2. Neoplasms of infancy andNeoplasms of infancy and
childhoodchildhood
Benign>malignantBenign>malignant
Incidence of malignancy:1-15 yrs - 1.3 /Incidence of malignancy:1-15 yrs - 1.3 /
10,000 /year but leading cause of death10,000 /year but leading cause of death
after accidents in the West.after accidents in the West.
Most malignant tumours in childrenMost malignant tumours in children
arise from hematopoietic,nervous andarise from hematopoietic,nervous and
soft tissues.soft tissues.
4. Difference between adult & PaedDifference between adult & Paed
tumourstumours
Association between abnormalAssociation between abnormal
development (teratogenesis) & tumourdevelopment (teratogenesis) & tumour
induction.induction.
Prevalence of constitutional geneticPrevalence of constitutional genetic
abnormalities or syndromes thatabnormalities or syndromes that
predispose to cancerpredispose to cancer
Tendency of malignancy to undergoTendency of malignancy to undergo
differentiationdifferentiation
Improved survivalImproved survival
7. Sacrococcygeal teratomasSacrococcygeal teratomas
Germ cell neoplasmGerm cell neoplasm
1:40,000 live births1:40,000 live births
Mass in the sacrumMass in the sacrum
and buttocksand buttocks
Composed ofComposed of
elements of > 1 germelements of > 1 germ
cell layer.mixture ofcell layer.mixture of
elements.elements.
Neural originNeural origin
determines thedetermines the
8. Signs of Childhood CancerSigns of Childhood Cancer
CContinued, unexplained weight lossontinued, unexplained weight loss
HHeadaches, often with early morning vomitingeadaches, often with early morning vomiting
IIncreased swelling or persistent pain in bones, joints, back, or legsncreased swelling or persistent pain in bones, joints, back, or legs
LLump or mass, esp. in the abdomen, neck, chest, pelvis, orump or mass, esp. in the abdomen, neck, chest, pelvis, or armpitsarmpits
DDevelopment of excessive bruising, bleeding, or rashevelopment of excessive bruising, bleeding, or rash
CConstant/recurrent infectionsonstant/recurrent infections
AA whitish color behind the pupilwhitish color behind the pupil
NNausea which persists or vomiting with or w/o seizureausea which persists or vomiting with or w/o seizure
CConstant tiredness or noticeable palenessonstant tiredness or noticeable paleness
EEye or vision changes which occur suddenly and persistsye or vision changes which occur suddenly and persists
RRecurrent or persistent fevers of unknown originecurrent or persistent fevers of unknown origin
9. WHY DIFFICULT TO DIAGNOSEWHY DIFFICULT TO DIAGNOSE
CHILDHOOD CANCER?CHILDHOOD CANCER?
Vague manifestationsVague manifestations
Childhood malignancies are rareChildhood malignancies are rare
Doctor’s reluctance to consider cancerDoctor’s reluctance to consider cancer
diagnosisdiagnosis
12. ACUTE LYMPHOBLASTICACUTE LYMPHOBLASTIC
LEUKEMIALEUKEMIA
Classification:Classification:
L1 – Predominantly small lymphoblasts with littleL1 – Predominantly small lymphoblasts with little
cytoplasm.cytoplasm.
L2 – Larger and pleomorphic with moreL2 – Larger and pleomorphic with more
cytoplasm irregular nuclear shapecytoplasm irregular nuclear shape
with prominent nucleuswith prominent nucleus
L3 – Have finely stippled and homogenousL3 – Have finely stippled and homogenous
nuclear chromatin, prominent nucleoli deep bluenuclear chromatin, prominent nucleoli deep blue
cytoplasm with prominent vacuolation.cytoplasm with prominent vacuolation.
25. Clinical featuresClinical features
Painless, firm, cervical or supraclavicularPainless, firm, cervical or supraclavicular
adenopathy is the most commonadenopathy is the most common
presenting sign. Rarelypresenting sign. Rarely
hepatosplenomegalyhepatosplenomegaly
Less commonLess common:: Pruritus, lethargy andPruritus, lethargy and
anorexiaanorexia
26. ANN ARBOR STAGINGANN ARBOR STAGING
Stage 1Stage 1 ::Single lymphnode or a single extralymphaticSingle lymphnode or a single extralymphatic
site or organ.site or organ.
Stage 2Stage 2 :: 2 or more lymphoid regions on the same2 or more lymphoid regions on the same
side of diaphragm or localized involvement of a ELS.side of diaphragm or localized involvement of a ELS.
Stage 3Stage 3 :: Lymphnode on both sides of diaphragm,Lymphnode on both sides of diaphragm,
may be ccompanied by involvement of spleen or ELS.may be ccompanied by involvement of spleen or ELS.
Stage 4Stage 4 ::Diffuse or disseminated involvementDiffuse or disseminated involvement
Also stage A & B- Presence of fever, night sweats &Also stage A & B- Presence of fever, night sweats &
weight lossweight loss
28. TreatmentTreatment
MOPP or ABVDMOPP or ABVD
Six cycles minimumSix cycles minimum
Prognosis:Prognosis: 70-90%70-90%
29. one year old child brought withone year old child brought with
the swelling in the b/l orbitalthe swelling in the b/l orbital
region with excessive cry. o/eregion with excessive cry. o/e
mass palpable in the rt lumbarmass palpable in the rt lumbar
region extending in to the iliacregion extending in to the iliac
area diagnosis??area diagnosis??
32. NeuroblastomaNeuroblastoma
Most frequent diagnosedMost frequent diagnosed
neoplasm in infantsneoplasm in infants
C/FC/F- May develop at any site of- May develop at any site of
sympathetic nervous tissuesympathetic nervous tissue
→→ involvement – hard fixed mass,involvement – hard fixed mass,
may produce spinal or neural rootmay produce spinal or neural root
compression.compression.
Cervical involvement- Horner’sCervical involvement- Horner’s
syndromesyndrome
Fever, Irritability, FTI, bone pain,Fever, Irritability, FTI, bone pain,
HypertensionHypertension
Opsoclonus- MvoclonusOpsoclonus- Mvoclonus
37. Pathology- usually a solitary growth in anyPathology- usually a solitary growth in any
part of either kidneypart of either kidney
Stage1: Limited to kidneyStage1: Limited to kidney
Stage2: Beyond kidneyStage2: Beyond kidney
Stage3: Confined to abdomenStage3: Confined to abdomen
Stage4: haematogenous extensionStage4: haematogenous extension
Stage5: B/L rental involvementStage5: B/L rental involvement
38. C/FC/F
Abdominal or flank massAbdominal or flank mass
½ have½ have →→ abdominal pain orabdominal pain or
vomiting hypertensionvomiting hypertension
Diagnosis-Diagnosis-
USG, CTUSG, CT
Chest X-ray, CTChest X-ray, CT
40. 3 ½ yr old female child brought3 ½ yr old female child brought
with c/o sudden onset abdwith c/o sudden onset abd
distension rapidly growing indistension rapidly growing in
size on day 1size on day 1
42. Non Hodgkins lymphomaNon Hodgkins lymphoma
3 Histologic subtypes3 Histologic subtypes ––
LymphoblasticLymphoblastic
Large cellLarge cell
Small non cleavedSmall non cleaved
43. Clinical featuresClinical features
Lymphoblastic – Intrathoracic tumor- dyspnea,Lymphoblastic – Intrathoracic tumor- dyspnea,
chest pain, dysphagia, pleural effusionchest pain, dysphagia, pleural effusion
Large cell – many sitesLarge cell – many sites
SNCL – abdominal tumor – ABD. Pain,SNCL – abdominal tumor – ABD. Pain,
distension, bowel obstruction, intestinaldistension, bowel obstruction, intestinal
bleeding, perforation may involve CNS or bonebleeding, perforation may involve CNS or bone
marrowmarrow
Also classified into 4 stagesAlso classified into 4 stages
44. InvestigationsInvestigations
CBC, S.electrolytes, uric acid, CO+, PO4,CBC, S.electrolytes, uric acid, CO+, PO4,
LDHLDH
LFTLFT
Spinal fluid cytologySpinal fluid cytology
Chest X – ray + CTChest X – ray + CT
Gallium scan ABD X – ray + CTGallium scan ABD X – ray + CT
Bone marrow aspirate & biopsyBone marrow aspirate & biopsy
46. Case scenerioCase scenerio
2 yr old child presented with slow growing2 yr old child presented with slow growing
mass started in the lateral canthal regionmass started in the lateral canthal region
n now attained the size as shown in figure.n now attained the size as shown in figure.
Histopathology showing the following .Histopathology showing the following .
Fundus examination shows the following .Fundus examination shows the following .
What might be differential diagnosis?What might be differential diagnosis?
51. RetinoblastomaRetinoblastoma
C/F- Leukocoria, strabismus, orbital infalmn,C/F- Leukocoria, strabismus, orbital infalmn,
painpain
DiagnosisDiagnosis →→ Opthalmology – orbital USG andOpthalmology – orbital USG and
CTCT
Treatment – u/l enucleatonTreatment – u/l enucleaton
Laser photocoagulation orLaser photocoagulation or
cryotherapycryotherapy
B/lB/l →→ enucleation of the more several effectedenucleation of the more several effected
eye.eye.