E-CLASS: ONCOLOGY COURSE

By Julius Matthew M. Luzana

CUES:
o C/C: Painless Lump on the Left Lower Quadrant of the abdomen
o Gradually enlarging mass by palpation for the past 6 months

History and PE:

o (-) Fever, (-) weight loss, (-) loss of appetite, (-) bowel or bladder changes
o (-) Hx of URTI or exposure to infections

With the given data, I have came up with 3 differential diagnoses which are:
o Wilm’s Tumor
o Neuroblastoma
o Non-Hodgkin’s Lymphoma

*note: Questions 1 and 2 are integrated per differential diagnoses

WILM’S TUMOR

Definition: Neoplastic embryonal renal cells of the metanephros gives rise to this kidney tumor, which is
composed of an admixture of cells (blastemic, epithelial, and stromal) in vcarying proportions. The
epithelial cells form tubules.

JUSTIFICATION ASK AND/OR ASSESS FURTHER FOR:

o C/C: Painless Lump on the Left Lower
Quadrant of the abdomen
o Gradually enlarging mass by palpation for
the past 6 months
o Epidemiology: Account for 6% of all
childhood cancers.
o Age: this tumor occurs during the first five
years of life
o Hypertension: presents with 25% of cases;
may be r/t to elaboration of renin by
tumor cells or to the compression of renal
vasculature by the tumor
o Microscopic Hematuria
o Abdominal Pain (especially if with
hemorrhage)
o Genetic Factors: Aniridia or
hemihypertrophy

Paraclinicals:
o Appropriate imaging studies: U/S, CT SCAN, MRI: to define the site of origin within the kidney
and evaluate contralateral kidney for tumor; also done to determine for presence of metastasis,
if present.
o Urinalysis: to confirm presence of microscopic hematuria
o Genetic tests: to determine possible WAGR syndrome for aniridia or Beckwith-Wiedemann
syndrome
 o CBC: to determine if anemia is present

NEUROBLASTOMA

Definition: a malignancy of neural crest cells, which, in the course of their normal development give rise
to the paraspinal sympathetic ganglia and the adrenal medulla.

JUSTIFICATION ASK AND/OR ASSESS FURTHER FOR:

o Epidemiology: Account for 7% of all o Abdominal mass that displaces the kidneys
childhood cancers; second most common anterolaterally and inferiorly.
solid tumor of the childhood o Abdominal pain
o Age: approximately 70% occur in children o Hypertension: if there is compression of
younger than 5 years old the renal vasculature
o C/C: Painless Lump on the Left Lower o Presence of thoracic tumors
Quadrant of the abdomen o Possible mets
o Gradually enlarging mass by palpation for
the past 6 months
o Abdominal tumor: the most common
presentation; accounting for about 70% of
cases

Paraclinicals:

o Tumor markers: catecholamines are particularly useful markers and include vanilymandellic acid
(VMA) and homonovanillic acid (HVA)
o Serum markers: elevation of the following serum amrkers is often associated with a poor
prognosis: ferritin and LDH
o Oncogene marker: amplification of the n-myc oncogene within tumor cells is also associated
with poor prognosis
o Appropriate imaging studies: U/S, CT SCAN, MRI: to define the site of origin within the
adrenals/kidney and evaluate contralateral adrenals/kidney for tumor; also done to determine
for presence of metastasis, if present.

NON-HODGKIN’S LYMHPOMA

Definition: are heterogenous group of diseases characterized by neoplastic proliferation of

immature lymphoid cells, which, accumulate primarily outside the bone marrow.
 JUSTIFICATION ASK AND/OR ASSESS FURTHER FOR:

o Epidemiology: Account for 6% of all o Anterior mediastinal mass: sometimes

childhood cancers
o Sex: stronger predilection in males
o C/C: Painless Lump on the Left Lower
Quadrant of the abdomen
o Gradually enlarging mass by palpation for
the past 6 months
associated with pleural effusions
o Respiratory distress from airway
compromise r/t Ant. Mediastinal Mass
o Possible SVC Obstruction
o Presence of jaw masses
o Peripheral lymph node involvement

Paraclinicals:

o Lymph node biopsy: to confirm for possible diagnosis

o CBC: to determine for normocytic, normochromic anemia
o Peripheral blood film may lymphoma cells
o Biochemistry: increased uric acid, abnormal LFT’s if with liver involvement, increased LDH
o Appropriate imaging studies: U/S, CT SCAN, MRI: to define the site of origin; it is also done to
determine for presence of metastasis to extranodal sites, if present.