This document provides information on neuroblastoma and Wilms' tumor, two common pediatric abdominal masses. Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. It typically presents as an abdominal mass and can metastasize. Treatment involves chemotherapy, surgery, and sometimes stem cell transplant depending on risk factors. Wilms' tumor arises from the kidneys and is also typically detected as an asymptomatic abdominal mass in young children. Staging involves evaluating the extent of the primary tumor and presence of metastases to determine the appropriate treatment, which usually involves surgery and chemotherapy. Both tumors require a multidisciplinary approach including imaging, biopsy, surgery, and chemotherapy.
Cystic Neoplasms of the Pancreas
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Cystic Neoplasms of the Pancreas
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. Neuroblastoma
This is a neoplasm of neural crest origin,
arising in the adrenal medulla and along
the sympathetic ganglion chain from the
neck to the pelvis
Arise during fetal or early postnatal
life
Is the most common extra cranial
solid tumors in children
10% of all childhood cancer and 15%
of all cancer deaths
Incidence 1 in 7500 – 10,000 children
40% in children younger than 1yr, 75% at age
7 and 98% at age 10
More than 50% occur in children under 2yrs of
age
Boys : Girls = 1.2:1
Majority occur sporadically but familial NB
occur in 2% of cases
Primary Sites of tumor:
Abdominal cavity 75%
Adrenal medulla 50%
Para spinal ganglia 25%
Posterior mediastinal 20%
Pelvic 4%
Cervical 1%
3
4. Gross Appearance
NB : Grossly, neuroblastoma usually appears as a highly vascular
purple-gray mass that is often solid, with friable pseudocapsule.
Wilm’s Tumor - cut section - soft, homogeneous, tan to gray,
with occasional foci of hemorrhage, cyst & necrosis
4
5. Clinical Presentation
Related to the
site of the primary tumor,
presence of metastases,
production of certain metabolic tumor byproducts
In 50% to 75% present with an abdominal mass
Generalized symptoms
Horner syndrome (Ipsilateral ptosis, miosis, anhidrosis)
associated with a paraneoplastic syndrome of
autoimmune origin, termed opsoclonus-myoclonus–ataxia
syndrome(OMS), in which patients experience rapid,
uncontrollable jerking eye and body movements,poor
coordination, and cognitive dysfunction.
5
6. Clinical Presentation
Symptoms due to metastatic
diseases
70% of patients have metastatic disease
at diagnosis mainly to bone marrow,
lymph nodes, liver and bone
Bone pain and limping
Anemia/pancytopenia weakness,
infection, and abnormal bleeding or
bruising
○ “Blueberry muffin” nodules
Symptoms related to excessive
catecholamine or VIP secretion
flushing, diarrhea, weight loss,
hypertension(25%), headache
Dumb-bell(Hour-glass) Tumor
6
7. Diagnostic Imaging
Radiographs
Fine calcification and as
mediastinal and mediastinal
mass
CT scan
Calcification in ~ 85% of tumors,
and intraspinal extension of the
tumor on contrast-enhanced CT
Overall, contrast-enhanced CT
has 82% accuracy in defining
neuroblastoma extent, with the
accuracy increasing to nearly
97% when performed with a
bone scan
7
►Imaging findings
Stippled calcification or
LN with calcification
Displace the kidney
inferiorly
Crossing the midline
Encasing/displace vessels
Paravertebral mass—
spinal extension
8. Diagnostic Imaging
MRI
More accurate than CT for detection
of stage 4 disease
○ The sensitivity of MRI is 83%(CT-
43%) and the specificity of MRI is
97%(CT-88%)
○ Metastases to the bone and bone
marrow and intraspinal tumor
extension are better detected by
MRI
MIBG bone scintigraphy
82% sensitivity and 91% specificity
for detection of metastases to the
bone and bone marrow
Required imaging studies
○ CT and/or MRI to address IDRFs is
mandatory for imaging the primary
tumor and metastatic sites
○ MIBG scintigraphy is mandatory
to define metastatic disease.
8
9. BM EXAM:
Bilateral bone marrow biopsy is a
routine method for detecting bone
marrow involvement
At least two aspirates and two
biopsies from bilateral sites
Tissue biopsy— requires 1cm³ of
tissue
Including immunohistochemistry and
genetic analysis whenever possible
LAB IX
LDH >1500 IU/L
Ferritin >150 ng/ml
Neuron-Specific Enolase (NSE >100
ng/mL)
Catecholamine Metabolites VMA &
HVA
Elevated in 90–95 % of
neuroblastomas
DIAGNOSIS OF NB
The minimum international
diagnostic criteria of
neuroblastoma –Needs one of
the following:
1. A tissue biopsy with
histologic confirmation or
2. The presence of
unequivocal tumor cells
within a bone marrow
biopsy/aspirate and
increased levels of
urinary/serum
catecholamine metabolites
9
10. Staging And Risk
Classification of
Neuroblastoma
Shimada histopathologic system: classifies
tumors into favorable or unfavorable categories
based on Stromal pattern, Age, degree of
neuroblastic Differentiation, Mitosis karyorrhexis
index (MKI relating to fragmentation of the
nucleus), and Nodularity (mnemonic: SADMaN).
Favorable Shimada: young age, low MKI, mature
neuroblast differentiation, rich stroma with non-
nodular pattern.
10
11. ►The International Neuroblastoma Staging System (INSS)
is a surgicopathologic staging system that depends on:
The completeness of resection of the primary tumor
Highly subjective
Assessment of ipsilateral and contralateral lymph
nodes, and
The relation of the primary tumor to the midline
4S Disease<12 months
Staging And Risk
Classification…
INSS Stage Description
1 Localized tumor, grossly resected, no lymph node involvement
2A
Unilateral tumor, incomplete gross excision, negative lymph
nodes
2B Unilateral tumor with positive ipsilateral lymph nodes
3
Tumor infiltrating across midline or unilateral tumor with
contralateral lymph nodes or midline tumor with bilateral
lymph nodes
4 Distant metastatic disease
4S
Localized primary tumor as defined by stage 1 or 2 in patient
under 12 months with dissemination limited to the liver, skin,
and/or bone marrow (<10% involvement)
11
12. Management
Treatment is determined by risk stratification into low, intermediate, and high
risk.
Factors incorporated into the most recent COG risk grouping include: Stage,
Age, N-myc, DNA ploidy, and Shimada histology (mnemonic “SANDS,”)
Low-Risk Disease
surgical resection alone
Infants with stage 4S disease who are not experiencing substantial symptoms may
undergo an initial biopsy and observation only
Intermediate-Risk Disease
Chemotherapy + surgical resection
Radiation therapy (if does not respond to initial chemotherapy)
Biopsy+ Chemotherapy,then Delayed surgery
High-Risk Disease
intensive induction chemotherapy
myeloablative consolidation therapy with BMT &13-cis-retinoic acid
radiation therapy is administered to the region of the primary tumor site, including involved
adjacent LNDs
delayed surgical resection
12
13. Surgical Principles In
Neuroblastoma
Approach depends on
Exact tumor location of the tumor
Tumor size
The extent of vascular encasement
13
►Operative principles
1. Approach the operation as a vascular-
type operation
Identification and skeletonization of the
major vessels
Dissecting in a subadventitial plane
2. The tumor should be removed
piecemeal
3. Dissection starts distal to the lower edge
of the tumor, along the common or
external iliac artery, and proceeds
proximally
14. Operative Complication
Bleeding
80% of patients will that
requires transfusion
Injury to a major
vascular structure—
10%
Injury to other viscera
(stomach, bowel, liver,
spleen, or kidney)—5%
Necessitates removal of
the injured organ—
most commonly –the
kidney
Wound complications ,
bowel obstruction1–
5%
Others
Hypertension, chyle leak,
pleural effusion, infection
and sepsis, diarrhea .
Depending on site:
Horner syndrome,
paralysis, foot drop,
nephrectomy
14
15. WILMS’ TUMOR
It is the second most common malignant abdominal tumor in
childhood after neuroblastoma
6-7% of all pediatric malignancies and by far the most
common of Renal tumors (91%)
The mean age at diagnosis is 36 months, with most children
presenting between the ages of 12 and 48 months.
Tumors tend to occur about 6 months later in girls than in
boys.
WT is rare at greater than 10 years and at less than 6
months of age.
>80% of cases are diagnosed before 5 years of age
Tumors can be unilateral or bilateral
Bilateral Wilms’ tumors (BWT) occur in 4% - 13% of patients
15
18. Clinical Presentation
Typical pt – Healthy preschool child
- with Asymptomatic abdominal mass
Most children present with only an abdominal mass - 90%
Abdominal pain (30-40%)
Hematuria (18%)
fever (10%)
Hypertension (25%)- Renin
Extension into the renal vein(10%),
IVC(4-8%) & Atrium(1-2%)
varicocele
hepatomegaly, ascites
18
19. Diagnostic imaging
objective – to establish
1. Size & extent of abdominal mass
2. organ of origin
3. presence of functioning contralateral kidney
4. bilateral disease
5. patency of IVC & renal vein
6. distant metastasis
Abdominal Ultrasound
Site & origion of the mass
Vascular extension
Ureteral extension
R/O – hydronephrosis & multicystic kidney
19
20. Contrast enhanced CT
Confirm renal origin
Further evaluate nature & extent
Detect small tumors or NRs in the
opposite kidney
MRI – not superior to CT
CXR – pulmonary metastasis
CYSTOSCOPY – hematuria (ureteral
extension)
IVP – distortion of collecting system
20
21. Laboratory tests
• CBC - Anemia
RFT & Urine analysis
○ Creatinine – reduction in GFR prior to surgery
○ Protienurea & hematuria
LFT – liver metastasis
Coagulation studies
○ Acquired Von Willebrand’s disease in WT – 10%
○ Prolonged PT, aPTT
○ Should be determined prior to surgery
21
22. Staging
Stage I – limited to kidney
- completely resectable
- intact capsule
- no rupture before & after
removal
- no residual tumor beyond
resection margin
Stage II – extends beyond kidney
- completely excised
- regional extension beyond
capsule
- BV may be infiltrated
- local spillage confined to
ipsilateral flank
- no residual tu beyond margins of
resection
Stage III – non hematogenous tu
within the abdomen
- regional LN metastasis
- diffuse peritoneal implants
- gross or microscopic tumor
post Op
- incomplete resection
Stage IV – hematogenous metastasis
( lung , liver , bone , brain etc.)
- LN metastasis outside
abdomen & pelvis
Stage V – bilateral disease at Dx
22
24. Management of WT
The management is guided by the NWTS protocol in the United States and the
SIOP protocol in Europe according to the stage of the tumor
Options of RX – Surgery, Chemotherapy & Radiotherapy
Prognostic factors
Histology
Stage
Response to Rx
LOH at 1p & 16q
The principles of surgery are as follows:
Palpation of liver, abdomen, and para-aortic region for regional spread of disease
Removal of intact specimen in total
Avoidance of local “spillage”
Nodal sampling
Palpation of the renal vein and IVC before ligation to rule out thrombus
Proper identification and avoidance of injury to contralateral renal vessels, aorta,
and iliac and superior mesenteric arteries
24
Unresectable Tumors
Extension of tumor thrombus above the level of the hepatic Veins
Bilateral tumors
Tumor in a solitary kidney
Pulmonary compromise resulting from extensive pulmonary
Metastases
When actual invasion is identified and radical en bloc resection (spleen, pancreas, and
colon ) is required to remove tumour
25. Chemotherapy
Dactinomycin is the backbone in the chemoRx against
WT
○ vincristine, doxorubicin, cyclophosphamide &
etoposide.
Vincristine & actinomycin D
Stage I & II favorable
Stage I unfavorable
Doxorubicine added
Stage III & IV favorable
Stage I – IV clear cell sarcoma
Cyclophosphamide added
Stage II – IV unfavorable
25
26. Radiotherapy
In the COG protocols, it is recommended that abdominal irradiation be
delivered as soon as practical after nephrectomy and not later than 14 days
after surgery.
Flank Irradiation
-- Stage III favorable histology and Recurrent Wilms’ tumor
Whole Abdominal Irradiation
--Preoperative tumor rupture
-- Peritoneal metastases are found at initial surgery
-- A large intraoperative tumor spill affecting areas outside the tumor bed
as
determined by the surgeon/
--Diffuse unresectable peritoneal implants
Liver Irradiation
-- Patients with residual tumor will receive supplemental irradiation
Whole lung radiation
it is a major cause of long-term morbidity
○ CHF, Pulmonary fibrosis & second malignancy.
26
antigen–antibody
complex involving antibodies that cross-react with Purkinje
cells in the cerebellum
Bone metastases occur in sites containing red marrow and involve the metaphyseal areas of long bones in addition to the skull, vertebral column, pelvis, ribs, and sternum
COG study demonstrated that in almost half of patients with thoracic neuroblastoma is detected on incidental chest radiographs.
MRI is becoming the most useful and most sensitive imaging modality for the diagnosis and staging of neuroblastoma
When considering skeletal metastases alone, MRI and bone scan have been shown to be equivalent
Metaiodobenzylguanidine (MIBG)
Evans staging was proposed for children's Cancer Study group in 1971
Incisions
Abdominal incision –transverse , Chevron, or a midline incision
A transthoracic (intercostal), transdiaphragmatic extension
For adrenal or abdominal sympathetic- chain primaries
Open thoracotomy