If neuroblastoma is cancer of the adrenal medulla in children.

What is the counterpart for the adult?

=PHEOCHROMOCYTOMA (benign tumor)

LEUKEMIA
> is a malignant increase in the number of leukocytes, usually at an immature
stage, in the bone marrow.
> In leukemia, proliferating immature WBCs depress the bone marrow, causing
anemia from decreased erythrocytes, infection from neutropenia and bleeding.

Cause: Unknown
Risk Factors: Genetics (Down Syndrome and family history), exposure to chemicals
(benzene found in gasoline), immunologic
3 Highest Risk Factor for developing leukemia:
1. ) Instant noodles (Pancit Canton)
2. ) Use of loose powder/talcum powder (pulbos) - it has an ingredient asbestos
3. ) Depression

Incidence: More common in boys, any age

Acute Lymphoblastic Leukemia (Children)

Acute Myelogenous Leukemia (Adult) - MORE DEADLY

4 Types of Leukemia

Acute Acute Chronic Chronic

Lymphoblastic Myelogenous Lymphoblastic Myelogenous
Leukemia Leukemia (Adult) Leukemia (Adults Leukemia
(Children) 55+)
> Found in > Found in myeloid > Found in > Found in myeloid
lymphoid cells cells lymphoid cells cells
> Grows quickly > Grows quickly > Grows slowly > Grows slowly
> 6,000 cases a > 18,000 cases a > 15,000 cases a > 6,000 cases a
year year year year

1.) Acute Lymphocytic/Lymphoblastic Leukemia (ALL)

> Peak Incidence: 2-4 years of age
- immature granulocytes proliferate and accumulate in the bone marrow

2.) Chronic Lymphocytic/Lymphoblastic Leukemia (CLL)

 - abnormal and incompetent lymphocytes proliferate and accumulate in the
lymph nodes and spread to other lymphatic tissues and the spleen

3.) Acute Myelogenous/Myelocytic Leukemia (AML)

- uncontrolled proliferation of myeloblast, which are precursors of granulocytes;
accumulate in the bone marrow

4.) Chronic Myelogenous Leukemia (CML)

- uncontrolled proliferation of granulocytes resulting in increased circulating
blast

Signs and Symptoms

Mild Symptoms
> Fatigue, fever, pallor, anorexia, petechiae, joint pain

Severe Symptoms
> Hepatosplenomegaly, lymphadenopathy, anemia,
bleeding episodes, increased ICP, cardiac failure

Diagnostic and Laboratory Tests

1.) Increased WBC (CLL and AML)
2.) A normal, increase or decrease WBC
3.) Decrease reaction to skin sensitivity tests
4.) Bone marrow tests reveal excessive blast cells
5.) Bone marrow biopsy and aspiration - is the definitive diagnostic
test/Confirmatory Test for Leukemia

*PRBC has the highest clotting factor of all blood products

PALLIATIVE MANAGEMENT OF LEUKEMIA

INFECTION BLEEDING OTHER MODALITIES
Reverse isolation Blood transfusions Chemotherapy
Avoid crowded areas PRBC for severe blood Bone marrow transplant
loss (highest clotting
factor)
Limit visitors Promote bed rest Small frequent feeding
Avoid raw and Avoid repetitive invasive Emotional support
undercooked foods procedures
LYMPHOMAS

1.) HODGKIN’S DISEASE/LYMPHOMA (Painless)

> is a malignancy of the lymph nodes that originates in a single lymph node or
a single chain of nodes

Cause: Epstein-Barr Virus EBV Diseases:

1.) Hodgkin’s disease
2.) Infectious Mononucleosis
3.) Scarlet fever
4.) AIDS

Signs and Symptoms

√ Painless enlargement of lymph nodes
√ “Sentinel node”(near the left clavicle may be the first enlarged node)
√ Nonproductive cough
√ Low-grade or intermittent fever, anorexia, nausea, weight loss, night sweats, and
pruritus
√ Presence of reed-sternberg cells
√ Macrocytosis (abnormal big RBCs, indication of Hodgkin’s disease)

Staging of Hodgkin’s Disease

Stage I - Single lymph node involvement
Stage II - 2 or more lymph nodes but limited to one side of the diaphragm
Stage III - Diseases on both sides of the diaphragm
Stage IV - Metastasis to the bones, lung parenchyma, bone marrow and liver

Treatment Strategy
Stage I & II - Radiation Therapy
Stage III & IV (Relapsed or progressive stage of disease) - single or
combination drugs

Single or Combination Drugs SAVANAH (7 Only Groups of

First Line -- Mechlorethamine Chemo Drugs)
Oncovin 1. S-teroids
Procarbazine 2. A-ntimetabolites (most
Prednisone expensive & effective)
3. V-inka
Second Line -- Adriamycin 4. A-lkylating
Bleomycin 5. N-itrossureas
Vinblastine 6. A-ntibiotics
Dacarbazine 7. H-ormones

BURKITT’S LYMPHOMA (NON-HODGKIN’S DISEASE)

 > is a form of non-Hodgkin’s lymphoma in which cancer starts in immune cells
called B-cells
> BL is common in young children who also have malaria and Epstein-Barr, the
virus that causes infectious mononucleosis

Cause: Human T-Lymphocytic Virus

Types of Non-Hodgkin’s/Burkitt’s Lymphoma

1.) Endemic BL (African)
> Endemic Burkitt lymphoma primarily affects African children ages 4-7 and is
twice as common in boys
2.) Sporadic BL (Non-African)
> occurs worldwide
3.) Immunodeficiency-Associated
> This variant of BL is most common in people with HIV/AIDS. It accounts for
30%-40% of non-Hodgkin’s lymphoma in HIV patients and may be an AIDS-defining
disease.

Signs and Symptoms

√ Tumors of the jaw
√ Waldeyer ring
√ Loss of appetite
√ Weight loss
√ Fatigue
√ Night sweats
√ Unexplained fever

Treatment
1.) Chemotherapy
2.) Drugs -- Cyclophosphamide
Hydroxydaunorubicin
Oncovin
Prednisone

Hodgkin’s Disease Non-Hodgkin’s Disease

Cause Epstein-Barr virus Human T-lymphocytic
virus
Sign Reed-Sternberg cells Waldeyer ring
Drugs MOPP CHOP