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Childhood Cancer

YETTY MOVIETA NENCY


PEDIATRIC HEMATOLOGY ONCOLOGY DIVISION.
MEDICAL FACULTY OF DIPONEGORO UNIVERSITY
SEMARANG
ETIOLOGY

INTRINSIC FACTORS (GENETIC)


ENVIRONMENT :
- RADIATION
- VIRAL INFECTION
- POLLUTANT
- FREE RADICALS
- PESTICIDE
- etc
Classification

1. BLOOD CANCER
- ACUTE LEUKEMIA (ALL and AML)
ALL L1- L3
AML M0-M7
- Chronic leukemia (CML)

2. Solid Tumour
Distribution of Childhood Cancer

NBL Hodgkin's
8% 5% NHL CNS
3% 18%
Soft Tissue
Sarcoma Liver
7% 1%
Wilm's
Tumor Leukemia
6% Retina 33%
Bone OtherGerm Cell 3%
5% 3%
8%
Type Of Leukemia

5%
19%

77%

ALL AML CML

Workshop Bone Marrow Diagnosis


Aula Lab RSDK, 25 Nov 2010 bambangsdmt@gmail.com
Three type of leukemia are
seen in children
Acute Lymphoblastic Leukemia (ALL- 75%- 83% of all
leukemia)
Acute Myeloid Leukemia (AML- about 17% - 20% of
leukemia)
Chronic Myeloid Leukemia (CML 5% of all leukemias)
chronic Lymphocytic leukemia is not seen in children.
Diagnosis

ALL-L1

Bone marrow aspirate


French-American-British Co-operative group (FAB)
proposed criteria for classifying ALL into three
subtypes L1, L2, and L3 :

ALL-L1 is the most frequent subtype in childhood ALL-L2

ALL
ALL-L2 morphology is more common in adults
ALL-L3 morphology is usually associated with B-
cell leukemia with t(8; 14) requiring a specific
therapeutic approach

Workshop Bone Marrow Diagnosis bambangsdmt@gmail.com


Aula Lab RSDK, 25 Nov 2010 ALL-L3
TYPE OF SOLID TUMOUR

LYMPHOMA
NEUROBLASTOMA
RETINOBLASTOMA
WILM TUMOUR
HEPATOMA
OSTEOSARCOMA
TERATOMA
BRAIN TUMOR
RHABDOMYOSARCOMA
etc
DIAGNOSIS SOLID TUMOUR

BIOPSYAND HISTOPATOLOGY
TUMOUR MARKERS
IMAGING
TREATMENT MODALITY

BLOOD CANCER:
CHEMOTHERAPY
BONE MARROW TRANSPLANTATION

SOLID TUMOUR:
OPERATION
CHEMOTHERAPY
RADIATION (IF NEEDED)
LYMPHOMA

CANCER THAT ORIGINATE FROM LYMPHATIC TISSUE/ LYMPH NODE


TYPE: HODGKIN AND NON HODGKIN LYMPHOMA
SIGN: PAINLESS ENLARGEMENT OF LYMP NODE IN THE NECK, ABOVE
COLLARBONE, AXILLA OR INGUINAL
SOMETIMES UNSPECIFIC SYMTOMP
OCCUR MORE OFTEN IN IMMUNODEFICIENCY PATIENTS

Diagnosis : BIOPSI + HISTOPATHOLOGY


TREATMENT: BASED ON STAGING , CHEMOTHERAPY
RETINOBLASTOMA
EMBRYONAL CANCER THAT DEVELOP FROM IMMATURE CEL OF RETINA
ALMOST ALL CHILDREN LOSE THEIR VISION
HEREDIATRY GENETIC DEFECT: MUTATION ON CHROMOSOM 13/ RB 1GENE
SIGN: LEUCOCORIA, STRABISMUS, LOW VISION, REDDISH EYE
DIAGNOSIS: FUNDUSCOPY
TREATMENT:
OPERATION ( ENUCLEATION)
CHEMOTHERAPY
LASER PHOTOCOAGULATION
RADIOTHERAPY
PROGNOSIS: DEPEND ON EARLY OR LATE PRESENTATION
WILM TUMOUR

OR NEPHROBLASTOMA: IS A CANCER THAT ORIGINATE FROM KIDNEY


SIGN: PAINLESS ABNORMALLY LARGE ABDOMEN, SOMETIMES FEVER AND
HEMATURIA
MOSTLY UNILATERAL
OCCUR MOST IN 3-5 YEAR (BOY)
ETIOLOGY: MUTATION OF WT1 GENE ON CHROMOSOME 11P13
DIAGNOSIS: USG, CT SCAN, MRI
TREATMENT: OPERATION AND CHEMOTHERAPY
PROGNOSIS: DEPEND ON STAGING AND TREATMENT.
IF RESPON WITH TREATMENT 5 YR SURVIVAL ALMOST 90%
NEUROBLASTOMA

CANCER THAT ARISING FROM NEURAL CREST OF SYMPHATETIC NERVOUS


SYSTEM.
LOCATION: INTRACRANIAL AND EXTRACRANIAL (MOSTLY IN ABDOMEN)
SIGN: DEPEND ON LOCATION
SWOLLEN BELLY, BREATHING PROBLEMS, BONE LESION, EYE BRUISING,
ANEMIA
50-60% WIDESPREAD DISEASE
CAUSE: UNCLEAR (FAMILIAL GENE MUTATION?)
DIAGNOSIS: BIOPSY, ELEVATED THE TUMOR METHABOLITES ( VMA/
VANILLYMANDELIC ACID)
TREATMENT: SURGERY, CHEMOTHERAPY, RADIATION, TRANSPLANTATION
PROGNOSIS

AGE
SEX
Pathology finding
STAGING
COMPLICATION
RESPOND OF TREATMENT
PATIENT COMPLIANCE
THANK YOU