Pediatric cancer. Kleebsabai Sanpakit, MD. Hemato/Oncology division, Department of Pediatrics Faculty of Medicine Siriraj hospital

Transcription

1 Pediatric cancer เทคน คการให รห สโรค Siriraj Cancer ICD-O Registry ฉบ บม ออาช พ Kleebsabai Sanpakit, MD. Hemato/Oncology division, Department of Pediatrics Faculty of Medicine Siriraj hospital

2 Different between childhood and adult cancer Childhood cancer Adult cancer 1. Incidence Less More 2. Origin Stem cells (undifferentiated and naive cells) Epithelial cells (highly differentiated cells surround body cavity or surface of the body)..carcinoma..sarcoma 3. Speculated cause Spontaneous mutation (genetic accident) Interaction of cells and environment (acquired) 4. Treatment Tolerate more aggressive treatment (more resilient than adult) Often have underlying other health problem 5. Overall outcome Better Worse

3 Age-adjusted incidence rates for childhood cancer by ICCC Group, N = 1421 cases ~ 50.9% N=266 ~ 9.5% of all childhood cancer Total 2,792 cases Age<15 yrs, Both Sexes Wiangnon S,et al. Asian Pacific J Cancer Prev 2011,12,

4 Pediatric Malignancies in Siriraj Hospital GCT 3% BRAIN 3% RHABDO 3% WILMS 3% HEPATOBLASTOMA 2% OSTEOSARCOMA 2% 0thers 1% EWS/PNET 1% ALL 35% RETINOBLASTOMA 6% NEUROBLASTOMA 8% OTHERS 4% LCH 2% HD 2% NHL 11% ThaiPOG(2004) Incidence 9.5/100, cases/year ANLL 14%

5 Childhood Leukemias Acute lymphoblastic leukemia % Acute non-lymphoblastic leukemia % Chronic leukemias 1-3 % Myeloproliferative disorders Myelodysplastic syndrome Juvenile CML Chronic myelomonocytic leukemia

6

7

8 Signs &Symptoms anemia, fever anorexia, weight loss generalized lymphadenopathy petichiae, bleeding hepatosplenomegaly bone/ joint pain &swelling

9 Acute leukemia Chronic myeloid leukemia

10 Treatment Strategies: To achieve long-term complete remission without untoward sequelae Complete Remission < 5% blasts in BM with trilineage hematopoietic recovery No leukemic cells in PB CSF negative for leukemia No physical signs of leukemia

11 Childhood Lymphoma Hodgkin s disease Non-Hodgkin s lymphoma Lymphoblastic LBL Small non-cleaved SNC Large cell LCL LN above diaphragm Mediastinal mass SVC obstruction LN below diaphragm abdominal mass ascites jaw mass orbital swelling CNS involvement any site hemophagocytic syndrome skin lesions T or B

12

13

14 Lymphadenopathy

15 Ix : CXR, CBC LN - Bx Bone scan, BMA + Bx Abdominal and pelvic or chest CT Rx : chemotherapy, local RT

16 Brain tumors in children

17 Medulloblastoma

18 Treatment SURGERY establish a histologic diagnosis reduce tumor bulk re-establish normal CSF pathways Radiation therapy Chemotherapy

19 Primary tumor site Abdomen (most common) Adrenal glands Celiac axis Thoracic Neck Rx : Surgery Chemotherapy Radiation therapy Neuroblastoma Sites of Disease Common age group : 1 st 5 year of age Metastatic sites Bone marrow Bone Nodes Liver CNS (relapse)

20

21 Retinoblastoma age : < 5 year S & S : leukocoria, eso/exotropia, exophthalmos Ix : eye exam by ophthalmologist BMA, LP Diagnostic imaging - CT / MRI orbit and brain CXR, bone scan Rx : Sx ( enucleation, laser), Chemotherapy, ( RT )

22 Wilms tumor Common age group : 1-5 years of age Signs & Symptoms : abdominal mass, IVC obstruction, hypertension, hematuria Ix : Diagnostic imaging - abdominal U/S, CT, IVP, CXR, bone scan (only CSS, RT) Rx : Surgery, Chemotherapy, ( Radiation therapy )

23 Rhabdomyosarcoma Age : any Location : most common - head & neck others - GU, extremities, trunk Signs & Symptoms : depend on location of tumor Ix : Diagnostic imaging (CT / MRI) Tumor biopsy Metastasis work up - CXR, bone scan, BMA Rx : Surgery, chemotherapy, Radiation therapy

24

25 Hepatoblastoma age : < 5 year S & S : abdominal mass, abdominal pain, anemia, weight loss, nausea, vomiting Ix : Tumor marker - alfa fetaprotein Liver function test Diagnostic imaging - U/S, CT, MRI Rx : Surgery, Chemotherapy

26 Osteosarcoma age : years old Location : Metaphyseal end of long bone distal end of femur > upper end of tibia > upper end of humerus Signs & Symptoms : pain, swelling Ix : X-ray, MRI, Biopsy of tumor Metastatic work up - CXR, bone scan Rx : Surgery, Chemotherapy

27

28 Germ cell tumor incidence 2 % of childhood cancer germinoma VS non germinoma GCT Ix : tumor marker (AFP, HCG ) diagnostic imaging Rx: biopsy/ chemorx/ RT

29 Langerhans-cell histiocytosis

30 Metastasis

31 Thank you for your attention