1. TA OGUNLESI (FWACP)1 OVERVIEW OF CHILDHOOD CANCERS

2. TA OGUNLESI (FWACP)2 CHILDHOOD CANCERS Involve tissues of: CNS, bone, muscle, endothelial tissue, haemopoietic tissue Grow in a short period of time Unlike malnutrition and infections, cancers are not remarkable causes of childhood morbidity & mortality in the developing world

3. TA OGUNLESI (FWACP)3 CLASSIFICATION Embryonal tumor arises from embryonic tissue  Neuroblastoma  Nephroblastoma  Retinoblastoma LymphomasLymphomas = lymphatic tissue  Hodgkin’s lymphoma  Burkitt’s lymphoma

4. TA OGUNLESI (FWACP)4 CLASSIFICATION Leukemias = blood  Acute Lymphoblastic Leukaemia  Acute Myeloblastic Leukaemia Sarcoma seen in tissues other than blood:  Skeletal muscle (rhabdomyosarcoma)  Bone (osteosarcoma)  Nerve (neuroma)

5. TA OGUNLESI (FWACP)5 AETIOLOGY The aetiology of most of the cancers in children are unknown. Only very few have been associated with specific environmental and genetic factors.

6. TA OGUNLESI (FWACP)6 PREDISPOSING FACTORS Viruses & their toxins Epstein-Barr Virus in Bukitt’s Lymphoma Chemical carcinogens  Aflatoxins in hepatocellular carcinoma  Benzene in myeloid leukaemia

7. TA OGUNLESI (FWACP)7 PREDISPOSING FACTORS Genetics  Autosomal dominant inheritance in Retinoblastoma  Down syndrome in leukaemia  Fanconi syndrome in leukaemia  Ataxia telangiectasia in leukaemia  Congenital aniridia in Nephroblastoma

8. TA OGUNLESI (FWACP)8 PREDISPOSING FACTORS Ionizing irradiation  Leukaemia  Brain tumors  Skin carcinoma Drugs  Phenytoin (lymphomas & neural crest tumors)  Barbiturates (brain tumors)  Cyclophosphamide (bladder cancer)  Androgens (leukaemia)

9. TA OGUNLESI (FWACP)9 RECOGNITION OF CHILDHOOD CANCERS Childhood cancers can be difficult to diagnose due to:  Low index of suspicion since they are thought to be rare  Features are non-specific initially & mimic those of other common conditions like viral infections

10. TA OGUNLESI (FWACP)10 CARDINAL SIGNS OF CANCERS Unusual mass or swelling Unexplained palor and loss of energy Spontaneous bruising Prolonged, unexplained fever Headaches in morning Sudden eye or vision changes Excessive – rapid weight loss.

11. TA OGUNLESI (FWACP)11 SIGNS & SYMPTOMS OF CANCERS AND CONDITIONS THEY MIMIC Fever in leukaemia & lymphoma may mimic infections Cough in mediastinal lymphoma & Wilm’s tumor may mimic URTI, asthma or pneumonia

12. TA OGUNLESI (FWACP)12 SIGNS & SYMPTOMS OF CANCERS AND CONDITIONS THEY MIMIC Bone & muscle pain in leukaemia & bone tumor may mimic trauma, SCA or viral myalgia Headache in brain tumor may mimic migraine Haematuria in Wilm’s tumor may mimic UTI, AGN

13. TA OGUNLESI (FWACP)13 SIGNS & SYMPTOMS OF CANCERS AND CONDITIONS THEY MIMIC Lymphadenopathy in leukaemia & lymphoma may mimic viraemia, collagen diseases Constipation in abdominal tumors may mimic poor diet or helminthiasis

14. TA OGUNLESI (FWACP)14 EVALUATION OF SIGNS & SYMPTOMS OF CANCERS Fever > 14 days with no obvious cause: FBC Vomiting > 7 days: Brain & abdominal CT Cough > 2 weeks: Chest X-Ray Bone or muscle pain > 2 weeks: FBC, Plain X-Ray, CT scan

15. TA OGUNLESI (FWACP)15 EVALUATION OF SIGNS & SYMPTOMS OF CANCERS Lymphadenopathy not responding to 7-day course of antibiotics: FBC, LDH Headache associated with emesis: Brain CT Haematuria: Abdomino-pelvic USS

16. TA OGUNLESI (FWACP)16 DIAGNOSTIC TESTS X-ray Skeletal survey CT scan Ultrasound MRI Bone marrow aspiration Biopsy

17. TA OGUNLESI (FWACP)17 PRINCIPLES OF THERAPY Chemotherapy to destroy all cells in the resting, dividing & maturing stages. This is achieved with:  Cytotoxic drugs (alkylating agents, anti-metabolites, antibiotics, alkaloids)  Hormones (steroids, estrogens, androgens) Major problem with chemotherapy are the sanctuary sites (testes, thyroid, CNS) Can be used alone or with other modalities

18. TA OGUNLESI (FWACP)18 PRINCIPLES OF THERAPY Surgery  Usually done to remove large masses which may have pressure effects  Debulking surgery may improve the efficacy of chemotherapy  Mostly done to obtain diagnostic material (biopsy) since chances of metastasis are high at the time of presentation

19. TA OGUNLESI (FWACP)19 PRINCIPLES OF THERAPY Radiotherapy  The use of ionizing radiation to break apart bonds within a cell causing cell damage and death  Most useful for regional tumor extension or tissues like bone & the sanctuary sites which drugs may not penetrate.  Major problem is the associated destruction of normal tissues.  Need to plan a safe radiation field to minimize normal tissue destruction.

20. TA OGUNLESI (FWACP)20 PRINCIPLES OF THERAPY Immunotherapy  Enhancement of normal cell-mediated immunity to destroy tumor cells  Largely experimental & disappointing Bone marrow transplantation  Useful for myeloproliferative diseases  Major problems include getting a suitable donor & Graft Versus Host disease Gene Therapy

21. TA OGUNLESI (FWACP)21 UNWANTED EFFECTS OF CANCER TREATMENT Alopecia Bone marrow depression with pancytopenia (anaemia, infections & abnormal bleeding) Protracted diarrhoea Nausea & Vomiting Infections

22. TA OGUNLESI (FWACP)22 UNWANTED EFFECTS OF CANCER TREATMENT Growth retardation Haemorrhagic cystitis (Cyclophosphamide) Skin necrosis (Vincristine) Sterility Secondary neoplasm