Incidence of Childhood Cancer - PowerPoint PPT Presentation

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Incidence of Childhood Cancer

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Incidence of Childhood Cancer What is cancer ? Uncontrolled growth of cells Are these cancer cells abnormal? No, but their behaviour is. – PowerPoint PPT presentation

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Title: Incidence of Childhood Cancer


1
Incidence of Childhood Cancer
2
  • What is cancer ?
  • Uncontrolled growth of cells
  • Are these cancer cells abnormal?
  • No, but their behaviour is.

3
Combination Chemotherapy
  • Use of two or more drugs administered together,
    which usually act at different phases of cell
    cycle and therefore kill more cells.

4
What is a clinical trial?
  • A standardised approach to the treatment of a
    certain disease which is treated the same in all
    participating centres.

5
Why the need for clinical trials?
  • So that the best approach to treatment is arrived
    at as quickly as possible by treating the
    largest number of patients in the shortest
    possible time.

6
Treatment of Cancer
  • Surgery
  • Chemotherapy
  • Radiotherapy

7
Childhood Leukaemia
  • Acute Lymphoblastic (ALL) 70
  • Acute Myeloid Leukaemia (AML) 20
  • Acute Undifferentiated (AUL) lt5
  • Chronic Myeloid (CML) and Juvenile Chronic
    Myeloid (JCML) 5

8
Acute Leukaemia
  • 30 childhood cancers
  • 4/100,000 children lt15years
  • Peak incidence 1-5 years

9
ALL - Clinical Features
  • Fever
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Bleeding
  • Bone pain

10
ALL - Differential Diagnosis
  • Non malignant -
  • Infectious mononucleosis
  • ITP
  • Aplastic anaemia
  • Malignant-
  • Neuroblastoma
  • Bone tumours

11
Lymphoma
  • 80 childhood lymphomas are NHL
  • Almost all high grade
  • Tendency to BM and CNS involvement
  • Disease free survival 70-85

12
Hodgkins Lymphoma
  • Lower incidence than NHL
  • Rare in childrenlt 10yrs
  • Usually present with cervical adenopathy
  • Often localised disease
  • Disease free survival good
  • Late effects considerable

13
Brain Tumours
  • Infratentorial -
  • disturbance of gait and co-ordination
  • cranial nerve palsy
  • headaches and vomiting

14
Brain Tumours
  • Supratentorial -
  • Headaches
  • Convulsions
  • UMN signs
  • Visual disturbance

15
Brain Tumours
  • Post fossa commonest site
  • Gliomas gtPNETgtependymoma gtothers
  • Surgery offers best chance of cure
  • Some tumours chemosensitive
  • Most tumours radiosensitive but avoid if possible
    lt4yrs.
  • Overall survival 50 approx

16
Differential Diagnosis of Malignant Abdominal
Tumours
  • Neuroblastoma
  • Wilms tumour
  • Non Hodgkins lymphoma
  • Soft tissue sarcoma
  • Hepatoblastoma

17
Neuroblastoma
  • Commonest extracranial tumour
  • Tumour of neuroectodermal origin
  • Incidence 7-8/million lt 15 years
  • Peak incidence 2-5 years

18
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19
Neuroblastoma - Clinical Features
  • Depends on local, regional and metastatic spread
  • Metabolic effects
  • Greatest mimicker in paediatric practice

20
NBL Survival Curve Patients Diagnosed 1993 to
2003
(76)
(30)
Stage 1 N 3 Stage 2 N 12 Stage 3 N
9 Stage 4 N 34 Stage 4S N 6
21
Wilms Tumour
  • Arises from the kidney
  • Incidence 7/million lt15 years
  • Peak incidence 2-5 year age group

22
Wilms Tumour - Clinical Features
  • Asymptomatic abdominal mass
  • Abdominal discomfort
  • Haematuria
  • Hypertension

23
Rhabdomyosarcoma
  • Tumour of mesenchymal origin
  • Commonest STS in childhood
  • Incidence 5-6 of childhood cancers

24
Rhabdomyosarcoma - Clinical Features
  • Occurs in all sites - 35 head neck
  • Prognosis depends on primary site -
  • paratesticular gt90, head neck 30
  • peripheral - worst prognosis, usually
    alveolar.
  • Histology major prognostic indicator

25
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26
Bone Tumours
  • Comprise 5 of childhood cancers.
  • Unusual lt5years of age
  • Ewing osteosarcoma commonest
  • Up to 20 will have metastases at diagnosis.

27
Ewing Sarcoma- Clinical Features
  • Pain usually gt6 months
  • Palpable mass
  • Pathological fracture
  • Fever

28
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29
Osteosarcoma - Clinical Features
  • Pain usually weeks cf months
  • Commonest around knee
  • Commoner in adoloscence
  • Up to 20 metastases at presentation.

30
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31
Bone Tumours - Differential Diagnosis
  • Ewing sarcoma
  • Osteosarcoma
  • Non Hodgkins lymphoma
  • Langerhan cell histiocytosis
  • Aneurysmal bone cyst
  • Acute osteomyelitis

32
Hepatoblastoma
  • Presents most commonly 1-3yrs
  • Large mass R hypochondrium
  • aFP usually grossly elevated
  • Usually chemosensitive
  • DFS gt80
  • Liver transplant rarely indicated.

33
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34
Germ cell tumours
  • 40 sacrococcygeal
  • May arise in gonads
  • Usually chemosensitive
  • AFP sensitive indicator

35
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36
Oncology Survival Curve Patients Diagnosed 1983
to 2003
70
59
1983 to 1993 N 729 1993 to 2003 N 1,160
37
Late Effects of Childhood Cancer
  • Depend on
  • Disease
  • Age
  • Treatment

38
SMN
  • Depends on - primary cancer
  • - treatment
  • - genetic predisposition
  • - age at diagnosis.
  • Adult survivors of childhood cancer 10-20 times
    greater risk of SMN than peers.
  • 12-20 within first 20 years.
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