Transcript When and How to Evaluate Signs and Symptoms for Cancer

CHILDHOOD
CANCERS
DR NADEEM ZUBAIRI
Incidence of Childhood Cancers
Cancer
Leukemia
Central nervous system
tumor
Lymphoma
Neuroblastoma
Soft tissue sarcoma
Renal tumor
Bone tumor
Others
Incidence (%)
30.2
21.7
10.9
8.2
7.0
6.3
4.7
11.0
Signs and Symptoms of Childhood Cancers and Conditions That Can Mimic These Cancers
Common conditions in the
Sign or symptom
Type of cancer
differential diagnosis
Fever
Leukemia, lymphoma
Infection
Vomiting
Abdominal mass, brain tumor Infection, gastroesophageal
reflux
Constipation
Abdominal mass
Poor diet
Cough
Mediastinal mass
Upper respiratory infection,
reactive airway disease,
pneumonia
Bone or muscle pain
Leukemia, bone tumor,
Musculoskeletal injury, viral
neuroblastoma
infection
Headache
Brain tumor
Tension headache, migraine,
infection
Lymphadenopathy (> 2 cm) Leukemia, lymphoma,
Lymphadenitis, systemic
metastatic disease
infection, collagen vascular
disease
Hematuria
Wilms' tumor
Urinary tract infection,
glomerulonephritis
Voiding difficulty
Rhabdomyosarcoma
Congenital urinary tract
abnormalities
When and How to Evaluate Signs
and Symptoms for Cancer
Symptom
Fever
Vomiting
Constipation
Cough
Bone or muscle pain
Headache
Hematuria
Voiding difficulty
Lymphadenopathy (> 2 cm)
When to evaluate
Test
Fever lasts longer than 14 days
CBC with differential
with no identifiable cause.
Vomiting lasts longer than 7 days Abdominal and head CT scans
with no identifiable cause.
Vomiting is associated with
headache during sleep.
Constipation is prolonged (> 1
month) and does not respond to
conventional measures.
Cough is prolonged (> 2 weeks)
and has no identifiable cause.
Pain is prolonged (> 2 weeks)
and has no identifiable cause.
Headache occurs during sleep, is
associated with neurologic signs
and vomiting, or occurs in the
absence of a family history of
migraine.
Evaluate immediately if hematuria
has no identifiable cause.
Evaluate immediately if voiding
difficulty has no identifiable
cause.
Evaluate if lymphadenopathy
does not respond to a 7-day
Head CT scan
Abdominal and pelvic CT scans
Chest radiograph
Plain-film radiograph, bone and
CT scans, CBC
Head CT scan
Abdominal ultrasound
examination
Abdominal ultrasound
examination
CBC with differential, lactate
dehydrogenase level
Diagnostic Tests
 X-ray
 Skeletal survey
 CT scan
 Ultrasound
 MRI
 Bone marrow aspiration
Biopsy
 Identify cell to determine type of treatment
Interventions
 Radiation therapy
 Chemotherapy
 Surgery
 Bone Marrow and Stem cell transplantation
Chemotherapy Drugs
 Alkylating drug: attack DNA
 Antimetabolites: interfere with DNA production
 Antitumor antibiotics: interferes with DNA
production
 Plant alkaloids: prevent cells from dividing
 Steroid hormones: slow growth of some cancers
Review of Common Side Effects
of
Chemotherapy and Radiation
 Chemotherapy
 Bone marrow
suppression
 Alopecia
 Malaise/fatigue
 Nausea
 Vomiting
 Anorexia
 Stomatitis
 Radiation side effects
 Skin reactions
 Fatigue
 Bone marrow suppression
 Nausea
 Vomiting
 Anorexia
 Mucositis
PREVENT COMPLICATIONS OF
MYELOSUPPRESSION
 Infection
Goal is prevention
 Hemorrhage
Platelet Count less than 20,000/mm
Epistaxis and Gingival
 Anemia
Transfusions
Surgery
 Curative
 Remove the tumor and cancerous tissue
 Palliative
 Relieve complications due to the cancer
Bone Marrow and Stem Cell
Transplantation
 The goal of therapy is to administer a
lethal dose of chemotherapy and radiation
therapy that will kill the cancer and then
re-supply the body with bone marrow and
stem cells to reconstitute immunologic
function.
 Healthy bone marrow or stem cells are
infused into the bloodstream and migrate
to the marrow space to replenish the
patient’s immunologic function and help
kill remaining cancer cells.
Types of Transplantations
 Syngeneic
 bone marrow comes from identical twin
 Allogeneic
 bone marrow comes from matched sibling (one in
four chances) or someone who is histocompatible.
 Autologous
 own bone marrow. May be harvested at time of
remission in preparation for relapse or when bone
marrow is free of malignant cells. Also being used
so toxic doses of chemotherapy and radiation can
be administered and the bone marrow rescued.
Side effects of Transplantation
1. Graft-Versus-Host Disease (GVHD) – potentially
lethal immunologic response of donor T cells
against the tissue of the recipient.
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Signs and symptoms – rash, malaise, high fever,
diarrhea, liver and spleen enlargement.
Because there is no cure, prevention is essential.
Careful tissue typing, irradiation of blood products
which helps to inactivate mature T lymphocytes.
2. Rejection of the transplant
Tumor Lysis Syndrome
 Intracellular contents are dumped into the
extracellular fluid as cells are lysed, or killed
 Intracellular electrolytes overload the kidneys and, if
the condition is not monitored and treated, cause
kidney failure
 Most common in children with leukemias with very
high WBCs and in children with non-Hodgkin’s
lymphomas, especially when extensive disease is
present
LEUKEMIA
 Definition - “White Blood”, Involves blood forming
tissues of the bone marrow, spleen, and lymph
nodes
 Outstanding Characteristic - Abnormal
uncontrolled proliferation of one type of wbc
 80-85% of childhood Leukemias are Acute
Lymphoblastic Leukemia (ALL)
INCIDENCE
 4 per 100,000 children per year
 Peak Incidence - Between 2-6 years
 Twice as common in white children as non-white
 More common in males
ETIOLOGY
 Largely unknown
 Most likely - complex interactions of both genetic and
environmental factors - Ecogentics
HOST FACTORS
 Ataxiatelangectasia - autosomal recessive
transmission
 Xeroderma Pigmentosum
 Immunodeficiency States - 100-fold increased risk,
either congenital or acquired
 Specific Congenital Anomalies - Down Syndrome
(10-18 times greater risk of developing Leukemia)
ENVIRONMENTAL FACTORS
 Chemical and Physical Agents - 1) DES
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Choramphenical, 3) Benzene, 4) Asbestos
Radiation Exposure
Anabolic Androgenic Steriods
Cytotoxic Agents
Immunosuppressive Agents
Viruses - Epstein Barr
2)
Pathophysiology of Leukemias
 The WBC's are produced so rapidly that
immature cells (blast cells) are released into
the circulation.
 These blast cells are nonfunctional, can't
fight infection, and are formed continuously
without respect to the body's needs
 The blasts cells then invade other organs
and interfere with metabolism / function.
The production of red blood cells and
platelets decreases leading to anemia and
thrombocytopenia.