ONCOLOGY : LEUKEMIA and BRAIN TUMOURS

cancer is second most common cause of death in children after 1 year of age (1st=injuries) usually occur sporadically, but increas...

1. cancer is second most common cause of death in children after 1 year of age (1st=injuries)
2. usually occur sporadically, but increased risk with
   • neurocutaneous syndromes
   • chromosomal syndromes
   • immunodeficiency syndromes        
   • prior malignancy
   • family history
   • exposure to radiation, chemicals, biologic agents 
3. leukemia (25-35%) and brain tumours (20%) most common 
4. some malignancies may be more prevalent in certain age groups
   • newborns:  neuroblastoma, congenital leukemia
   • infancy and childhood:  leukemia, neuroblastoma, Wilms’, retinoblastoma
   • adolescence:  lymphoma, gonadal tumours, bone

 

LEUKEMIA

 

1. most common childhood malignancy 
2. heterogenous group of diseases; types: ALL (80%), AML (15%) and CML (5%) 
3. etiology unknown; EBV associated with African Burkitt lymphoma,
   retrovirus with T cell leukemia
4. signs and symptoms due to infiltration of leukemic cells
   • into bone marrow (bone pain, anemia, neutropenia, thrombocytopenia)
   • into tissues(lymphadenopathy, hepatosplenomegaly, CNS, testes)
5. prognosis:  low-risk - 90% long-term remission, high-risk - 70% long-term remission
6. see also Hematology Notes

	Good	Poor
age	2-10 years	<2 or >10 years
ethnicity	white	black
sex	female	male
lymphadenopathy	no	yes
hepatosplenome galy	no	yes
mediastinal mass	no	yes
initial WBC	<20x 109/L	>20x 109/L
hemoglobin	> 100 g/L	< 100 x g/L
IDH	low	high
lymphoblasts	typical	undifferentiated
hyperploidy	yes	no
translocation	no	yes

 

 

LYMPHOMA

 

• third most common childhood tumour 

Hodgkinís lymphoma

1. older children (age > 15), similar to adult Hodgkinís
2. presents with painless, firm lymphadenopathy
3. B symptoms only in 30% of children

Non-Hodgkinís lymphoma

1. younger children (7-11 years)
2. rapidly growing tumour with distant metastases
3. signs and symptoms related to disease site, most commonlyabdomen, chest (mediastinal mass), head and neck region
4. see also Hematology Notes
   

BRAIN TUMOURS

 

1. predominantly infratentorial involving cerebellum, midbrain, brainstem
2. glial (astrocytomas most common) or primitive neuroectodermal
   (medulloblastoma, germ cell tumours, ependymothera)

signs and symptoms

1. infratentorial: vomiting, morning headache, increased head circumference, ataxia, diplopia, nystagmus, papilledema
2. supratentorial: focal deficits, seizure, long tract signs

 

Evaluation

1. history, physical exam including complete neurological exam
2. CT and/or MRI of head as indicated
3. see also Neurosurgery Notes