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HEMATOlOGY - ONCOLOGY DIVISION CHILD HEALTH DEPARTEMENT UNIVERSITY OF SUMATERA UTARA
• Each year ± 6500 children < 15 years : diagnosed with cancer in the US. • Cancer : the second leading caused death in children. • > 65% of children diagnosed with cancer to now to be cured of their diseases. • The diagnosis of cancer with a history & physical examination. • Environmental & genetics associated with the development of malignancy. • Treatment : start after accurate diagnosis & staging.
COMMON CHIEF COMPLAINTS GIVEN PARENTS THAT SUGGEST A PEDIATRIC CANCER
Chronic drainage from ear Recurrent fever with bone pain Morning headache with vomiting Lump in neck that does’nt respond to antibiotics White dot in eye Swollen face and neck Mass in abdomen Paleness & fatigue Limping Bone pain Bleeding from vagina Weight loss Mass in extremity
Langerhan’s cell histiocytosis Leukemia,Ewings sarcoma, neuroblastoma Brain tumor Hodgkin’s or non-hodgki’s lymphoma, leukemia Retinoblastoma NHL, leukemia Wilm’s tumor, neuroblastoma, hepatoma Leukemia, lymphoma Osteosarcoma, leukemia Leukemia, Ewing sarcoma, neuroblastoma Rhabdomyosarcoma, Yolk sac tumor Hodgkin’s lymphoma Rhabdomyosarcoma
trauma Constipation. neuroblastoma Leukemia. lymphoma. leukemia Wilm’s tumor. full bladder Infection. DIAGNOSIS PRESENTING SIGNS OR SYMPTOMS Headache. leukemia Bone tumor. neuroblastoma Lymphomas Leukemia Leukemia.PRESENTING SIGNS & SYMPTOM OF SOME COMMON PEDIATRIC CANCERS & THEIR DIFF. sinusitis Infection Infection. cysts Infection Coagulation disorders. ITP Trauma CANCER Brain tumor Lymphoma. CNS tumor or extension of abdominal tumor into spinal cord . kidnet cyst. platelet disorders. morning vomiting Lymphadenopathy Bone pain Abdominal mass Mediastinal mass Pancytopenia Bleeding Back pain COMMON DIAGNOSISI (NONMALIGNAT CONDITIONS) Migraine.
– ALL (75%) & AML (20 %) of the total number of cases leukemia. Fatigue – Tachycardia.1. neutropenia – Pallor .thrombocytopenia. papilledema . fever.the peak incidence is between 2 & 5 yrs of age. VI palsy.000 children < 15 years. cranial n. • Clinical manifestation : – Marrow invasion : Anemia. LEUKEMIA • Incidence : – 4/100. vomiting. bleeding – Hepatosplenomegali – CNS : Morning headache. leukopenia.
– Chest radiograph : to evaluate the possible presence of mediastinal mass. – Metabolic panel (liver function. – Coagulation profile – Blood culture if febrile. electrolyte. review peripheral blood smear.• Diagnostic studies : – Complete blood count (CBC). differential. renal function). . – Bone marrow aspiration The presence of 25% or more blasts.
0 7.0 – 11.000 ≥ 50.000 – 49.0 > 11.000 – 99.000 20.COMMON CLINICAL & LABORATORY FEATURES OF ALL AT PRESENTATION Findings Fever Pallor Bleeding Bone pain Lymphadenopathy Splenomegaly Hepatosplenomegaly White blood cell count (µl) < 10.000 Hb (g/dl) 7.000 Percentage of patient 60 40 50 25 50 60 70 50 30 20 40 45 15 30 45 25 .000 10.000 ≥ 100.0 Platelet (µl) < 20.
2. Bilateral : 20-30 % of patients. The tumor from retina. The most common : < 2 years.RETINOBLASTOMA • • • • Incidence : 1/18.000 live birth in the United State. hyphema – Proptosis – Pain . – Strabismus – Orbital inflammation. • Clinical manifeatation : – A white pupilay reflex : leukocoria/ Cat’s eyes reflex.
3. • Characterized by progressive enlargement of the lymph nodes with extension to contiguous nodes. • Mediastinal adenopathy : 60% of the cases. • Clinical manifestation : HODGKIN’S LYMPHOMAS • Incidence : – with a peak in 15 -34 years and 55 – 74 years. – Rarely in children younger than 5 years. • Cellular immunodefficiency is present in >50%. • 60 % : Non-Hodgkin’s Lymphoma (NHL) of all lymphomas. LYMPHOMAS • 10 – 12% of malignancies in children. – Slight male predominant. .
HODGKIN’S LYMPHOMAS Enlargement of the lymph nodes .
HODGKIN’S LYMPHOMA .
• The incidence in children increasea with age. primarily in the lymph nodes. undifferentiated. • Children with congenital or acquired dysfunction of immune system : >>> • Mayor hystologic subtypes : large cwll. • Clinical manifestation : – NHLs can arise any where in the body . Waldeyer ring.5 times as common of Hodgkin’s lymphomas. & bone marrow. – Nausea. superior vena cava syndromes. vomiting. & abdominal distention.NON-HODGKIN’S LYMPHOMA • 1. . lymphoblastic. peyer patches.
LIMFOMA NON HODGKIN ENLARGEMENT OF LYMPH NODES .
An abdominal mass (70%). • Clinical manifestation : – It present as : . . 7% of all malignancies.4. size & degree of spread. . – Tumor can also be found : neck. – The signs & symptoms depend on the site of the tumor. a coagulopathy. – Hepatomegaly. bone pain. NEUROBLASTOMA • The most common solid tumor in childhood outside the CNS. • The peak incidence :2 years of age. thorax & pelvis.A tumor mass along symphathetic ganglia. anemia.
• Diagnostic evaluation : – History – Physical examination – Laboratorium studies – Diagnostic imaging : CT scan – Biopsy . – Racoon eyes with periorbtal hemorrhage. enopthalmus.– Horner’s syndrome : contracted pupil. anhidrosis). ptosis.
RACOON EYES .
BONE MARROW .
hypertension. malise. polycythemia. microscopic hematuria. Approximately : 6% of childhood malignancies.5. Occurs in young children : 1 & 5 years. The second retroperitoneal tumor in children. fatgue – Thrombus. pallor. • Cinical manifestation : – Abdominal mass – Abdominal pain. – Bleeding : Anemia. . NEFROBLASTOMA (WILMS TUMOR) • • • • It’s a tumor of the developing kidney.
WILMS TUMOR GLOMERULUS IN WILMS TUMOR .
Clinical manifestation : – A mass that may or may not be painful. extremities (20%). trismus. mouth breathing. . etc. cranial nerve paralysis. blindess. headache.6. RHABDOMYOSARCOMA • Incidence : 5 – 8% of childhood cancers. – Nasal congestion. trunk (10%). genitourinary tract (20%). epistaxis. • It’s occur at virtually any anatomic site. – Symptoms due to displacement or obstruction of normal structure. • Most often found : head & neck (40%). vomiting.
In males : most common in white. Male : female = 1:4 • Clinical manifestation : – Present as masses. depends on location. Incidence : 4. – AFP is elevated.2 cases permillion population per year. . TERATOMA • • • • Germ cell neoplasma >> in the children.7.
SACROCOCCYGEAL TERATOMA .
• Etiology : unknown. • Patient : taller than their peers of similar age. joint effusion. warmth. . OSTEOSARKOMA • The high risk period : the adolescent growth spurt.8. tenderness. – Limitation of motion. • Clinical manifestation : – Pain & swelling : >>> – Initial complaints : sport injury & sprain.