term respiratory issues:
corticosteroids
bronchodilators
expectorants
antibiotics
oxygen
bed rest
What are the most common pathological abnormalities of the GI tract in long term survivors?
- fibrosis
- enteritis
from esophagus to rectum
Long term complications of the GI tract include:
- structures
- adhesions
- obstruction
- ulcers
- malabsorption
What are the most common pathological abnormalities of the liver in long term survivors?
- fibrosis
- cirrhosis
T/F
Parts of the small intestine appear to be more sensitive to radiation than the esophagus or colon.
True
T/F
Bowel obstruction is rarely seen in those who have had abdominal radiation but not abdominal surgery.
True
Radiation greater than 25 Gy puts pts at risk for :
secondary GI malignancies

> screening should beging @ age 35 then every 10 years
What chemo can increase acute radiation related toxicities of the GI tract?
1. Anthracyclines
2. Dactinomycin
What chemo agents have been associated with esophageal ulcerations, fibrosis, and strictures?
Vinblastine
Dactinomycin
Doxorubicin
5- flurorouracil
Methotrexate
GVHD can lead to GI tract complications such as:
1. strictures
2. perimuscular fibrosis
3. chronic diarrhea
4. impaired absorption
There is an increase risk of hepatic damage with radiation therapy if:
- hx of hepatic resection,
- VOD
- Chronic hepatitis
- Chronic alcohol use
Splenomegaly and thrombocytopenia may develop as a consequence of
- portal HTN
- hypersplenism
T/F
Dactinomycin and doxorubicin can enhance the hepatic effects of radiation.
True
Methotrexate is associated with the development of:
- hepatic dysfunction
- fibrosis
- cirrhosis
T/ F
Daily oral methotrexate therapy is associate with a higher incidence of fibrosis and cirrhosis than intermittent parenteral dosing.
True
Thioguanine has been associated with :
acute hepatotoxicity & VOD
chronic dysfunction including portal hypertension, nodular hyperplasia, fibrosis, and siderosis (iron in liver)
The potential long term clinical s/s of intestinal fibrosis are:
abd pain (severe and intermittent), dysphagia, vomiting, diarrhea, constipation, bleeding, weight loss, poor linear growth, fatigue, obstruction, rectal pain
The potential long term clinical s/s of adhesions and strictures are:
abd pain, bilious vomitting, hyperactive bowel sounds, dyphagia, reflux, and aspiration pneumonia
The potential long term clinical s/s of cholelithiasis:
colicky abdominal pain related to increased fatty foods and excessive flatulence
upper right sided abd pain
+ Murphy's sign on palpation
The potential long term clinical s/s of hepatic fibrosis are:
elevated transaminase
elevated bilirubin
hepatomegaly
icterus
jaundice
itching
bruising
portal HTN
encephalopathy
T/F
Chronic hepatitis may have no signs or symptoms
True
The potential long term clinical s/s of hepatitis are:
elevated transaminase, elevated bilirubin
anorexia, malaise, n/v, abd pain, arthralgia, jaundice, hepatomegaly, hepatic fibrosis, + hepatitis screens
What is the medical management of long term effects of intestinal fibrosis?
- dilatation of the affected area
- dietary mgmt
What is the medical management of long term effects of enteritis?
- dietary mgmt
What is the medical management of long term effects of bowel obstruction?
decompression if needed
contrast studies
surgical resection or ballon dilatation
What is the medical management of long term effects of GI strictures?
barium test with endoscopy
dilatation of affected area
What is the medical management of long term effects of esophagitis?
pharmacological agents
What is the medical management of long term effects of cholelithiasis?
- avoid fatty foods
cholecystectomy
What is the medical management of long term effects of hepatic fibrosis or cirrhosis?
diuretics
diet
liver transplant
What is the medical management of long term effects of hepatitis?
viral (interferon or antivirals)
liver transplant
What are potential long term risk factors with radiation to the kidneys?
renal insufficiency
HTN

@ > 10 Gy
What are potential long term risk factors with radiation to the bladder?
dysfunctional voiding
fibrosis
vesicouretral reflux
hemorrhagic cystitis
hydronephrosis
unlikely, but bladder malignancies
@ > 30 Gy
Long term bladder effects are greater with radiation + what chemo agents?
Cyclophosphamide
ifosfamide
What are potential long term risk factors with radiation to the ureter, urethra ?
@ greater than 5000 cGY

Generalized effects
What are potential long term risk factors with radiation to the female pelvis?
vaginal stenosis/fibrosis
uterine growth retardation
ovarian dysfunction

@ > 20 Gy
What are potential long term risk factors with radiation to the male pelvis?
Leydig cell and germ cell dysfunction
decreased fxn in prostate gland
decreased seminal fluid
Radiation + what chemos can cause long term genitorourinary late effects?
cytoxan
methotrexate
dactinomycin
nitrosoureas
anthracyclines
What chemo agents cause late term gonadal dysfunction?
alkylating agents
cisplatin
carboplatin
What factors put one at higher risk for gonadal dysfunction?
- being male
- if received MOPP (mechlorethamine, oncovin, prednisone, and procarbazine)
- > 3 cycles of busulfan (600mg/m2), cyclphosphamide (7.5 mg/m2) or alkylators with radiation
What are the clinical presentation of renal insufficiency?
- tubular dysfunction
- hematuria
- fatigue
- HTN
- hypomagnesemia
- Fanconi Syndrome
- proteinuria
- anemia
- growth abnormalities
What are the clinical presentation of bladder dysfunction?
mucosal irritation, microscopic (or macro) hematuria, urgency, frequency, dysuria, hemorrhagic cystitis, incontinence, pain, and fibrosis
What are the clinical presentation of long term effects prostate?
inability for erection
diminished ejaculum
What are the clinical presentation of long term effects vagina/uterus?
alteration in sexual fxn
uterine vascular insufficiency
adverse pregnancy outcomes
altered gonadal fxn (delayed or arrest puberty)
What is the medical tx of long term effects of cystitis?
hydration, instillation of alum solution, cauterization of bleeding sites, partial or total cystectomy, bladder augmentation
What is the medical tx of long term effects of kidney dysfunction?
re: nephroplogist
antihypertensives
electrolyte supplements
What is the medical tx of long term effects of strictures?
- placement of stents
- urinary diversion
What is the medical tx of long term effects of reproductive organs?
surgical interventions
pharmalogical interventions
T/F
Spermatogenesis can occur 3/5 years after the use of some chemotherapeutic agents has ceased.
True
Males are at higher risk for infertility if:
- > 3 cycles of nitrogen mustard, vincritine, procarbazine and prednisone
- combo therapy for Hodgkin's
- Busulfan and cyclophosphamide
- radiation to the testes (200cGy)
If the following lymph node is dissected for staging of ferm cell or testicular tumors, then ejaculation function can be damaged?
retroperitoneal lymph node
Secondary testicular failure is a result of damage to the:
HPA axis
What are the clinical presentations of primary testicular dysfunction?
delayed or arrested development
small testicles
oligospermia
azoospermia
elevated fondadotropin level
Leydig's cell dysfunction
decreased testerosterone
increased FSH and LH
What are the typical labs for germinal cell dysfunction ?
increased FSH
with normal LH and testosterone
Girls are at risk for premature ovarian failure if they receive what chemotherapy?
alkylating agent
combo alkylating with radiation below the diaphragm or TBI
@ what age are you concerned if there is no breast buds in prepubertal females ?
12 or no progression past Tanner 2 @ by age 14
What are the clinical presentation of postpubertal females with ovarian failure?
hot flashes, mood swings, headache, vaginal dryness, dyspareunia, low libido, irregular menses or amenorrhea
What is the medical tx of ovarian failure?
oophoropexy
shield ovaries pre radiation
preserve ovarian tissue
Hormone replacement therapy
Musculoskeletal late effects are:
weakness, alteration or loss of function, osteopathy or fractures
occasionally, limb salvage, poor development, and amputation
Complete arrest of he epiphysis occurs at _____ cGY
2,000
Prolonged use of steroids can result in :
avascular necrosis of the femoral head, osteopenia, osteoporosis
Pt are at an increased risk of bone abnormalities when the have the following comorbid conditions:
hyperthyriodism
growth hormone deficiency
hypogondism
Family hx of osteropenia
co administration of corticosteroids
Vincristine can cause acute:
neuropathy
foot drop
abnormal gait
Methotrexate is associate with with bone abnormality:
development of osteopathy
What long term effects can result from radiation to the bones?
spinal abnormalities, discrepancies in limb length, exostoses, slipped capitofermoral epiphysis, pathologic fracture, poor tooth development
What long term effects can result from radiation to the muscles?
hypoplasia
muscle asymmetry (reduced or uneven growth)
What is the medical management of limb length discrepancies?
shoe lift
contranlateral epiphyssiodesis to arrest growth in a nonaffected limb
contralateral limb shortening
ipslateral lengthening procedures
What is the medical management of slipped capitofemoral epiphysis ?
medical emergency requires fixation
What is the medical management of pathological fractures?
internal fixation
immobilization
bone grafting
amputation
What is the medical management of scoliosis ?
> 20 degrees bracing
> 45 degrees (rare) fusion
What is the medical management of osteopenia and osteoporosis?
calcium supplementation
biphosphonates
tx exacerbating conditions
evaluate with scans and bone mineral density
Pt are predisposed to long term myelodysplasia when the following chemo agents are used:
- alkylating agents
- topoisomerase II inhibitors
Radiation between 4 - 5K cGY to the Bone can take more than 4-6 weeks up to ___ years
2
T/F
Incomplete T Cell reconstitution has been reported up to 4 years after radiation of 1,000 cGy
True
The spleen can become completely compromised after _____ cGY. Therefore putting the patients at risk of sudden and overwhelming infections from encapsulated organisms.
4,000
What labs are used to evaluate long term effects on immune system?
Immunoglobins
T cell studies with T4 and T8 subset studies
With long term immune compromise, what medical management should be considered?
- pneumococcal conjugate and/or polysaccharide vaccine/ HIB vaccine menengococcal, influenza
- antimicrobial prophylaxis
- daily prophylactic dose of penicillin or erythromycin
Secondary Cancers can result from (2)
- previous cancer therapy
- genetic determinants
T/F
The cumulative risk of developing a second cancer 20 years after having a childhood cancer is estimated to be 10- 12 %
False

3-5 %
AML is a risk after receiving what chemotherapy agents?
alkaylating agents
epipodophyllotoxins

4-6 years after initial therapy
What secondary cancers are associated with radiation?
- carcinomas
- sarcomas
- CNS tumors
- skin cancer

Begins 8-10 years after completion of radiation therapy
What genetic mutations predispose family members to specific cancers?
- Von Recklinghausen Neurofibromatosis
- Li-Fraumeni
What are the clinical presentation of secondary leukemia?
-fatigue, anemia, thrombocytopenia, granulocytopenia, bone pain, bleeding, fever, and frequent infections
What are the clinical presentation of secondary solid tumors?
fatigue, anorexia, palpable mass, bloody stools, melena, anemia, pain
What are the clinical presentation of CNS tumors?
seizures, headache, altered mental states, visual changes, nausea, and vomiting
What laws protect cancer survivors from discrimination?
American with Disabilities Act of 1990 ( employers can not discriminate based on medical hx)
Family and Medical Leave Act of 1993 ( job security up to 12 weeks)
Employee Retirement and Income Security Act ( can not be fired for cancer dx/hx)
Military service admission pending no treatment for 5 years.
What organizations are available for advocacy and education for survivors?
- Candlelighters Childhood Cancer Foundation (legal)
- National Coalition for Cancer Survivorship
- American Cancer Society
- Job Accommodation Network
- Cancer Legal Resource Center
True/ False
Most states sponsor a comprehensive health insurance plan called a high risk pool.
True
What is the Comprehensive Omnibus Budget Reconciliation Act?
requires employers to offer group medical coverage to employees to offer group medical coverage to employees and their dependents who otherwise would lose their group coverage due to individual circumstances
Health Insurance Portability and Accountability Act of 1996
allows individuals to change jobs without losing coverage if they have been insured for at least 12 months