Pediatric oncologyPediatric oncology- The Majority are sporadic.- The Majority are sporadic.

-2 -2ndnd cause of death in the… cause of death in the…while the 5while the 5thth in the….countries in the….countries

Some forms of cancer are Some forms of cancer are confined to children:confined to children:

- Nephroblastoma- Nephroblastoma- Neuroblastoma- Neuroblastoma- Retinoblastoma- Retinoblastoma

Incidence of Incidence of malignancies:malignancies:1 in 600 of< 151 in 600 of< 15Leukemias; 35%Leukemias; 35%C.N.S; 25%C.N.S; 25%Lymphomas; 10%Lymphomas; 10%All other forms; 30%All other forms; 30%

AetiologyAetiology::Mainly unknown and sporadic but Mainly unknown and sporadic but may be associated with;may be associated with;- Fameleal tendency.- Fameleal tendency.- Genetic disorders.- Genetic disorders.- Immunodefeciency disorders.- Immunodefeciency disorders.- Chromosomal disorders.- Chromosomal disorders.- Viral infections.- Viral infections.- Enviromental factors.- Enviromental factors.

Presenting featuresPresenting features::1)Prol.fever1)Prol.fever2)Masses:2)Masses: Abdominal Abdominal Mediastinal Mediastinal Trunk & extremities Trunk & extremities3)Bone pain3)Bone pain4) Lymphadenopathy4) Lymphadenopathy5)↑ I.C.P.5)↑ I.C.P.6)Bruising,petechiae,& pallor6)Bruising,petechiae,& pallor7)Leukorcia7)Leukorcia8)Hypertention.8)Hypertention.

Leukemia:Leukemia:Most common pediatric Most common pediatric malignancy.malignancy.85% are of ALL85% are of ALLpeak at 2-6yrpeak at 2-6yrALL classification:ALL classification:1)Morphologicaly to 1)Morphologicaly to L1,L2,&L3L1,L2,&L32)Immunophenotypicaly to T-2)Immunophenotypicaly to T-cell , B-cell, & pre B-cell.cell , B-cell, & pre B-cell.

Clinical picture:Clinical picture:PallorPallor

BleedingBleedingHepatosplenomegally and Hepatosplenomegally and

LAPLAPFeverFever

Bone painBone painTesticular painTesticular pain

DIAGNOSISDIAGNOSIS C.B.C. may rarely be C.B.C. may rarely be

normalnormal B.M examination ; B.M examination ;without which without which

diagnosisdiagnosis should never be made.should never be made.

Prognosis:Prognosis:Favorable in:Favorable in:

1-9 years1-9 yearsfemalesfemales

White raceWhite race<50,000 W.B.C.<50,000 W.B.C.

Ploidy(>53 chromosomes within Ploidy(>53 chromosomes within lymphoblasts)lymphoblasts)

No organomegaly.No organomegaly.No Chromosomal translocationNo Chromosomal translocation

Late relapasersLate relapasers

TreatmentTreatment::1)Induction.;1)Induction.; 98% of ALL go to 98% of ALL go to remission by a 4 weeks course of:remission by a 4 weeks course of:VincristineVincristineSteroidSteroidL.asparaginaseL.asparaginaseC.S.F. treatment by MTH, cytarabine C.S.F. treatment by MTH, cytarabine &H.C.&H.C.2)Consolidation:2)Consolidation:Cyclical MTH, L-asparaginase, Cyclical MTH, L-asparaginase, doxorubicin, cytarabine, doxorubicin, cytarabine, vincristine,cyclophosphamide & vincristine,cyclophosphamide & cranial radiation ( in over 5 years ).cranial radiation ( in over 5 years ).

3)Maintenance:3)Maintenance:Daily; 6-mercaptopurine; Weekly; Daily; 6-mercaptopurine; Weekly; Methotrexate and Monthly; Vincristine Methotrexate and Monthly; Vincristine and steroids for 2-3 years.and steroids for 2-3 years.B.M transplantation for high risk cases B.M transplantation for high risk cases & frequent relapsers.& frequent relapsers.