This document provides information on the types of cancers that affect children, including hematological malignancies such as leukemia and lymphomas, as well as solid tumors like brain tumors and abdominal masses. It discusses the signs, symptoms, diagnostic testing, staging, and treatment options for common childhood cancers.
The document discusses acute lymphoblastic leukemia (ALL), which is the most common childhood leukemia. It makes up around 80% of childhood leukemia cases. The document covers the introduction, classification, etiology, diagnosis, clinical presentation, and treatment of ALL. It notes that the cure rate for ALL is around 85% with current treatments involving remission induction, intensification, and maintenance therapy. Prognosis depends on factors like age, white blood cell count at diagnosis, and the ALL subtype.
This document discusses pediatric oncology, specifically lymphoma in children. It begins with definitions of lymphoma and its types. Hodgkin lymphoma is more common in older children while non-Hodgkin lymphoma occurs more in younger children. The document describes the histology, clinical features, investigations, differential diagnosis, supportive treatment and chemotherapy-based management of Hodgkin and non-Hodgkin lymphoma in children. The goal of treatment is to cure the disease using multi-agent chemotherapy regimens tailored to the specific lymphoma type and stage.
Non-Hodgkin's lymphomas arise from monoclonal expansion of malignant B or T cells. There are many subtypes of NHL, classified based on cell lineage and other features. Treatment depends on factors like aggressiveness - indolent NHLs grow slowly while very aggressive NHLs can be life-threatening if not treated rapidly. The most common subtypes are diffuse large B-cell lymphoma and follicular lymphoma. Diagnosis involves biopsy and other tests to identify the histologic subtype and stage of disease. Prognosis and treatment approach are guided by these factors.
The document discusses acute myeloid leukemia (AML), including its pathophysiology, signs and symptoms, laboratory diagnosis, classification, and genetic abnormalities. AML results from the uncontrolled growth of immature myeloid cells in the bone marrow, preventing normal blood cell production and leading to symptoms like infections, anemia, and bleeding. Diagnosis involves blood and bone marrow tests to identify the percentage and type of immature blast cells present and any genetic mutations driving the cancer.
“One of the most important building blocks of our nation is our concern for our children…” these words, quoted from a speech given by Nelson Mandela in 1997, will resonate louder than usual during the month of September that is recognised as Childhood Cancer Awareness month by the Cancer Association of South Africa (CANSA). #ChildhoodCancerAwareness
Read more: http://www.cansa.org.za/caring-for-our-future/
Acute lymphoblastic leukemia (ALL) is the most common childhood leukemia, accounting for 80% of cases. It is a cancer of the lymphoid cells of the bone marrow. Patients present with fatigue, fever, and bleeding due to bone marrow failure. Diagnosis involves blood tests showing reduced blood counts and blast cells in the bone marrow. Treatment involves remission induction, intensification, and maintenance therapy, with an overall cure rate of around 85%. Prognosis depends on factors like age, genetics, and response to initial treatment.
This document discusses several childhood tumours. It begins by noting that both benign and malignant tumours occur in childhood, with benign tumours being more common. Childhood cancers comprise 2% of all cancers but are a leading cause of death in children. The document then focuses on specific childhood cancers, discussing their epidemiology, molecular pathogenesis, clinical features, pathology, prognosis and management. It provides detailed information on Burkitt lymphoma and Wilms tumor.
The document discusses chronic lymphocytic leukemia (CLL), including its definition, epidemiology, etiology, pathogenesis, clinical symptoms, diagnosis, staging, prognosis, and treatment. Some key points:
- CLL is characterized by the proliferation and accumulation of small, mature lymphocytes in the blood, bone marrow, and lymphoid tissues. It most commonly affects elderly adults.
- Diagnosis is based on blood cell counts and immunophenotyping of lymphocytes. Prognosis depends on factors like clinical stage, genomic abnormalities, and biomarker expression levels.
- Treatment involves chemotherapy, chemoimmunotherapy, targeted therapies, and supportive care. The appropriate treatment approach depends on a patient's risk
The document discusses acute lymphoblastic leukemia (ALL), which is the most common childhood leukemia. It makes up around 80% of childhood leukemia cases. The document covers the introduction, classification, etiology, diagnosis, clinical presentation, and treatment of ALL. It notes that the cure rate for ALL is around 85% with current treatments involving remission induction, intensification, and maintenance therapy. Prognosis depends on factors like age, white blood cell count at diagnosis, and the ALL subtype.
This document discusses pediatric oncology, specifically lymphoma in children. It begins with definitions of lymphoma and its types. Hodgkin lymphoma is more common in older children while non-Hodgkin lymphoma occurs more in younger children. The document describes the histology, clinical features, investigations, differential diagnosis, supportive treatment and chemotherapy-based management of Hodgkin and non-Hodgkin lymphoma in children. The goal of treatment is to cure the disease using multi-agent chemotherapy regimens tailored to the specific lymphoma type and stage.
Non-Hodgkin's lymphomas arise from monoclonal expansion of malignant B or T cells. There are many subtypes of NHL, classified based on cell lineage and other features. Treatment depends on factors like aggressiveness - indolent NHLs grow slowly while very aggressive NHLs can be life-threatening if not treated rapidly. The most common subtypes are diffuse large B-cell lymphoma and follicular lymphoma. Diagnosis involves biopsy and other tests to identify the histologic subtype and stage of disease. Prognosis and treatment approach are guided by these factors.
The document discusses acute myeloid leukemia (AML), including its pathophysiology, signs and symptoms, laboratory diagnosis, classification, and genetic abnormalities. AML results from the uncontrolled growth of immature myeloid cells in the bone marrow, preventing normal blood cell production and leading to symptoms like infections, anemia, and bleeding. Diagnosis involves blood and bone marrow tests to identify the percentage and type of immature blast cells present and any genetic mutations driving the cancer.
“One of the most important building blocks of our nation is our concern for our children…” these words, quoted from a speech given by Nelson Mandela in 1997, will resonate louder than usual during the month of September that is recognised as Childhood Cancer Awareness month by the Cancer Association of South Africa (CANSA). #ChildhoodCancerAwareness
Read more: http://www.cansa.org.za/caring-for-our-future/
Acute lymphoblastic leukemia (ALL) is the most common childhood leukemia, accounting for 80% of cases. It is a cancer of the lymphoid cells of the bone marrow. Patients present with fatigue, fever, and bleeding due to bone marrow failure. Diagnosis involves blood tests showing reduced blood counts and blast cells in the bone marrow. Treatment involves remission induction, intensification, and maintenance therapy, with an overall cure rate of around 85%. Prognosis depends on factors like age, genetics, and response to initial treatment.
This document discusses several childhood tumours. It begins by noting that both benign and malignant tumours occur in childhood, with benign tumours being more common. Childhood cancers comprise 2% of all cancers but are a leading cause of death in children. The document then focuses on specific childhood cancers, discussing their epidemiology, molecular pathogenesis, clinical features, pathology, prognosis and management. It provides detailed information on Burkitt lymphoma and Wilms tumor.
The document discusses chronic lymphocytic leukemia (CLL), including its definition, epidemiology, etiology, pathogenesis, clinical symptoms, diagnosis, staging, prognosis, and treatment. Some key points:
- CLL is characterized by the proliferation and accumulation of small, mature lymphocytes in the blood, bone marrow, and lymphoid tissues. It most commonly affects elderly adults.
- Diagnosis is based on blood cell counts and immunophenotyping of lymphocytes. Prognosis depends on factors like clinical stage, genomic abnormalities, and biomarker expression levels.
- Treatment involves chemotherapy, chemoimmunotherapy, targeted therapies, and supportive care. The appropriate treatment approach depends on a patient's risk
This document discusses pediatric stroke. It begins with definitions, types, epidemiology, etiology, and pathophysiology of pediatric stroke. The main types are ischemic and hemorrhagic stroke. Risk factors in children include structural heart disease, vasculopathies, hematological disorders, and prothrombotic states. Clinical features can include focal neurological deficits like hemiparesis. Diagnosis involves neuroimaging such as MRI and distinguishing stroke from other conditions. Management aims to prevent recurrence and support rehabilitation.
This document provides information on paediatric oncology and various childhood cancers. It discusses that benign tumors are more common than malignant tumors in children, but cancer is a leading cause of death after accidents. The most common malignant tumors in children arise from hematopoietic, nervous and soft tissues. It then describes several specific childhood cancers like acute lymphoblastic leukemia, Wilms tumor, neuroblastoma, Hodgkin's lymphoma, and non-Hodgkin lymphoma. For each cancer, it discusses clinical features, diagnostic evaluation, classification, treatment and prognosis.
This document defines myocarditis as inflammation of the myocardium, outlines its main etiologies as viral and bacterial infections, and describes its pathogenesis. Signs and symptoms range from asymptomatic to cardiogenic shock. Diagnosis involves ECG, chest X-ray, echocardiogram, and endomyocardial biopsy. Treatment focuses on supportive care and conventional heart failure therapies. Prognosis depends on age, with higher mortality in newborns and potential recovery of function in children and adolescents.
1. Lymphoma is the third most common childhood cancer and is broadly categorized into Hodgkin's disease and non-Hodgkin's lymphoma.
2. Hodgkin's disease is characterized by Reed-Sternberg cells and is further classified under Rye or REAL systems. Common subtypes include lymphocyte predominant, mixed cellularity, and nodular sclerosis.
3. Non-Hodgkin's lymphoma in children includes subtypes like Burkitt's lymphoma, lymphoblastic lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma.
Lymphomas originate from cells of the lymphoid tissue. They are divided into Hodgkin's and non-Hodgkin's lymphomas. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells. It commonly presents with peripheral lymphadenopathy and B symptoms. Diagnosis involves biopsy and imaging. Staging involves the Ann Arbor or Cotswolds classification. Treatment involves chemotherapy, radiation therapy or a combination based on prognostic factors. Complications can include pneumonitis, cardiomyopathy, secondary cancers and gonadal dysfunction.
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
Rhabdomyosarcoma is a rare cancer that forms in the body's soft tissues, such as muscle and connective tissue. In rhabdomyosarcoma, the cancer cells look similar to immature muscle cells.
This document discusses pediatric multiple sclerosis. It begins with defining pediatric MS as occurring in children under 18 years old. It then covers the epidemiology, finding the incidence is highest between 13-16 years old and females are more commonly affected than males. Risk factors discussed include genetics, obesity, and passive smoking. The pathophysiology in pediatric MS involves less axonal damage and innate immune response dominance over adaptive. Clinical features can include polysymptomatic or monosymptomatic presentations, and differential diagnosis must consider ADEM, CIS, and other conditions. MRI and CSF findings are discussed. Treatment involves steroids for attacks and first-line DMTs like interferons and glatiramer acetate.
This document summarizes Hodgkin lymphoma, including:
1. Epidemiology, risk factors, and association with Epstein-Barr virus infection. Hodgkin lymphoma incidence peaks between ages 25-30 and 75-80 and is more common in males. Risk is increased with a history of infectious mononucleosis.
2. Presentation, staging, pathology, and prognostic factors. Hodgkin lymphoma typically presents with painless lymphadenopathy and B symptoms. Staging uses the Ann Arbor system and prognostic factors include age, stage, ESR, and albumin levels.
3. Management involves chemotherapy, radiation therapy, or combined modality treatment depending on stage and risk factors. Standard first-line
This document discusses meningioma, a benign tumor that arises from meningothelial cells of the arachnoid membrane. It can occur in locations other than the skull base, such as the orbit, nasal cavity, paranasal sinuses, and soft tissues. Meningiomas are classified by their WHO grade, from grade I-IV, with higher grades indicating a higher rate of recurrence and more aggressive behavior requiring radiation therapy. Common subtypes include syncytial, fibroblastic, transitional, psammomatous, secretory, microcystic, angioblastic, atypical, clear cell, choroid, anaplastic, and rhabdoid meningiomas.
Chronic lymphocytic leukemia (CLL) is characterized by the proliferation and accumulation of small, mature lymphocytes in the blood, bone marrow, and lymphoid tissues. CLL is diagnosed based on an absolute lymphocyte count over 5000 with immunophenotyping showing a clonal CD5+/CD19+/CD23+ B-cell population. Prognosis is based on factors like clinical stage, bone marrow histology, lymphocyte doubling time, genetic abnormalities, CD38 and ZAP-70 expression levels, and IgVH mutation status. Treatment options range from watchful waiting to chemotherapy, chemoimmunotherapy, monoclonal antibodies, and stem cell transplantation depending on prognostic factors and symptom severity.
This document discusses techniques used to study lymphomas, including immunophenotyping, cytogenetics, and molecular analysis. Immunophenotyping helps differentiate between benign and malignant processes and between B and T cell neoplasms by identifying cell surface markers. Cytogenetics identifies translocations and deletions that help classify lymphomas. Molecular analysis identifies immunoglobulin and T-cell receptor gene rearrangements in B and T cell malignancies, respectively. The document also summarizes the history of lymphoma classification systems and the current WHO system, which classifies lymphomas based on morphology, immunophenotype, molecular abnormalities, and clinical profile.
From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia and Lymphoma Society
Polyarteritis nodasa and microscopic polyangitisMarwa Besar
This document discusses Polyarteritis Nodosa (PAN) and Microscopic Polyangiitis (MPA). PAN is a necrotizing vasculitis predominantly affecting medium-sized arteries that spares small vessels. It is typically ANCA-negative. MPA is a pauci-immune necrotizing vasculitis involving small vessels and sometimes medium arteries, associated with ANCA positivity. Both diseases can affect multiple organ systems and have variable clinical manifestations. Differentiation is based on vessel size involvement and ANCA status according to the Chapel Hill consensus criteria.
This document discusses patterns of lymph node hyperplasia. It begins by describing the normal anatomy of a lymph node and then discusses various causes of lymph node hyperplasia including infectious, immune, and neoplastic causes. Various patterns of lymph node hyperplasia are classified including follicular, paracortical, sinus, diffuse, and mixed patterns. Specific types of follicular, paracortical, sinus, and mantle/marginal zone hyperplasia are described in detail. The document compares the architectural and cytological features of follicular hyperplasia versus follicular lymphoma. References for further information are also provided.
This document discusses two childhood tumors - neuroblastoma and retinoblastoma. Neuroblastoma originates from neural crest cells and most commonly presents as an adrenal or sympathetic ganglia tumor. Microscopically, it appears as sheets of small, round, blue cells that may show maturation. Prognosis depends on factors like stage, age, MYCN gene amplification. Retinoblastoma is a malignant eye tumor of childhood caused by mutations in the RB1 tumor suppressor gene. Microscopically, it resembles neuroblastoma and may form Flexner-Wintersteiner rosettes. Both tumors can spread widely if not treated.
This document discusses different types of hemoblastoses, which are abnormal proliferations of blood-forming tissues. It describes leukemias, which originate in bone marrow, and lymphomas, which are regional tumors of lymphoid tissue. Specifically, it summarizes the etiology, classification, clinical features, and morphological characteristics of both acute and chronic forms of leukemia and lymphoma.
1. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of auto-antibodies against components of the cell nucleus.
2. SLE affects multiple organ systems and is more common in females, with a female to male ratio of 9:1 before puberty.
3. Diagnosis of SLE requires meeting 4 out of 11 American College of Rheumatology diagnostic criteria, including at least 1 clinical and 1 immunological criterion. Common clinical manifestations include malar rash, arthritis, renal disease, and hematological abnormalities.
Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by increased numbers of immature lymphocytes in the bone marrow. It is the most common cancer in children. Treatment involves chemotherapy given systemically and intrathecally in phases including induction, consolidation and maintenance to achieve and maintain remission. Prognosis depends on risk factors like age, white blood cell count, genetics. Late effects of intensive chemotherapy include secondary cancers, organ dysfunction. Relapse indicates poor prognosis requiring aggressive salvage therapies like stem cell transplant.
This document discusses hematopoietic malignancies including lymphoma and leukemia. It provides details on lymphomas, the lymphatic system, lymphocyte development, and three common lymphomas - follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Follicular lymphoma is associated with BCL-2 gene rearrangement and is typically widespread at presentation. Diffuse large B-cell lymphoma is the most common aggressive lymphoma. Hodgkin lymphoma is characterized by Reed-Sternberg cells and has distinct histologic subtypes.
This document provides information about lymphoma and Hodgkin lymphoma. It defines lymphoma as cancer originating from lymphocytes in the lymphatic system. Common lymphomas include follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells. The document discusses the development, classification, symptoms, staging, diagnosis, and treatment of lymphomas.
This document discusses pediatric stroke. It begins with definitions, types, epidemiology, etiology, and pathophysiology of pediatric stroke. The main types are ischemic and hemorrhagic stroke. Risk factors in children include structural heart disease, vasculopathies, hematological disorders, and prothrombotic states. Clinical features can include focal neurological deficits like hemiparesis. Diagnosis involves neuroimaging such as MRI and distinguishing stroke from other conditions. Management aims to prevent recurrence and support rehabilitation.
This document provides information on paediatric oncology and various childhood cancers. It discusses that benign tumors are more common than malignant tumors in children, but cancer is a leading cause of death after accidents. The most common malignant tumors in children arise from hematopoietic, nervous and soft tissues. It then describes several specific childhood cancers like acute lymphoblastic leukemia, Wilms tumor, neuroblastoma, Hodgkin's lymphoma, and non-Hodgkin lymphoma. For each cancer, it discusses clinical features, diagnostic evaluation, classification, treatment and prognosis.
This document defines myocarditis as inflammation of the myocardium, outlines its main etiologies as viral and bacterial infections, and describes its pathogenesis. Signs and symptoms range from asymptomatic to cardiogenic shock. Diagnosis involves ECG, chest X-ray, echocardiogram, and endomyocardial biopsy. Treatment focuses on supportive care and conventional heart failure therapies. Prognosis depends on age, with higher mortality in newborns and potential recovery of function in children and adolescents.
1. Lymphoma is the third most common childhood cancer and is broadly categorized into Hodgkin's disease and non-Hodgkin's lymphoma.
2. Hodgkin's disease is characterized by Reed-Sternberg cells and is further classified under Rye or REAL systems. Common subtypes include lymphocyte predominant, mixed cellularity, and nodular sclerosis.
3. Non-Hodgkin's lymphoma in children includes subtypes like Burkitt's lymphoma, lymphoblastic lymphoma, diffuse large B-cell lymphoma, and anaplastic large cell lymphoma.
Lymphomas originate from cells of the lymphoid tissue. They are divided into Hodgkin's and non-Hodgkin's lymphomas. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells. It commonly presents with peripheral lymphadenopathy and B symptoms. Diagnosis involves biopsy and imaging. Staging involves the Ann Arbor or Cotswolds classification. Treatment involves chemotherapy, radiation therapy or a combination based on prognostic factors. Complications can include pneumonitis, cardiomyopathy, secondary cancers and gonadal dysfunction.
Acute Promyelocytic Leukemia (APL) is a subtype of AML characterized by the t(15;17) translocation resulting in the PML-RARA fusion gene. APL has a high cure rate with all-trans retinoic acid (ATRA) and chemotherapy due to its differentiation of promyelocytes. Complications include disseminated intravascular coagulation, ATRA syndrome, and pseudotumor cerebri. Modern treatment protocols using risk stratification and ATRA with chemotherapy have increased survival to over 80% for APL.
Rhabdomyosarcoma is a rare cancer that forms in the body's soft tissues, such as muscle and connective tissue. In rhabdomyosarcoma, the cancer cells look similar to immature muscle cells.
This document discusses pediatric multiple sclerosis. It begins with defining pediatric MS as occurring in children under 18 years old. It then covers the epidemiology, finding the incidence is highest between 13-16 years old and females are more commonly affected than males. Risk factors discussed include genetics, obesity, and passive smoking. The pathophysiology in pediatric MS involves less axonal damage and innate immune response dominance over adaptive. Clinical features can include polysymptomatic or monosymptomatic presentations, and differential diagnosis must consider ADEM, CIS, and other conditions. MRI and CSF findings are discussed. Treatment involves steroids for attacks and first-line DMTs like interferons and glatiramer acetate.
This document summarizes Hodgkin lymphoma, including:
1. Epidemiology, risk factors, and association with Epstein-Barr virus infection. Hodgkin lymphoma incidence peaks between ages 25-30 and 75-80 and is more common in males. Risk is increased with a history of infectious mononucleosis.
2. Presentation, staging, pathology, and prognostic factors. Hodgkin lymphoma typically presents with painless lymphadenopathy and B symptoms. Staging uses the Ann Arbor system and prognostic factors include age, stage, ESR, and albumin levels.
3. Management involves chemotherapy, radiation therapy, or combined modality treatment depending on stage and risk factors. Standard first-line
This document discusses meningioma, a benign tumor that arises from meningothelial cells of the arachnoid membrane. It can occur in locations other than the skull base, such as the orbit, nasal cavity, paranasal sinuses, and soft tissues. Meningiomas are classified by their WHO grade, from grade I-IV, with higher grades indicating a higher rate of recurrence and more aggressive behavior requiring radiation therapy. Common subtypes include syncytial, fibroblastic, transitional, psammomatous, secretory, microcystic, angioblastic, atypical, clear cell, choroid, anaplastic, and rhabdoid meningiomas.
Chronic lymphocytic leukemia (CLL) is characterized by the proliferation and accumulation of small, mature lymphocytes in the blood, bone marrow, and lymphoid tissues. CLL is diagnosed based on an absolute lymphocyte count over 5000 with immunophenotyping showing a clonal CD5+/CD19+/CD23+ B-cell population. Prognosis is based on factors like clinical stage, bone marrow histology, lymphocyte doubling time, genetic abnormalities, CD38 and ZAP-70 expression levels, and IgVH mutation status. Treatment options range from watchful waiting to chemotherapy, chemoimmunotherapy, monoclonal antibodies, and stem cell transplantation depending on prognostic factors and symptom severity.
This document discusses techniques used to study lymphomas, including immunophenotyping, cytogenetics, and molecular analysis. Immunophenotyping helps differentiate between benign and malignant processes and between B and T cell neoplasms by identifying cell surface markers. Cytogenetics identifies translocations and deletions that help classify lymphomas. Molecular analysis identifies immunoglobulin and T-cell receptor gene rearrangements in B and T cell malignancies, respectively. The document also summarizes the history of lymphoma classification systems and the current WHO system, which classifies lymphomas based on morphology, immunophenotype, molecular abnormalities, and clinical profile.
From Queens Library's expert-led panel, Cancer Awareness: What You Need to Know, featuring professionals from New York Hospital Queens, North Shore LIJ, the American Cancer Society, and the Leukemia and Lymphoma Society
Polyarteritis nodasa and microscopic polyangitisMarwa Besar
This document discusses Polyarteritis Nodosa (PAN) and Microscopic Polyangiitis (MPA). PAN is a necrotizing vasculitis predominantly affecting medium-sized arteries that spares small vessels. It is typically ANCA-negative. MPA is a pauci-immune necrotizing vasculitis involving small vessels and sometimes medium arteries, associated with ANCA positivity. Both diseases can affect multiple organ systems and have variable clinical manifestations. Differentiation is based on vessel size involvement and ANCA status according to the Chapel Hill consensus criteria.
This document discusses patterns of lymph node hyperplasia. It begins by describing the normal anatomy of a lymph node and then discusses various causes of lymph node hyperplasia including infectious, immune, and neoplastic causes. Various patterns of lymph node hyperplasia are classified including follicular, paracortical, sinus, diffuse, and mixed patterns. Specific types of follicular, paracortical, sinus, and mantle/marginal zone hyperplasia are described in detail. The document compares the architectural and cytological features of follicular hyperplasia versus follicular lymphoma. References for further information are also provided.
This document discusses two childhood tumors - neuroblastoma and retinoblastoma. Neuroblastoma originates from neural crest cells and most commonly presents as an adrenal or sympathetic ganglia tumor. Microscopically, it appears as sheets of small, round, blue cells that may show maturation. Prognosis depends on factors like stage, age, MYCN gene amplification. Retinoblastoma is a malignant eye tumor of childhood caused by mutations in the RB1 tumor suppressor gene. Microscopically, it resembles neuroblastoma and may form Flexner-Wintersteiner rosettes. Both tumors can spread widely if not treated.
This document discusses different types of hemoblastoses, which are abnormal proliferations of blood-forming tissues. It describes leukemias, which originate in bone marrow, and lymphomas, which are regional tumors of lymphoid tissue. Specifically, it summarizes the etiology, classification, clinical features, and morphological characteristics of both acute and chronic forms of leukemia and lymphoma.
1. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the production of auto-antibodies against components of the cell nucleus.
2. SLE affects multiple organ systems and is more common in females, with a female to male ratio of 9:1 before puberty.
3. Diagnosis of SLE requires meeting 4 out of 11 American College of Rheumatology diagnostic criteria, including at least 1 clinical and 1 immunological criterion. Common clinical manifestations include malar rash, arthritis, renal disease, and hematological abnormalities.
Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by increased numbers of immature lymphocytes in the bone marrow. It is the most common cancer in children. Treatment involves chemotherapy given systemically and intrathecally in phases including induction, consolidation and maintenance to achieve and maintain remission. Prognosis depends on risk factors like age, white blood cell count, genetics. Late effects of intensive chemotherapy include secondary cancers, organ dysfunction. Relapse indicates poor prognosis requiring aggressive salvage therapies like stem cell transplant.
This document discusses hematopoietic malignancies including lymphoma and leukemia. It provides details on lymphomas, the lymphatic system, lymphocyte development, and three common lymphomas - follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Follicular lymphoma is associated with BCL-2 gene rearrangement and is typically widespread at presentation. Diffuse large B-cell lymphoma is the most common aggressive lymphoma. Hodgkin lymphoma is characterized by Reed-Sternberg cells and has distinct histologic subtypes.
This document provides information about lymphoma and Hodgkin lymphoma. It defines lymphoma as cancer originating from lymphocytes in the lymphatic system. Common lymphomas include follicular lymphoma, diffuse large B-cell lymphoma, and Hodgkin lymphoma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells. The document discusses the development, classification, symptoms, staging, diagnosis, and treatment of lymphomas.
Lymphoid proliferations can be benign or malignant. Benign causes include infections while malignant causes include lymphomas. Lymphomas are divided into Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is characterized by Reed-Sternberg cells while non-Hodgkin's lymphoma can be of B-cell or T-cell origin. Investigation of lymph node enlargement includes history, examination, blood tests, imaging and biopsy to determine if the cause is benign reactive hyperplasia, infection, or malignancy such as lymphoma or metastatic carcinoma.
Lymphoid proliferations can be benign or malignant. Benign causes include infections while malignant causes include lymphomas. Lymphomas are divided into Hodgkin's lymphoma and non-Hodgkin's lymphoma. Hodgkin's lymphoma is characterized by Reed-Sternberg cells while non-Hodgkin's lymphoma can be of B-cell or T-cell origin. Different cell markers are used to identify the specific cell type by flow cytometry and immunohistochemistry. Investigation of lymph node enlargement includes history, examination, blood tests, imaging and biopsy to determine if the cause is benign reactive hyperplasia or malignant lymphoma or metastatic carcinoma.
This document discusses lymphoproliferative disorders, which include lymphomas and leukemias characterized by excessive lymphocyte production. It defines key lymphoproliferative disorders like lymphoma, leukemia, chronic lymphocytic leukemia, and provides information on infectious mononucleosis, Burkitt's lymphoma, follicular lymphoma, and Hodgkin and non-Hodgkin lymphomas including their causes, clinical features, diagnostic criteria, staging systems, and treatment approaches.
This document discusses white blood cell (WBC) disorders including reactive changes, neoplastic disorders like leukemia and lymphoma, and precancerous conditions. It begins by outlining the learning objectives which are normal WBCs, reactive changes involving increases or decreases of different WBC types, cancers like acute and chronic leukemias and Hodgkin's and non-Hodgkin's lymphomas, and precancerous myeloproliferative disorders and myelodysplastic syndromes. Top WBC disorders are then listed as reactive changes, leukemia, lymphoma, myeloproliferative disorder, and myelodysplastic syndrome. The document proceeds to describe these disorders in further detail.
This document discusses lymphomas, including Hodgkin's lymphoma and non-Hodgkin's lymphoma. It covers the classification, pathogenesis, clinical features, investigations, and treatment of these conditions. Key points include: lymphomas are malignant tumors of lymphoreticular tissues, Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells, classifications include Rye and WHO systems, clinical features depend on location and include enlarged lymph nodes and systemic symptoms, investigations involve imaging, biopsies and blood tests, and treatment involves chemotherapy, radiation therapy, bone marrow transplants or supportive care.
This document provides an overview of leukemia, including its definition, types, causes, symptoms, diagnosis, treatment, and nursing management. It discusses the main types of leukemia - acute lymphocytic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia. For each type, it covers clinical manifestations, diagnostic evaluation, medical management options like chemotherapy and stem cell transplantation, and associated nursing care. The document also reviews the TNM staging system and mentions a research study on imatinib therapy for chronic myeloid leukemia.
This document provides an overview of white blood cell disorders, including common conditions such as neutropenia, lymphocytosis, leukemia, and lymphoma. It begins with an introduction to normal white blood cell production and classification. Key points covered include the clinical features and pathogenesis of various leukopenias and leukocytoses. Classification systems for hematologic neoplasms such as leukemia subtypes (AML, ALL, CML, CLL) and lymphomas (Hodgkins, Non-Hodgkins) are summarized. Premalignant conditions like myeloproliferative disorders and myelodysplastic syndromes are also briefly outlined.
Leukemia and lymphoma are cancers that affect the blood and bone marrow. Leukemia begins in the bone marrow and results in high numbers of abnormal white blood cells. There are two main types of leukemia - acute and chronic. Lymphoma is a cancer of the lymphatic system that most often spreads to the lungs, liver and brain, causing enlarged lymph nodes and systemic symptoms like fever and night sweats. Both are diagnosed through blood tests and biopsies and treated with chemotherapy, radiation or other medications, with varying survival rates depending on the specific type and stage of cancer.
1) Hodgkin lymphoma is a cancer of the lymphatic system that is characterized by the presence of Reed-Sternberg cells on histology and spreading in an orderly fashion to contiguous lymph nodes.
2) Risk factors include certain viruses like Epstein-Barr virus, a weakened immune system, age (most common in teens/young adults and those over 55), and family history.
3) Clinical presentation includes enlarged, painless lymph nodes as well as potential involvement of extralymphatic sites and "B" symptoms like night sweats and fever.
4) Staging involves determining the number and location of affected lymph nodes and sites of spread, with each stage divided into A or B
Lymphomas are cancers that begin in the lymphatic system. They start in the lymph nodes or other lymphatic tissues such as the spleen. There are two main types of non-Hodgkin's lymphoma: B-cell and T-cell lymphomas. B-cell lymphomas account for about 80% of cases and start in B-cells. T-cell lymphomas account for 15% of cases and start in T-cells. Common types of B-cell lymphomas include diffuse large B-cell lymphoma, follicular lymphoma, and mantle cell lymphoma. Burkitt's lymphoma and lymphoblastic lymphoma are more common in children.
Summary - Neoplasms of infancy and childhood - Asem M. Shadid Asem Shadid
Neoplasms of infancy and childhood :
obj :
1. Describe the findings from the history and physical exam that suggest malignant disease.
2. Know the incidence rates of the major childhood neoplasms and the significance of neoplasms in childhood mortality.
3. Identify the presenting symptoms, physical findings, and diagnostic tests for the major neoplasms (leukemia, CNS tumors, lymphoma, neuroblastoma and Wilm's tumors).
4. Recognize the major therapeutic modalities for childhood neoplasms and the relative advantages and disadvantages of each (chemotherapy, surgery, irradiation, bone marrow transplants).
Cancer is the uncontrolled growth of abnormal cells that can form tumors and spread throughout the body. There are several types of cancer including carcinomas, sarcomas, leukemias, lymphomas, and myelomas. Leukemia is a cancer that affects the blood and bone marrow and results in high numbers of abnormal white blood cells. The main types of leukemia are acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and chronic lymphocytic leukemia. Treatment depends on the type of leukemia but may include chemotherapy, radiation therapy, stem cell transplants, and targeted therapy.
This document discusses the diagnostic approach and classification of nodal T-cell lymphomas. It notes that T-cell lymphomas represent a higher proportion of non-Hodgkin lymphomas in Asia compared to Western countries. Peripheral T-cell lymphomas originate from mature T lymphocytes and include several subtypes like PTCL-NOS and angioimmunoblastic T-cell lymphoma. It provides details on the clinical features, pathology, immunophenotype, genetics, and prognosis of PTCL-NOS and AITL.
Cancer is defined as abnormal cells that divide uncontrollably and can invade other tissues or spread to other parts of the body. The development of cancer is thought to be a multistage process involving genetic changes that alter normal cell growth mechanisms. Primary risk factors for cancer include exposure to carcinogens like radiation, chemicals, and certain viruses or bacteria. Common childhood cancers include leukemia, which affects blood cells; lymphoma like Hodgkin's disease affecting lymph nodes; and tumors of the kidney (Wilms'), brain, bone (osteosarcoma), and neuroblastoma originating in nerve tissue. Treatment involves chemotherapy, radiation therapy, and surgery depending on the cancer type and stage.
1. White blood cells (leukocytes) include granulocytes like neutrophils, eosinophils, and basophils which fight infection, and agranulocytes like monocytes and lymphocytes which are involved in immune responses.
2. Leukemia is a cancer of the blood cells characterized by abnormal proliferation of white blood cells. The four main types are acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and chronic lymphocytic leukemia.
3. Factors involved in leukemia development include genetic mutations, chromosomal translocations, radiation exposure, certain chemicals, and some viruses. Maintaining overall health can help support white blood cell counts.
The document discusses lymphoma, which is a cancer of the lymphatic system. It begins by describing the anatomy and function of the lymphatic system. It then defines lymphoma and discusses the two main types: Hodgkin lymphoma and non-Hodgkin lymphoma. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells and has a good prognosis. Non-Hodgkin lymphoma is more common and diverse, with several subtypes that can vary in aggressiveness. The document outlines signs and symptoms, diagnostic tests, treatment options including chemotherapy and stem cell transplant, and the nursing management of patients with lymphoma.
This document discusses lymphomas, including malignant lymphoma concepts, classification, epidemiology, and approaches to lymphoma patients. It focuses on Hodgkin's lymphoma, covering the clinical presentation, diagnosis, histologic subtypes, associated factors, treatment approaches, chemotherapy regimens, prognostic factors, and treatment recommendations for early and advanced stage Hodgkin's lymphoma.
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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8. TYPES OF CANCERS IN CHILDREN
CHILDH00D
CANCERS
HAEMATOLOGICAL
MALIGNANCY
SOLID TUMORS BRAIN TUMORS
9.
10.
11. Hematologic malignancies
•
Form of cancer that begin in the cells of blood-forming tissue,
such as the bone marrow, or in the cells of the immune system
ie: lymphatic system.
12. Types
•Leukemia's
• Onset: acute or chronic
• Lineage: myeloid or lymphoid
•Lymphomas
• Hodgkins Lymphoma
• Non Hodgkins Lymphoma
13. What’s the difference
Leukemia- from the bone marrow producing
abnormal cells- Blasts
Lymphoma- starts from the immune system
affects lymph nodes and lymphocytes B and T
cells.
14. Bone Marrow
• Present in the soft inner part of some bones such as
the skull, shoulder, blade, ribs, pelvis, and
backbones. (Occupies central cavity of bone)
• The bone marrow is made up of blood-forming stem
cells, lymphoid tissue, fat cells, and supporting
tissues that aid the growth of blood forming cells.
24. What is Lymphoma
• Lymphomas are cancers that begin by the
“malignant transformation” of a lymphocyte
in the lymphatic system
• Many lymphomas are known to be due to
specific genetic mutations
25. What is the Lymphatic System?
• Made up of organs, such as the tonsils, spleen,
liver, bone marrow and a network of lymphatic
vessels that connect glands, called lymph nodes
• Lymph nodes located throughout the body
• Lymph nodes filter foreign particles out of the
lymphatic fluid
• Contain B and T lymphocytes
26. Lymphatic System
• Lymph nodes act as a filter to remove
bacteria, viruses, and foreign particles
• Most people will have had “swollen
glands” at some time as a response to
infection
27.
28.
29. Lymphocytes
• Most lymphocytes are in lymph nodes, spleen,
bone marrow and lymphatic vessels
• 20% of white blood cells in blood are lymphocytes
• T cells, B cells, natural killer cells
• B cells produce antibodies that help fight
infectious agents
• T cells help B cells produce antibodies and they
fight viruses
30. T-Cells and B-Cells
Immature lymphocytes that travel to the
thymus differentiate into T-Cells
– “T” is for thymus
Immature lymphocytes that travel to the
spleen or lymph nodes differentiate into B
cells
– "B" stands for the bursa of Fabricius, which is
an organ unique to birds, where B cells
mature.
31. ALL MM
CLL Lymphomas
Hematopoietic
stem cell
Neutrophils
Eosinophils
Basophils
Monocytes
Platelets
Red cells
Myeloid
progenitor
Myeloproliferative disorders
AML
Lymphoid
progenitor T-lymphocytes
Plasma
cells
B-lymphocytes
naïve
35. Epidemiology of lymphomas
• males > females
• incidence
– NHL increasing
– Hodgkin lymphoma stable
• in NHL: 3rd most frequently diagnosed cancer
in males and 4th in females
• in HL: 5th most frequently diagnosed cancer in
males and 10th in females
36. Risk factors for NHL
• immunosuppression or immunodeficiency
• connective tissue disease
• family history of lymphoma
• infectious agents
• ionizing radiation
37. Burkitt’s Lymphoma
• Very Aggressive
• Curable with standard-dose therapy but
requires very extensive chemotherapy
protocol
• Translocation t(8,14)
• Specific Hematopathology Finding
– Starry, Starry Night
39. Clinical manifestations
• Variable
• severity: asymptomatic to extremely ill
• time course: evolution over weeks, months, or years
• Systemic manifestations
• fever, night sweats, weight loss, anorexia, pruritis
• Local manifestations
• lymphadenopathy, splenomegaly most common
• any tissue potentially can be infiltrated
40.
41. Other complications of lymphoma
• bone marrow failure (infiltration)
• CNS infiltration
• immune hemolysis or thrombocytopenia
• compression of structures (eg spinal cord,
ureters)
• pleural/pericardial effusions, ascites
42. Non-Hodgkin’s Lymphoma
Staging
• Stage is the term used to describe the extent of
tumor that has spread through the body ( I and
II are localized where as III and IV are advanced.
• Each stage is then divided into categories A, B,
and E
–A: No systemic symptoms
–B: Systemic Symptoms such as fever, night sweats
and weight loss
–E: Spreading of disease from lymph node to another
organ
43. Stage I Stage II Stage III Stage IV
Staging of lymphoma
A: absence of B symptoms
B: fever, night sweats, weight loss
44. Symptoms
• Painful Swelling of lymph nodes located in the
neck, underarm and groin.
• Unexplained Fever
• Night Sweats
• Constant Fatigue
• Unexplained Weight loss
• Itchy Skin
Cancer Sourcebook
45. Causes and Risk Factors
• The Exact causes are still unknown
– Higher risk for individuals who:
• Exposed to chemicals such as pesticides or solvents
• Infected w/ Epstein-Barr Virus
• Family history of NHL (although no hereditary pattern
has been established)
• Infected w/ Human Immunodeficiency Virus (HIV)
Lymphoma.org
46. Diagnosis
Staging Studies
• Bone marrow aspiration and biopsy
• Radionuclide scans:
• GI x-rays
• Spinal fluid analysis
• CT scans
• Magnetic Resonance Imaging (MRI)
• Biopsy
47. Treatment Options
• Chemotherapy
• Radiation
• Bone Marrow Transplantation
• Surgery
• Immunotherapy
• Using the bodies own immune system combined with
material made in a lab.
49. Hodgkin lymphoma
• cell of origin: germinal centre B-cell
• Reed-Sternberg cells (or RS variants) in the
affected tissues
• most cells in affected lymph node are
polyclonal reactive lymphoid cells, not
neoplastic cells
62. Introduction
• Abdominal masses are most common in
children younger than 5 years of age.
• In < 5 year group, the older the child
presenting with the mass, the higher the
likelihood of malignancy.
• Often an incidental finding.
63. Most Common Abdominal Solid Tumors
in Childhood
Lymphomas
Wilms Tumour
Neuroblastoma
64. Pallor plus Bleeding
Fever / Apathy / Weight Loss (exclude TB, HIV and UTIs)
Bone Pain (wakes at night, toddler who stops walking, backache)
Adenopathy (cervical > 2cm, supraclavicular, no regional infection,
negative TB work up, not responding to antibiotics)
Unexplained Neurological Signs (headache > 2/52, early morning
vomiting, cranial nerve palsies, ataxia, hemiplegia)
Unexplained Mass (abdominal mass under the age of 5 years is a
tumour until proven otherwise)
Eye Changes (proptosis, leucocoria, acute onset squint, loss of vision)
What Are The Warning Signs ?
66. GENERAL EXAMINATION
DYSMORPHOLOGY BWS, Overgrowth syndromes (WT, Hepatoblastoma)
ANTHROPOMETRY Malnourished, immunocompromised, syndromic
PALLOR, BRUISING, PETECHIAE Haematological malignancy, Stage IV neuroblastomas
JAUNDICE Portal tract obstruction by nodes,
NHL
LYMPHADENOPATHY Haematological malignancies
PERI-ORBITAL ECCHYMOSIS Neuroblastoma (NBS)
PROPTOSIS AML or NBS (bilateral), rhabdomyosarcoma or
retinoblastoma (unilateral)
HORNER’S SYNDROME NBS
VARICOCOELE WT
BLOOD PRESSURE WT, NBS, syndromic
67. Abdominal Examination
• Site Central / Flank Lymphoma vsWT
Filling loin/ not WT vs NBS
Unilateral / Bilateral WT
Crossing midline
• Characteristics Size
Consistency
Tender
Smooth / Nodular
Mobile / Fixed
• Associated Ascites / Pleural effusions NHL
findings
68. Initial Imaging for Diagnosis and Referral
How are plain film X rays useful?
AXR
• Confirm Obstruction - lymphoma
• Show calcification - NBS
CXR
• Metastasis
• Mediastinum (nodes and thymus)
69. Initial Imaging For Diagnosis And Referral
ULTRASOUND
Cheap and readily available.
No Sedation (usually)
Good initial imaging
Doppler studies to assess blood vessel involvement by
tumour – where there is concern regards tumour thrombus (WT, HBS) or
compression by mass (NBS).
Useful to remember:
• Neuroblastoma encases vessels / calcification
• WT displaces vessels, no calcification.
• Check the BP!
70. Further Imaging at Referral Centre
CT CHEST
Essential to assess chest metastases
best modality.
CT ABDOMEN
Sedation not such a problem / no
anaesthetic.
Good imaging of blood vessels.
Radiation: Implications for follow up
imaging.
Need for “child friendly” imaging.
MRI
Best imaging of abdominal
tumours in ideal situation
(abdomen and pelvis).
Expensive
Sedation/often anaesthetic
required.
No radiation: Implications
for initial and follow up
scans.
NEVER let imaging delay the transfer of a child to a treatment centre.
EARLIER DIAGNOSIS = BETTER OUTCOMES!
71. Additional tests
• MIBG SCAN Neuroblastoma
• BONE SCAN Neuroblastoma, Clear cell
sarcoma
• PET / CT (PET ) Hodgkin’s Lymphoma
• BONE MARROW NBS, RMS, lymphomas
94. Approach to management
• Supportive management
– Shunting for hydrocephalus
• Meds Acetazolamide
– Anti epileptic medication
– Anti emetics
Steroids- Dexamethasone
to reduce inflammation and vasogenic edema
95. Approach to management
• Surgery- Main stay of treatment
– Biopsy if the tumor is on important structures
– Complete resection
– Incomplete resection or De-bulking reduction of
the tumor volume,
• More than 50 % advice
Less than 50% high chance of relapse.
96. Approach to treatment
• Chemotherapy
– Not all brain tumors respond to chemotherapy
• Radiotherapy
– On the lesion itself
– Both brain and spine
97. complications
• Neurological concerns
– Seizures
– Cognitive issues
– Decrease school performance
– Loss of other motor skills
All patients with brain tumor require occupation
and physiotherapy and rehabilitation
98. CONCLUSION
• Childhood cancers are treatable
• Better outcome depends on early diagnosis
• Let’s continue to spread awareness of
childhood cancers in the community
101. Retinoblastoma (RB) is the most common childhood intraocular
tumor. However, it is rare,
• accounting for 1% to 3% of all childhood cancers. The tumor
originates in one or both eyes,
• arising from embryonic retinal cells and growing into the
vitreous humor and the sub-retinalspace.
The tumor has a variable growth rate and may have a single or
multiple foci in one
(unilateral) or both eyes (bilateral).
RETINOBLASTOMA
102. 25%-40% percent of retinoblastomas are bilateral and hereditary
(familial)
• approximately 60-75 % are unilateral and occur as a (A – 2) non-
hereditary, spontaneous(sporadic) form.
• The term “familial” or “hereditary” is commonly used for bilateral
retinoblastoma.
However, only 25% of children with bilateral disease have family history
of retinoblastoma.
The other 75% usually acquire the mutation of the RB1 gene in utero, in
the absence of a family history of this cancer
103. Bilateral RB is often diagnosed at an early age (< 1 year old), and is
often hereditary, while unilateral RB is commonly diagnosed during
the toddler years.
In rare cases, RB can present as trilateral disease involving the pineal
gland.
• Trilateral retinoblastoma is a pineal tumor typically appearing
approximately 3-5 years after diagnosis of bilateral RB. It is often
associated with high mortality.
104. The retinoblastoma gene (RB1) is located on band 14 of chromosome
13.
• RB1 is a tumor suppressor gene (acts as a brake on the cell division
cycle to prevent uncontrolled cell division).
The loss of RB1 causes unregulated cell proliferation and tumor
development.
Abnormalities in the retinoblastoma gene not associated with RB are
very common and occur in many types of malignancies.
RISK FACTORS
105.
106.
107.
108. Common clinical signs
Leukocoria:“cat’s eye reflex,” “white eyes,” white
pupil, the most common presentation
Strabismus: esotropia (eye turning in) and extropia
(eyes turning out)
Decreased vision: especially if only in one eye
(unilateral)
Painful eyes
Erythmatous conjunctivae
109. Diagnostic work up options
Complete history of illness including familial incidence of
retinoblastoma,
• ocular loss of unknown etiology,
• decreased vision in one eye, changes in the appearance
of eyes.
• The child may be bumping into things because he does
not see them.
Physical exam assesses visual acuity and tracking,
strabismus, esotropia, exotropia, and
leukocoria
Funduscopic exam (direct or indirect) is done under
anesthesia by a ophthalmologist
110. Treatment options
1.Surgical enucleation: Complete removal of the eye is recommended
when there is no vision
2. Systemic chemotherapy
3. Local therapy
• Cryotherapy: A freezing process that kills tumor cells is used
mostly for tumors in the anterior retina
• Thermotherapy: The use of heat from a laser to destroy the cancer
cells;
the heat can also improve the efficacy of chemotherapy or
radiotherapy.
111. Radiation therapy (RT):
• External Beam RT: Used in multifocal advanced disease, usually after
chemotherapy and focal treatments. Lateral or anterior fields are used.
• Brachytherapy (Radioactive applicators - Plaques): Used to treat
individual tumors that are too large for treatment with cryotherapy,
laser or thermotherapy, usually after chemotherapy