Pediatric Oncologic Disorders

Blast cells

Immature white cells found in the bone marrow.

Leukocytosis

Significant increase in white blood cells.

Polycythemia

Significant increase in red blood cells.

Thrombocytopenia

Decreased platelet count of less than 50,000 mcl

Absolute neutrophil count (ANC)

A measure of the body’s ability to fight infection that uses the mature and immature neutrophils as an index.

Neutropenia

Absolute neutrophil count (ANC) less than 1500/mcl.

Blood cell involvement – changes in production (Warning Signs of Cancer)

• Anemia

• Lethargy

• Fatigue

• Activity Intolerance

• Pallor

• Infections

• Petechiae

• Bruising

Caused by tumor - Compression, infiltration, obstruction (Warning Signs of Cancer)

• Pain

• Palpable Mass

• Swelling

• Neurological symptoms

• Abdominal discomfort

Osteosarcoma

Cancer primally of the long bones in adolescence and young adults

Osteosarcoma Patho

• Tumor arises from bone-forming osteoblast

• Characterized by the production of osteoid or immature bone by the malignant cells

• Occurs most commonly in femur, but also tibia

Osteosarcoma Diagnosis

Biopsy for definitive diagnosis CT scan or MRI to determine extent of lesion for surgery and to identify metastasis

Osteosarcoma Treatment

involves chemotherapy and surgery. Chemotherapy is given before and after surgery to target the tumor and any cancer cells that may have spread. Surgery may be limb-sparing or an amputation

Osteosarcoma Clinical Presentation

Bone pain, swelling, a lump, or decreased movement in the affected limb. Pain may be sharp or dull, and it may increase with activity or lifting

Neuroblastoma

Usually diagnosed between ages 1 and 2 years

Neuroblastoma Diagnosis

Urine catecholamine level may be elevated. Ultrasonography is the first-line diagnostic test Biopsy for staging

Neuroblastoma Treatment

involves chemotherapy, radiation and surgery

Neuroblastoma Patho

• originates from primitive sympathetic ganglion cells.

• can occur anywhere along the sympathetic nervous system chain.

Neuroblastoma Clinical Presentation

• Abdominal mass

• Fever

• Lump in the abdomen

• Periorbital Ecchymosis

• Wheezing

• Increased WOB

• Coughing

• Bone Pain

Wilms tumor

Typically occurs in children younger than age 5 years, presenting between ages 3 and 5 years

Wilms tumor Patho

• Abnormal renal development alters the cellular function responsible for differentiation of the tubules and glomerulus.

• Several tumor suppressor genes appear to be involved, but their exact role in the development of Wilms tumor is unknown

Wilms tumor Diagnosis

• Renal and abdominal ultrasound

• CT scan or MRI to determine if mets is present

• 24-hour urine collection

Wilms tumor Clinical Presentation

• Firm abdominal mass

• Asymmetry or visible mass in abdomen

• Hypertension

• Due to increased renin production

Wilms tumor Treatment

• Surgical removal of the tumor

• Nephrectomy

• Chemotherapy & radiation dependent on staging

Acute lymphocytic (lymphoblastic) leukemia

characterized by abnormal growth of lymphocyte precursors (lymphoblasts)

Acute lymphocytic (lymphoblastic) leukemia Diagnosis

Complete blood count (CBC) with differential shows a decreased RBC count, thrombocytopenia, and neutropenia, and a WBC differential shows the cell type.

Acute lymphocytic (lymphoblastic) leukemia Patho

The immature, nonfunctioning WBCs replace normal marrow elements, resulting in a marked decrease in the production of normal blood cells

Acute lymphocytic (lymphoblastic) leukemia Clinical Presentation

• Pallor

• Lymph node enlargement

• Liver or spleen enlargement

• Petechiae, especially on the lower extremities

Acute lymphocytic (lymphoblastic) leukemia Treatment

• Chemo

• Well-balanced diet

• Neutropenic diet

Retinoblastoma

• Malignant tumor of the eye involving the retina

• Can be unilateral or bilateral usually diagnosed before the age of 3 years

Retinoblastoma Diagnosis

Computed tomography scanning, magnetic resonance imaging, or ultrasonography of the head and eyes reveals a tumor.

Retinoblastoma Patho

• During embryonic growth, retinocytes (rapidly growing cells in the eye) undergo maturation to form the retina.

• A genetic mutation causes these cells to continue to grow uncontrolled, forming a mass of cells (tumor) on the retina.

Retinoblastoma Clinical Presentation

• Leukocoria

• Strabismus that occurs with vision loss due to central macular degeneration

• Erythema

Retinoblastoma Treatment

• radiation, chemo, Cryotherapy (used in focal therapy)

• Laser photocoagulation

• Enucleation with ocular prosthesis (when treatment fails, for advanced disease, and when orbital or optic nerve involvement is suspected)