CANCER in CHILDREN

INTRODUCTION
Cancer In Children -3% all cancer cases worldwide -Philippines (1998): 3.7% of male case 2.6% of female -2707 new case dx yearly -(2000):ASR 127.6&103.1for boys and girls -Leukemias are most common

SITE
Cancer in Children involves ALL organs. Specific Sites: -Brain & nervous system -Retina -Lymph Nodes -Nasopharynx -Salivary Glands -Lungs -Heart

 -Kidney -Adrenals -Liver -Spleen -Gastrointestinal tract -Urinary Bladder -Bone -Soft tissues -Bone Marrow -Gonads (Testes & Ovaries) -germ cell tissues

WARNING SIGNS

Prolonged, unexplained fever of illness Unexplained pallor Inc tendency to bruise Unexplained localized pain or limping Unusual masses or swelling Frequent headaches, w/ projectile vomiting Sudden eye or visual changes

 Change in color & character or urine & stool Change n urine & bowel habits
Sudden or progressive weight loss or loss of appetite

RISK FACTORS
Multifactorial causes of Ca in Children -strong family history -random spontaneous mutation -radiation -smoking, alcohol drinking, drug

intake, abortifacients, viral infxns (Hep B & EBV) in pregnant mother -environmental pollution, benzene, insecticide, fertilizer & electromagnetic flds

DIAGNOSIS
History & physical examination
Parent should aware of warning Sxs Bring to pediatrician or family physician

Refer to pediatric oncologist

Treat holistically

LEUKEMIA
Most common (47.8%)
Acute (w/ uncontrollable proliferation of immature or blastic cells S/Sx: pallor, easy bruisability, malaise, anorexia, fever, bone pains, abdominal enlargement, lymphadenopathy, bleeding

DIAGNOSIS
CBC w/ platelet count
Peripheral smear

Bone marrow aspiration Immunophenotyping

BRAIN &SPINAL CANCER

2nd (9.7%)
Early S/Sx: headaches, dizziness, nausea, vomiting, blurring of vision, double vision, difficulty in walking or in coordination like drunken gait & difficulty in handling objects. Late S/Sx: convulsions, deterioration of sensorium--- coma

DAIGNOSIS
Head CT scan or MRI
Tumor markers like AFP & B-HCG

Biopsy

LYMPHOMA
-Non-Hodgkins & Hodgkins disease: 3rd (9.0%) -Usually involves the lymph nodes but may arise from other organs rich in lymphoid tissue. Swelling of LN in neck , chest, axilla, groin. S/Sx: general weakness, fever, night sweats, pruritus & abdominal pain

LYMPHOMA
Burkitts type of NHL:asso w/ EBV infection Diagnosis
CBC w/ platelet count Bone marrow aspiration

Lymph node biopsy w/ immunohistochemical stains for LCA & other CD markers
LDH

RETINOBLASTOMA
4th (7.5%)
Eye cancer occurs in <4 y/o

S/sx: leukocoria or cats eye reflex or squint, red or painful eye, mass in the eye, limitation of vision or blurring of vision, proptosis or forward displacement of the eye

RETINOBLASTOMA
Hereditary form is bilateral Diagnosis Eye ultrasound or B scan CT scan of orbit & head Biopsy

CANCER of EPITHELIAL ORIGIN

Nasopharyngeal Carcinoma,5th (7%)
S/Sx: nose bleeding deafness & enlarged neck nodes Diagnosis Thorough ENT exam

CT scan of head & neck

Biopsy

SOFT TISSUE SARCOMA

Rhabdomyosarcoma, 6th (5.8%) All body sites w/ soft tissues maybe involved Sites: head & neck,genitourinary tract, trunk & extremities S/Sx: swelling or mass> rapid growth> pain

SOFT TISSUE SARCOMA

Diagnosis
MRI of involved site

Biopsy w/ immunohistochemical stains for soft tissues like actin, desmin, vimentin LDH

BONE TUMORS
Osteosarcoma (long bones) & Ewings sarcoma (Flat bones, 7th (5.7%) Adolescents,>10 years old most affected
Very active (athletes,dancers)afflicted S/Sx: bone pain w/ or w/o swelling or mass overlying involved bone Diagnosis: Bone Xray, CT scan or MRI, Biopsy

WILMS TUMOR
8th (4.5%)
Kidney cancer,<5 year olds

S/Sx: abdominal or flank massaccidentally noted by caregiver-rapid growth asso w/ abdominal pain and red urine
Diagnosis: urinalysis, abdo UTZ, KUBIVP CT scan of abdomen & biopsy

GONADAL& GERM CELL TUMOR

Ovarian, testicular or malignant teratoma
9th (4.4%)

At birth, sacrococcygeal teratoma: swelling or mass in buttocks

Testicular CA: swelling or mass in scrotum Ovarian CA: mass in lower abdomen, pain & changes in urine & bowel habits

GONADAL & GERM CELL TUMOR

Abdominal & pelvic UTZ Abdominal & pelvic CT scan Tumor markers like AFP & B HCG Biopsy

NEUROBLASTOMA
10th (3.7%)
Cancer of the adrenals & other sympathetic chain ganglion cells fr head to coccyx Rapidly growing mass- bone & bone marrow Periorbital ecchymosis (racoons eye)

NEUROBLASTOMA
Abdominal NB: vomiting, diarrhea, abdominal enlargement & pain Mediastinal NB: cough and obstructive s/sx & pain
Diagnosis: CBC w/ platelet count, abdo & chest UTZ, CT scan, BMA, urine VMA, serum LDH & biopsy w/ immunohistochemical stain for NSE

LIVER CANCER
Hepatoblastoma or hepatocellular Carcinoma, 11th (2.3%) Hepatoblastoma: congenital, RUQ abdo mass- growth- pain, w or w/o jaundice early but later asso w/ vomiting & abdominal obstruction
HCC; prev Hep B infection in mom or pt

Diagnosis: ABdo UTZ, CT, MRI & AFP

STAGING
Unique for each type of cancer
Need to determine approach to mgt & prognosis Stage 1: confined to organ of origin only Stage 11: out of organ of origin but not involved LN of that side of diaphragm Stage 111: spread to LN of same side Stage 1V: spread to LN both sides

STAGING
Requires lab an radiologic exam to determine extent of dse at diagnosis CBC w/ platelet ct BUN, crea, SGOT,SGPT, LDH Urinalysis Xray of chest, bones UTZ of chest, abdomen CT scan of organ required

STAGING
Other examinations
Bone marrow aspiration

CSF analysis Tumor markers like AFP, B HCG, urine VMA Nuclear scans like bone scan, gallium scan

TREATMENT
Childhood cancer is a systemic disease Multidisciplinary team Surgery: total excision or partial excision or debulking or biopsy Chemotherapy Neoadjuvant: before surgery, to shrink tumor Adjuvant: after surgery, to take care of residual or microscopic metastases

TREATMENT
Chemotherapy, side effects
Hair loss

Nausea/vomiting Anemia,neutropenia,thrombocytopenia
Oral sores or mucositis

Anorexia or loss of appetite

TREATMENT
Radiotherapy: local tx reserved for

residual dse after surgery & chemotx Side effects: Skin changes Hair loss Nausea/vomiting Diarrhea Skeletal changes Gonadal damage Secondary malignancies

TREATMENT

Supportive care Optimum nutrition (vitamins,minerals, etc) Prevention of infxn (handwashing,daily baths) Blood support products Colony stimulating factors Prophylactic cotrimoxazole & nystatin Fluconazole for severe mucositis