Pediatric Oncology

Classification, Epidemiology, Clinical Features, Prognosis

Prof. Imran Iqbal

Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
It contains estimated 200 Billion Stars, the sun lies roughly 27,000 light-years
from the centre of the galaxy. And there are estimated minimum
100 Billion Galaxies in the Universe.
In the name of Our Creator Allah, the most Gracious, the most Merciful

(God speaking to Prophet Muhammad (PBUH)

And (remember) Ayub (Job), when he called his Lord saying
“I have been afflicted by distress (disease), and
You are the most merciful of all those who have mercy”
The Holy Quran; surah Al-Anbiya 21:83
 Pediatric Oncology - Epidemiology
• Malignancies are one of the leading causes of death in
children under 15 years of age

• It is estimated that approximately 7500- 8000 children less

than 18 years get cancer, every year in Pakistan.
 Pediatric Oncology – Types of Malignancies
Pakistan Data
Disease Percentage
Leukemia 35
Lymphoma 20
Bone Tumor 08
Soft Tissue Sarcoma 07
Brain Tumor 07
Retinoblastoma 06
Neuroblastoma 04
Wilms Tumor 04
Germ Cell Tumor 03
Others 06
 Pediatric Oncology
Solid Tumors in Children
Neuroblastoma, Nephroblastoma

Prof. Imran Iqbal

Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan
 Solid Tumors in Children
• Bone Tumor (Osteosarcoma)
• Soft Tissue Sarcoma (Rhabdomyosarcoma)

• Brain Tumor (Medulloblastoma)

• Retinoblastoma

• Neuroblastoma
• Wilms Tumor (Nephroblastoma)
Bone Tumor (Osteosarcoma)
Rhabdomyosarcoma
Brain Tumor (Medulloblastoma)
Brain Tumor (Medulloblastoma)
Neuroblastoma
 Neuroblastoma
Epidemiology

• Neuroblastoma arises from neural crest cells

• Origin – adrenal medulla OR paraspinal sympathetic ganglia

• Age – less than 5 years

• Metastasis are formed early

 Neuroblastoma
Clinical Features

• Abdominal mass

• Thorax / Mediastinal mass

• Proptosis of eyes

• OMS (Opsoclonus – myoclonus syndrome)

 Neuroblastoma
Investigations
• CBC, ESR, CRP
• LFT, RPM, LDH, Uric acid
• Coagulation profile
• VMA (catecholamine metabolites in urine)

• US abdomen
• CT scan Thorax / Abdomen

• Bone marrow Biopsy

• Excision / Needle Biopsy - Histopathology
Neuroblastoma
Histology
 Neuroblastoma
Management

• Surgery

• Chemotherapy (Vincristine, Cisplatin, Etoposide)

Nephroblastoma
Wilm’s Tumor
 Nephroblastoma (Wilm’s tumor)
Epidemiology

• Wilms tumor (Nephroblastoma) is the most common renal

tumor of childhood.

• Wilms tumor (Nephroblastoma) constitutes about 5% of all

cancer in children

• Wilms tumor (Nephroblastoma) metastasizes early

• Wilms tumor (Nephroblastoma) has a 5 year survival rate of

50% after treatment
 Nephroblastoma (Wilm’s tumor)
Clinical Features

• Abdominal mass

• Pain abdomen

• Hematuria

• Fever

• Hypertension
 Wilm’s Tumor (Nephroblastoma)
Investigations

• CBC, ESR, CRP

• LFT, RPM, LDH, Uric acid
• Coagulation profile
• Urine examination

• US abdomen
• X-ray Chest
• CT scan Thorax / Abdomen

• Excision / Needle Biopsy - Histopathology

Nephroblastoma (Wilm’s tumor)
Histology
 Nephroblastoma (Wilm’s tumor)
Management

• Surgery

• Chemotherapy (Vincristine, Daunorubicin, Actinomycin - D)

• Radiotherapy