- Neuroblastoma and Wilms tumor are the two most common childhood solid tumors that arise from neural crest cells and kidney respectively.
- Neuroblastoma has a peak incidence between ages 1-2 years and can occur anywhere along the sympathetic nervous system. Wilms tumor has a peak incidence below 5 years of age and presents as an abdominal mass.
- Both tumors are diagnosed through imaging such as CT/MRI and biopsy. Treatment involves surgery, chemotherapy and radiation depending on disease stage and risk factors. Prognosis is generally good, especially for early stage disease. Long term follow-up is important to monitor recurrence.
Prostate cancer is the second most common cancer in men. Detecting recurrent prostate cancer is challenging with current imaging methods. Prostate-specific membrane antigen (PSMA) is overexpressed in prostate cancer cells and provides a promising target for imaging and therapy. A new PET tracer labeled with 18F, 18F-FACBC, shows potential superiority over choline PET/CT in detecting recurrent prostate cancer.
This document discusses neuroblastoma, a type of cancer that commonly affects children. It is the third most common malignancy diagnosed in children and most often presents before age 12 months. The document covers the epidemiology, natural history, clinical presentation, diagnostic workup, staging, pathological classification, prognostic factors, management approaches, results of therapy, and potential sequelae of treatment for neuroblastoma. Treatment approaches are stratified based on risk level - low, intermediate, or high risk - and may involve surgery, chemotherapy, radiation therapy, stem cell transplantation, or palliative care depending on the stage and risk level. Outcomes vary significantly depending on stage, with low and intermediate risk disease having survival rates of 60-99% and high
This document provides an overview of neuroblastoma, including its clinical presentation, pathology, risk grouping, diagnostic workup, prognostic factors, and management. Some key points:
- Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. Over 70% present with metastases.
- Risk grouping systems include INSS (International Neuroblastoma Staging System) and more recently INRG (International Neuroblastoma Risk Group) staging.
- Prognostic factors include age, stage, pathology, MYCN status, and other biomarkers.
- Treatment depends on risk but may include surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy. Precise management
1) Short term ADT added to radiation therapy improved outcomes for intermediate risk prostate cancer, while long term ADT showed benefits in high risk disease based on multiple trials.
2) The AFFIRM trial showed that enzalutamide improved median survival to 18.4 months compared to 13.6 months for placebo in metastatic CRPC patients after docetaxel failure.
3) The COU-AA-301 trial found that abiraterone acetate plus prednisone improved median survival to 15.8 months compared to 11.2 months for placebo in metastatic CRPC patients after docetaxel failure.
Lung cancer is a major cause of cancer deaths with approximately 80% of cases accounting to nonsmall cell lung cancer (NSCLC) . In NSCLC target therapy, epidermal growth factor receptor (EGFR) is a promising candidate.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
Prostate cancer is the second most common cancer in men. Detecting recurrent prostate cancer is challenging with current imaging methods. Prostate-specific membrane antigen (PSMA) is overexpressed in prostate cancer cells and provides a promising target for imaging and therapy. A new PET tracer labeled with 18F, 18F-FACBC, shows potential superiority over choline PET/CT in detecting recurrent prostate cancer.
This document discusses neuroblastoma, a type of cancer that commonly affects children. It is the third most common malignancy diagnosed in children and most often presents before age 12 months. The document covers the epidemiology, natural history, clinical presentation, diagnostic workup, staging, pathological classification, prognostic factors, management approaches, results of therapy, and potential sequelae of treatment for neuroblastoma. Treatment approaches are stratified based on risk level - low, intermediate, or high risk - and may involve surgery, chemotherapy, radiation therapy, stem cell transplantation, or palliative care depending on the stage and risk level. Outcomes vary significantly depending on stage, with low and intermediate risk disease having survival rates of 60-99% and high
This document provides an overview of neuroblastoma, including its clinical presentation, pathology, risk grouping, diagnostic workup, prognostic factors, and management. Some key points:
- Neuroblastoma arises from neural crest tissue and is the most common extracranial solid tumor in children. Over 70% present with metastases.
- Risk grouping systems include INSS (International Neuroblastoma Staging System) and more recently INRG (International Neuroblastoma Risk Group) staging.
- Prognostic factors include age, stage, pathology, MYCN status, and other biomarkers.
- Treatment depends on risk but may include surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy. Precise management
1) Short term ADT added to radiation therapy improved outcomes for intermediate risk prostate cancer, while long term ADT showed benefits in high risk disease based on multiple trials.
2) The AFFIRM trial showed that enzalutamide improved median survival to 18.4 months compared to 13.6 months for placebo in metastatic CRPC patients after docetaxel failure.
3) The COU-AA-301 trial found that abiraterone acetate plus prednisone improved median survival to 15.8 months compared to 11.2 months for placebo in metastatic CRPC patients after docetaxel failure.
Lung cancer is a major cause of cancer deaths with approximately 80% of cases accounting to nonsmall cell lung cancer (NSCLC) . In NSCLC target therapy, epidermal growth factor receptor (EGFR) is a promising candidate.
Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor positive (HR+) early breast cancer (BC):
Surgery plays an important but limited role in the management of testicular cancer. The main surgical procedures are:
1) Radical high inguinal orchidectomy, which is the primary treatment and provides staging information.
2) Retroperitoneal lymph node dissection (RPLND), which may have a therapeutic, prophylactic, or diagnostic role depending on the stage and histology.
3) In select cases, hemi scrotectomy or metastectomy may be performed. While surgery is crucial for diagnosis and staging, most testicular cancers are highly responsive to chemotherapy and radiotherapy, which are the primary treatment modalities.
1. Retroperitoneal tumors are rare and often malignant, with liposarcoma and leiomyosarcoma being the most common.
2. They typically present as large abdominal masses without symptoms until they compress nearby structures.
3. CT scan is the main imaging method used to identify the tumor type, size, and involvement of surrounding organs.
4. Surgical resection is the primary treatment when possible, though radiation and chemotherapy may be used as adjuvants or for advanced disease. Prognosis depends on tumor grade, size, and whether a complete resection can be achieved.
1. Testicular cancer is most common in young men aged 20-40 years and 90-95% are germ cell tumors.
2. Survival rates have improved to over 95% for stage I and II seminomas and 90% for stage I non-seminomas due to better understanding of the disease, use of tumor markers, and cisplatin chemotherapy.
3. Treatment involves radical orchidectomy followed by radiotherapy for seminomas or lymph node dissection/chemotherapy for non-seminomas depending on stage.
1) Locally advanced breast cancer (LABC) includes stage IIB-IIIC disease and encompasses operable, inoperable, and inflammatory breast cancer at presentation.
2) Patients with LABC undergo neoadjuvant chemotherapy followed by surgery and radiation therapy. Additional tests are only indicated based on symptoms.
3) The goals of neoadjuvant therapy are tumor response before surgery to enable breast conservation and provide information about response to therapy. Anthracycline and taxane regimens are appropriate, and 15-25% will experience complete pathologic response.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
This document discusses total neoadjuvant therapy (TNT) for rectal cancer. It summarizes evidence from trials showing that TNT with chemotherapy prior to chemoradiation and surgery improves pathologic complete response rates and reduces distant metastases compared to adjuvant chemotherapy. The document also reviews the experience with TNT at the author's institution, including a clinical complete response rate of 36% and a pathologic complete response rate of 15.6% among surgery patients. Non-operative management strategies with a watch-and-wait approach are also discussed.
PI-RADS v2 is a standardized reporting system for multiparametric MRI of the prostate to improve detection and characterization of prostate cancer. It assesses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast enhanced imaging on a 1-5 scale. A score of 1 indicates cancer is highly unlikely while 5 indicates cancer is highly likely. PI-RADS v2 aims to improve outcomes for patients by facilitating targeted biopsies and treatment decisions. While it has good performance, limitations include not addressing recurrent cancer or other body parts. Further studies are still needed to validate its accuracy and reduce interpreter variability.
This document discusses metastatic colorectal liver cancer. It outlines risk factors, evaluation, and treatment options including surgery, chemotherapy, local tumor ablation, and radiotherapy. Surgery offers the best chance of survival if metastases are resectable, with 5-year survival rates of 24-58% for resection. Neoadjuvant chemotherapy can help make previously unresectable tumors operable. Local ablation techniques are alternatives for tumors that cannot be surgically removed.
1. Several molecular pathways are involved in breast cancer pathogenesis, including steroid hormone receptors, HER2/neu, cell cycle proteins, and growth factors.
2. Risk factors for breast cancer include increasing age, female gender, family history, genetic mutations, personal history of breast cancer or other breast diseases, reproductive factors, and hormone use.
3. High risk patients are identified using tools like the Gail model and managed through increased screening including breast self-exams, clinical exams, mammograms, and MRI. Preventive options include tamoxifen, raloxifen, and prophylactic surgeries.
Radiotherapy in paediatrics - late effects and second malignanciesAshutosh Mukherji
1. Childhood cancer survivors face risks of late sequelae from radiation therapy including growth impairment, cognitive deficits, infertility and cardiac issues.
2. The risks are dependent on factors like radiation dose, age at treatment, and volumes of normal tissues irradiated.
3. Second malignancies are a major concern after radiation therapy, with bone tumors, soft tissue sarcomas and breast cancer being common second cancers seen in survivors.
This document summarizes the results of two randomized controlled trials (PORTEC-1 and PORTEC-2) that compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) or no additional treatment (NAT) for patients with endometrial carcinoma. PORTEC-1 showed that EBRT improves local control over NAT but does not provide a survival benefit and is associated with long-term side effects. PORTEC-2 found that VBT achieves similar local control as EBRT with fewer side effects, establishing VBT as the preferred adjuvant treatment for high intermediate risk patients.
This document provides a detailed overview of testicular cancer classifications, histology, screening tools, management approaches, and prognostic factors. It discusses the various histologic types of germ cell tumors and sex cord-gonadal stromal tumors. For each type, it describes characteristics such as common age range, histologic features, tumor markers, and treatment approaches. It also summarizes staging evaluations and the role of imaging, tumor markers, surgery, radiation therapy, chemotherapy, and surveillance in testicular cancer management.
This document summarizes information about PSMA PET-CT scans for imaging prostate cancer. It explains that PSMA is overexpressed in prostate cancer cells and is a good target for imaging. A new development is using radiolabeled PSMA ligands like Ga-68 for PET imaging, which can detect prostate cancer with high sensitivity and specificity, including small lymph nodes and bone metastases. The benefits of Ga-68 include its generator production and labeling chemistry allowing automated preparation with a short half-life for reduced radiation dose. PSMA PET is useful for staging, recurrence detection, and assessing treatment response in prostate cancer.
1. Non-seminomatous germ cell tumors of the testis can be managed with surveillance, chemotherapy, surgery such as radical orchiectomy or RPLND, and radiotherapy for brain metastases.
2. Surveillance is indicated for early stage disease while chemotherapy is preferred for advanced stages or elevated tumor markers.
3. RPLND is performed for staging or residual masses after chemotherapy and can preserve ejaculation through nerve-sparing techniques.
4. Prognosis is generally excellent even for advanced stages, though toxicity from treatment needs monitoring.
This document discusses current trends in the treatment of liver tumors. It covers various types of liver tumors including primary and secondary tumors. For hepatocellular carcinoma (HCC), the main treatment options discussed are surgical resection, liver transplantation, radiofrequency ablation, transarterial chemoembolization (TACE), radiotherapy, and targeted therapy. For colorectal liver metastases, surgical resection is the main treatment discussed along with ablation, liver directed therapies like TACE, and chemotherapy. The document provides details on patient selection criteria, techniques like portal vein embolization to improve outcomes of resection, and prognostic scoring systems for colorectal liver metastases.
Hepatoblastoma- Investigations and managementARJUN MANDADE
This document summarizes information about hepatoblastoma, a rare type of liver cancer that mostly affects young children. It discusses the history and terminology of hepatoblastoma. Key points include: hepatoblastoma typically affects children under 3 years old and accounts for about 1% of childhood cancers. Complete surgical resection is the main treatment when possible but less than 50% of patients are resectable at diagnosis. The addition of cisplatin-based chemotherapy has improved outcomes by increasing resectability. Prognosis remains suboptimal for patients with unresectable or metastatic disease after chemotherapy. Chemoembolization and liver transplantation are promising alternative treatments in these cases.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Immunotherapy for Metastatic Triple Negative Breast Cancerbkling
Sylvia Adams, MD, medical oncologist, and associate professor at the NYU School of Medicine, discusses the latest research including the role of immunology in the treatment of triple negative metastatic breast cancer. This webinar was hosted on October 19, 2016.
Wilms tumor is the most common kidney cancer in children, peaking between ages 2-3. It is usually treated with surgery to remove the kidney followed by chemotherapy. For bilateral cases, chemotherapy is given first to shrink tumors before kidney-sparing surgery. Neuroblastoma arises from nerve tissue and most often appears in the abdomen. It is the most common cancer in infants and has a wide range of severity. Treatment involves surgery, chemotherapy, and sometimes radiation. Both cancers are staged to determine prognosis and guide therapy. Overall, current multi-disciplinary approaches have significantly improved survival rates.
Wilms tumor, also known as nephroblastoma, is the most common malignant renal tumor of childhood. It develops from embryonic kidney tissue and accounts for 6-7% of childhood cancers. The tumor is usually diagnosed before age 5 and may be detected via abdominal mass or hematuria. Staging involves imaging like CT or MRI to determine extent. Prognosis depends on histology and stage. Treatment typically involves nephrectomy followed by chemotherapy, with radiation sometimes used. Late effects can include growth issues, infertility, and second cancers. Long term follow up is important after treatment ends.
Surgery plays an important but limited role in the management of testicular cancer. The main surgical procedures are:
1) Radical high inguinal orchidectomy, which is the primary treatment and provides staging information.
2) Retroperitoneal lymph node dissection (RPLND), which may have a therapeutic, prophylactic, or diagnostic role depending on the stage and histology.
3) In select cases, hemi scrotectomy or metastectomy may be performed. While surgery is crucial for diagnosis and staging, most testicular cancers are highly responsive to chemotherapy and radiotherapy, which are the primary treatment modalities.
1. Retroperitoneal tumors are rare and often malignant, with liposarcoma and leiomyosarcoma being the most common.
2. They typically present as large abdominal masses without symptoms until they compress nearby structures.
3. CT scan is the main imaging method used to identify the tumor type, size, and involvement of surrounding organs.
4. Surgical resection is the primary treatment when possible, though radiation and chemotherapy may be used as adjuvants or for advanced disease. Prognosis depends on tumor grade, size, and whether a complete resection can be achieved.
1. Testicular cancer is most common in young men aged 20-40 years and 90-95% are germ cell tumors.
2. Survival rates have improved to over 95% for stage I and II seminomas and 90% for stage I non-seminomas due to better understanding of the disease, use of tumor markers, and cisplatin chemotherapy.
3. Treatment involves radical orchidectomy followed by radiotherapy for seminomas or lymph node dissection/chemotherapy for non-seminomas depending on stage.
1) Locally advanced breast cancer (LABC) includes stage IIB-IIIC disease and encompasses operable, inoperable, and inflammatory breast cancer at presentation.
2) Patients with LABC undergo neoadjuvant chemotherapy followed by surgery and radiation therapy. Additional tests are only indicated based on symptoms.
3) The goals of neoadjuvant therapy are tumor response before surgery to enable breast conservation and provide information about response to therapy. Anthracycline and taxane regimens are appropriate, and 15-25% will experience complete pathologic response.
This document summarizes the management of pancreatic carcinoma. It discusses the anatomy, epidemiology, risk factors, hereditary syndromes, pathophysiology including pre-cancerous lesions, types of pancreatic cancer, staging, prognostic factors, diagnostic techniques, treatment including surgery, chemotherapy, targeted therapy, radiotherapy and historical prospective studies. It provides a comprehensive overview of pancreatic carcinoma covering all relevant aspects of the disease.
This document discusses total neoadjuvant therapy (TNT) for rectal cancer. It summarizes evidence from trials showing that TNT with chemotherapy prior to chemoradiation and surgery improves pathologic complete response rates and reduces distant metastases compared to adjuvant chemotherapy. The document also reviews the experience with TNT at the author's institution, including a clinical complete response rate of 36% and a pathologic complete response rate of 15.6% among surgery patients. Non-operative management strategies with a watch-and-wait approach are also discussed.
PI-RADS v2 is a standardized reporting system for multiparametric MRI of the prostate to improve detection and characterization of prostate cancer. It assesses T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast enhanced imaging on a 1-5 scale. A score of 1 indicates cancer is highly unlikely while 5 indicates cancer is highly likely. PI-RADS v2 aims to improve outcomes for patients by facilitating targeted biopsies and treatment decisions. While it has good performance, limitations include not addressing recurrent cancer or other body parts. Further studies are still needed to validate its accuracy and reduce interpreter variability.
This document discusses metastatic colorectal liver cancer. It outlines risk factors, evaluation, and treatment options including surgery, chemotherapy, local tumor ablation, and radiotherapy. Surgery offers the best chance of survival if metastases are resectable, with 5-year survival rates of 24-58% for resection. Neoadjuvant chemotherapy can help make previously unresectable tumors operable. Local ablation techniques are alternatives for tumors that cannot be surgically removed.
1. Several molecular pathways are involved in breast cancer pathogenesis, including steroid hormone receptors, HER2/neu, cell cycle proteins, and growth factors.
2. Risk factors for breast cancer include increasing age, female gender, family history, genetic mutations, personal history of breast cancer or other breast diseases, reproductive factors, and hormone use.
3. High risk patients are identified using tools like the Gail model and managed through increased screening including breast self-exams, clinical exams, mammograms, and MRI. Preventive options include tamoxifen, raloxifen, and prophylactic surgeries.
Radiotherapy in paediatrics - late effects and second malignanciesAshutosh Mukherji
1. Childhood cancer survivors face risks of late sequelae from radiation therapy including growth impairment, cognitive deficits, infertility and cardiac issues.
2. The risks are dependent on factors like radiation dose, age at treatment, and volumes of normal tissues irradiated.
3. Second malignancies are a major concern after radiation therapy, with bone tumors, soft tissue sarcomas and breast cancer being common second cancers seen in survivors.
This document summarizes the results of two randomized controlled trials (PORTEC-1 and PORTEC-2) that compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) or no additional treatment (NAT) for patients with endometrial carcinoma. PORTEC-1 showed that EBRT improves local control over NAT but does not provide a survival benefit and is associated with long-term side effects. PORTEC-2 found that VBT achieves similar local control as EBRT with fewer side effects, establishing VBT as the preferred adjuvant treatment for high intermediate risk patients.
This document provides a detailed overview of testicular cancer classifications, histology, screening tools, management approaches, and prognostic factors. It discusses the various histologic types of germ cell tumors and sex cord-gonadal stromal tumors. For each type, it describes characteristics such as common age range, histologic features, tumor markers, and treatment approaches. It also summarizes staging evaluations and the role of imaging, tumor markers, surgery, radiation therapy, chemotherapy, and surveillance in testicular cancer management.
This document summarizes information about PSMA PET-CT scans for imaging prostate cancer. It explains that PSMA is overexpressed in prostate cancer cells and is a good target for imaging. A new development is using radiolabeled PSMA ligands like Ga-68 for PET imaging, which can detect prostate cancer with high sensitivity and specificity, including small lymph nodes and bone metastases. The benefits of Ga-68 include its generator production and labeling chemistry allowing automated preparation with a short half-life for reduced radiation dose. PSMA PET is useful for staging, recurrence detection, and assessing treatment response in prostate cancer.
1. Non-seminomatous germ cell tumors of the testis can be managed with surveillance, chemotherapy, surgery such as radical orchiectomy or RPLND, and radiotherapy for brain metastases.
2. Surveillance is indicated for early stage disease while chemotherapy is preferred for advanced stages or elevated tumor markers.
3. RPLND is performed for staging or residual masses after chemotherapy and can preserve ejaculation through nerve-sparing techniques.
4. Prognosis is generally excellent even for advanced stages, though toxicity from treatment needs monitoring.
This document discusses current trends in the treatment of liver tumors. It covers various types of liver tumors including primary and secondary tumors. For hepatocellular carcinoma (HCC), the main treatment options discussed are surgical resection, liver transplantation, radiofrequency ablation, transarterial chemoembolization (TACE), radiotherapy, and targeted therapy. For colorectal liver metastases, surgical resection is the main treatment discussed along with ablation, liver directed therapies like TACE, and chemotherapy. The document provides details on patient selection criteria, techniques like portal vein embolization to improve outcomes of resection, and prognostic scoring systems for colorectal liver metastases.
Hepatoblastoma- Investigations and managementARJUN MANDADE
This document summarizes information about hepatoblastoma, a rare type of liver cancer that mostly affects young children. It discusses the history and terminology of hepatoblastoma. Key points include: hepatoblastoma typically affects children under 3 years old and accounts for about 1% of childhood cancers. Complete surgical resection is the main treatment when possible but less than 50% of patients are resectable at diagnosis. The addition of cisplatin-based chemotherapy has improved outcomes by increasing resectability. Prognosis remains suboptimal for patients with unresectable or metastatic disease after chemotherapy. Chemoembolization and liver transplantation are promising alternative treatments in these cases.
This document discusses the management of non-small cell lung cancer. It outlines the various treatment options depending on the stage of cancer, including surgery for early stages, radiation therapy, chemotherapy, and stereotactic body radiotherapy. It provides details on surgical procedures, radiation techniques, outcomes of stereotactic body radiotherapy, and the use of concurrent chemotherapy and radiation for locally advanced stages.
Immunotherapy for Metastatic Triple Negative Breast Cancerbkling
Sylvia Adams, MD, medical oncologist, and associate professor at the NYU School of Medicine, discusses the latest research including the role of immunology in the treatment of triple negative metastatic breast cancer. This webinar was hosted on October 19, 2016.
Wilms tumor is the most common kidney cancer in children, peaking between ages 2-3. It is usually treated with surgery to remove the kidney followed by chemotherapy. For bilateral cases, chemotherapy is given first to shrink tumors before kidney-sparing surgery. Neuroblastoma arises from nerve tissue and most often appears in the abdomen. It is the most common cancer in infants and has a wide range of severity. Treatment involves surgery, chemotherapy, and sometimes radiation. Both cancers are staged to determine prognosis and guide therapy. Overall, current multi-disciplinary approaches have significantly improved survival rates.
Wilms tumor, also known as nephroblastoma, is the most common malignant renal tumor of childhood. It develops from embryonic kidney tissue and accounts for 6-7% of childhood cancers. The tumor is usually diagnosed before age 5 and may be detected via abdominal mass or hematuria. Staging involves imaging like CT or MRI to determine extent. Prognosis depends on histology and stage. Treatment typically involves nephrectomy followed by chemotherapy, with radiation sometimes used. Late effects can include growth issues, infertility, and second cancers. Long term follow up is important after treatment ends.
This document discusses common malignancies in children and embryonal tumors specifically. It outlines four main embryonal tumors - Wilms tumor, retinoblastoma, neuroblastoma, and medulloblastoma. For each tumor, it describes the clinical presentation, cellular origins based on embryonic development, molecular pathology including key genetic drivers, and current treatment approaches. It concludes by noting certain genetic predisposition syndromes can increase the risk of developing cancer in childhood.
2021 World Cancer Day Campaign
World Cancer Day aims to save millions of preventable deaths each year by raising awareness and education about cancer, and pressing governments and individuals across the world to take action against the disease.
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This document discusses germ cell tumors of the ovary. It begins by explaining that germ cell tumors originate from primordial germ cells and make up about 90-95% of ovarian malignancies in young women. It then covers the various subtypes of germ cell tumors, including their incidence rates, typical patient demographics, clinical presentations, diagnostic markers, pathological classifications, treatment approaches, and prognosis. Dysgerminoma is discussed as the most common subtype, while immature teratoma, endodermal sinus tumor, embryonal carcinoma, and choriocarcinoma are also described in terms of their defining characteristics and management. Throughout, the focus remains on applying knowledge from testicular germ cell tumor research
This document summarizes key information from a presentation on early diagnosis of cancer in neonates and young infants. It discusses how cancer can present non-specifically in infants, with symptoms like lethargy and feeding difficulties. Several common childhood cancers are mentioned, including neuroblastoma, Wilms tumor, retinoblastoma, and leukemia. Challenges in diagnosing and treating neonatal cancer are outlined, such as the need for specialized pathology expertise and reduced chemotherapy doses. The presentation concludes with acknowledgements and a call for improved early diagnosis and shared care models for childhood cancer.
Neuroblastoma diagnosis, treatment, complications, and further management. The main contents of this review have been accessed from MedScape. Please do not reprint or copy this material without permission from the copyright owner.
- Neuroblastoma is the most common abdominal cancer in children and accounts for 15% of pediatric cancer deaths. It arises from nerve tissue and occurs most often in the abdomen.
- Presentation depends on location but often includes an abdominal mass, pain, bone lesions, or organ compression. Over 40% have metastases at diagnosis.
- Staging involves imaging and biopsy to determine extent of disease. Treatment depends on risk stratification and may include surgery, chemotherapy, radiation, stem cell transplant, and targeted therapy. Surgery aims to remove the primary tumor but carries risks of injury and complications.
This document provides an overview of common pediatric solid tumors, including definitions, epidemiology, etiology, types, symptoms and signs, staging, diagnosis, treatment, and prognosis for each tumor type. The tumors discussed include lymphomas, nephroblastoma (Wilms tumor), neuroblastoma, hepatoblastoma, and hemangioma. For each tumor type, the summary defines the tumor, discusses prevalence and risk factors, describes common subtypes, and outlines the standard diagnostic and treatment approaches.
Thyroid cancers can affect the follicular or parafollicular cells of the thyroid gland. The most common types are papillary carcinoma, follicular carcinoma, and medullary carcinoma. Risk factors include genetics, family history, radiation exposure, and iodine deficiency. Symptoms may include thyroid nodules, neck lymphadenopathy, or changes in voice. Diagnosis involves blood tests, ultrasound, biopsy, and imaging. Treatment depends on cancer type and severity but commonly includes surgery followed by radiation or other therapies. Prognosis depends on factors like cancer stage, size, and spread.
ca uterus cancer in uterus, common female problemSasiSoman3
Endometrial cancer arises from the lining of the uterus. The major risk factors include increased estrogen exposure unopposed by progesterone, obesity, and hereditary nonpolyposis colorectal cancer. Symptoms include abnormal uterine bleeding, especially in postmenopausal women. Diagnosis is made by endometrial biopsy, which is recommended for women with risk factors or abnormal bleeding. Most cases are diagnosed early and treated with hysterectomy and radiation, resulting in high survival rates.
- Nephroblastoma, also known as Wilms tumor, is the most common renal malignancy in children under 5 years old.
- It accounts for 5-6% of all childhood cancers worldwide. Risk factors include genetic syndromes like WAGR or Beckwith-Wiedemann syndrome.
- Treatment involves surgical resection of the tumor followed by chemotherapy and sometimes radiation therapy. With a multidisciplinary approach, the 5-year survival rate is around 90%. Intensive follow-up is important after treatment to monitor for recurrence or late effects.
Wilms tumor, or nephroblastoma, is a malignant kidney tumor that typically occurs in young children under 5 years old. It is the fifth most common pediatric cancer and is highly responsive to treatment, with a 90% survival rate. While the exact cause is unknown, genetic factors and abnormalities in genes like WT1 and WT2 may play a role in tumor development. Treatment involves surgery to remove the tumor, radiation therapy, and chemotherapy depending on the stage. Early detection and complete surgical removal of localized tumors results in high survival rates.
This document discusses cervical cancer, including its incidence, risk factors, diagnosis, staging, treatment, and prognosis in Bangladesh. It notes that cervical cancer rates are high in Bangladesh due to lack of screening and various social risk factors. Diagnosis involves examination, biopsy, and imaging. Staging follows the FIGO system and considers tumor size and spread. Treatment options include surgery, radiation, chemotherapy, or combinations. Prognosis depends on stage, tumor size and type, age, lymph node involvement, and HPV status.
Dr. Aisha Nazeer presented on malignant ovarian tumors. Key points include:
- Ovarian cancer is the second most common gynecological cancer and a major cause of death.
- 75% of cases are diagnosed at an advanced stage when survival is only 10-20%.
- Risk factors include age, reproductive history, family history, and genetic mutations.
- Symptoms are often vague in early stages leading to it being called the "silent killer".
- Staging and treatment involves surgical staging and chemotherapy or radiation depending on the type and stage of cancer.
Pediatric solid tumors are a diverse group of cancers that arise in children. They account for 60% of pediatric malignant neoplasms and can originate from mesoderm, endoderm or ectoderm tissues. The most common types are brain tumors, neuroblastoma, rhabdomyosarcoma, Wilms' tumor, and osteosarcoma. Presentation depends on tumor location and type but may include masses, compression symptoms, metastases, and paraneoplastic effects. Diagnosis involves imaging, biopsy and laboratory tests. Treatment involves surgery, chemotherapy and/or radiation depending on tumor characteristics and stage. Prognosis depends on specific tumor type and stage.
- Neuroblastoma is a type of childhood cancer that develops from immature nerve cells and most commonly affects infants and young children.
- It can arise in adrenal glands or sympathetic nervous system ganglia and often spreads to bones, bone marrow, liver and other sites.
- Presentation varies from asymptomatic masses to symptoms of metastasis like bone pain or organ compression. Diagnosis involves urine and bone marrow tests detecting nerve cell markers.
- Staging uses the International Neuroblastoma Staging System and treatment may include surgery, chemotherapy, radiation, stem cell transplant, immunotherapy and retinoids depending on risk level.
This document provides an overview of thyroid tumors, including their epidemiology, classification, clinical features, investigations, and treatment. It discusses the main types of benign and malignant thyroid tumors such as follicular adenoma, papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma. Papillary carcinoma is the most common thyroid malignancy. Follicular carcinoma and medullary carcinoma can occasionally be familial. Anaplastic carcinoma is very aggressive and usually has a poor prognosis.
This document provides an overview of several types of pediatric solid tumors, including sarcomas, carcinomas, nephroblastoma (Wilms' tumor), neuroblastoma, hepatoblastoma, and germ cell tumors. It discusses the epidemiology, etiology, clinical presentation, diagnosis, staging, treatment, and prognosis for each tumor type. Treatment typically involves surgery, chemotherapy, and radiotherapy based on tumor staging and characteristics. Many of these tumors are associated with genetic syndromes or mutations that can increase risk. Accurate diagnosis relies on histologic confirmation of biopsy or surgical specimens.
Testicular cancer is one of the most curable cancers, with a 5-year survival rate now over 95% due to improved treatments. It typically affects young men between puberty and age 35. Successful treatment involves radical orchiectomy, chemotherapy, and sometimes radiation or retroperitoneal lymph node dissection. A radical orchiectomy surgically removes the testicle and is the standard treatment for suspected testicular cancer based on findings such as a painless testicular mass. While scrotal violations during surgery were once thought to worsen prognosis, evidence now suggests this is not the case if there is no tumor spillage.
Classification of surgical wounds based on contaminationIrfanNashad1
Wounds are classified into four categories based on their cleanliness and risk of infection. Class I wounds are clean and uninfected. Class II wounds are clean-contaminated and enter respiratory, alimentary, genital, or urinary tracts under controlled conditions. Class III wounds are contaminated with acute inflammation. Class IV wounds are dirty and infected with devitalized tissue.
Introduction to general surgery and history of general surgeryIrfanNashad1
This document provides an introduction to surgery, including definitions of key terms like indication, types of incisions and wounds. It discusses the different types of wounds that can occur like open wounds from surgery, burns or bites, and closed wounds under intact skin. The document also outlines factors that affect wound healing and different types of dressings that can be used, including absorbent, nonadherent, occlusive and medicated dressings.
Surgical options for different Pleural DiseasesIrfanNashad1
This document discusses various pleural diseases including pleural effusion, empyema, and chylothorax. It begins by defining the pleura and pleural space. For pleural effusion, it describes the types (hydrothorax, haemothorax, pyothorax), causes, signs and symptoms, investigations including thoracentesis, and treatments including drainage, pleurodesis, and surgery. For empyema, it covers definition, causes, pathogenesis, complications, investigations and criteria for diagnosis, and treatments including antibiotics, drainage, decortication, and thoracoplasty. For chylothorax, it defines it as chyle in the pleural space due to thoracic
Sprengel shoulder deformity is a congenital condition where the scapula is elevated above its normal position. The modified Green method is a surgical treatment that involves an osteotomy of the clavicle, detaching the supraspinatus and trapezius muscles, excising the omovertebral bar, releasing all attached muscles, reducing the scapula to a normal position, and suturing the muscles back together.
This document describes a case study of a 3-year-old girl from Peshawar, Pakistan who presented with urinary and fecal incontinence due to a history of meningomyelocele repair as an infant. Investigations revealed a bladder infection which was treated. Cystoscopy showed a trabeculated bladder with wide ureteric openings and normal bladder neck coaptation. She was initially managed conservatively but later underwent a split appendix procedure where the appendix was used to create both a Mitrofanoff channel for clean intermittent catheterization and a Monti channel for antegrade enemas to manage her neurogenic bowel and bladder. Follow up after 3 months found her to be clean and dry with
TYPES OF WOUND HEALING by Mishal Khan.pptxIrfanNashad1
There are three main types of wound healing: primary intention, secondary intention, and tertiary intention. Primary intention involves closing clean wounds with sutures, leading to rapid healing and a neat scar. Secondary intention involves leaving wounds open to heal, resulting in a longer healing time and larger scar. Tertiary intention involves initially leaving contaminated wounds open to clean before later closure, aiming to prevent chronic inflammation and scarring. Complications can include hypertrophic scarring, keloids, contractures, wound dehiscence, adhesions, and infection.
This document summarizes several lower limb deformities:
Coxa vara is a hip deformity where the femoral neck angle is reduced below 120 degrees, causing limb shortening and limp. Coxa valga is the opposite deformity with an increased femoral neck angle. Femoral retroversion and hallux valgus (bunions) are also common deformities discussed. Treatment options ranged from observation to osteotomies and surgery depending on the severity of the case. Clubfoot (congenital talipes equinovarus) is often treated using the Ponseti method of manipulation and casting to correct deformity without surgery.
Developmental dysplasia of the hip (DDH) is a condition where the ball and socket joint of the hip do not develop properly. It can affect one or both hips and is more common in females. Treatment depends on the age of the patient, ranging from hip harnesses or splints for young infants to closed or open surgical reduction for older patients. Common spinal deformities discussed include scoliosis, kyphosis, lordosis, torticollis, and flat back. Scoliosis causes an abnormal lateral curvature of the spine. Treatment involves observation, bracing, or surgery depending on the severity of the curvature. Kyphosis and lordosis refer to abnormal curvatures of the thoracic and lumbar
Epigastric pain can originate from several sources including the heart, stomach, esophagus, gallbladder, and pancreas. Cardiac epigastric pain increases with exertion and is accompanied by shortness of breath. Gastroesophageal pain occurs after spicy meals and is characterized by heartburn and regurgitation. Gallbladder pain increases after fatty meals due to blocked bile ducts and radiates to the right shoulder. Pancreatic pain persists and radiates to the back, accompanied by tenderness and fever in cases of pancreatitis. Investigations like ECG, blood tests, ultrasound and enzyme levels help determine the underlying cause, while treatment focuses on the specific condition and uses antacids for pain relief.
This document discusses conflict resolution with a focus on considerations for doctors and subordinate staff. It defines conflict as the perception of mutual interference between parties' goals due to differences in resources, goals, structures, perceptions, communication or within individuals. Conflicts can be about tasks, emotions between people, or administrative processes. The goal of conflict resolution is to confront problems respectfully through open communication to provide optimal patient care. Addressing conflicts is important to prevent feelings of powerlessness, divided loyalties, and viewing others as adversaries in the workplace.
- A bursa is a fluid-filled sac that acts as a cushion between bones, muscles, and ligaments near joints. Injury to a bursa can cause pain, limited motion, and decreased mobility.
- The cervical vertebrae are the smallest and most movable part of the spine. Injuries can occur from direct or indirect trauma and include fractures, dislocations, and ligament injuries.
- Treatment depends on the injury but may include immobilization, traction, steroids, and surgery to stabilize or fuse the spine to preserve neurological function and spinal stability.
Soft tissue injuries can be acute or chronic and include injuries to muscles, ligaments, and tendons. Acute injuries occur suddenly from trauma while overuse injuries occur gradually. Injuries are classified by degree from mild (grade 1) to severe (grade 3) based on the extent of tissue damage. Treatment focuses on PRICE principles initially followed by rehabilitation exercises to restore strength, mobility, and function. More severe injuries may require surgical intervention.
A fracture is a break in the bone's continuity. Fractures are classified based on appearance (transverse, oblique, spiral, comminuted), cause (traumatic, pathological), and stability (complete, incomplete). Common causes include accidents, falls, abuse, and diseases. Symptoms include pain, tenderness, swelling, deformity, loss of function, and restricted movement. Diagnosis involves x-ray, CT scan, MRI, or ultrasound. Treatment goals are to regain correct position and alignment, function, and return to usual activities quickly. Management includes closed techniques like splinting, casting, and traction or open techniques like internal or external fixation. Bone healing occurs in stages of hematoma formation, soft
Cystic diseases of the kidney can be congenital or acquired and range from benign and asymptomatic to severe and life-threatening. There are several types of cystic kidney disease including polycystic kidney disease (PKD), which is autosomal dominant and involves multiple expanding cysts leading to kidney destruction. Multicystic dysplastic kidney disease (MCDK) is a non-functioning dysplastic kidney with multiple cysts present at birth. Acquired cystic kidney disease develops secondary to long-term dialysis and carries an increased risk of kidney tumors.
Bladder stones can be classified as primary, secondary, or migratory based on their underlying cause. Primary stones typically occur in children in endemic areas with poor nutrition. Secondary stones are associated with an underlying bladder pathology like benign prostatic hyperplasia. Migratory stones initially form in the upper urinary tract. Management options include medical dissolution, shockwave lithotripsy, transurethral lithotripsy, percutaneous cystolithotomy, open surgery, or a combination depending on factors like stone size and location. Prevention involves adequate hydration and treatment of any predisposing conditions.
PUJO is an obstruction of the proximal ureter at the junction with the renal pelvis. It is most common in childhood, affecting 1 in 1000 children, with boys more commonly affected than girls. Presentation includes flank pain, flank mass, nausea, vomiting, recurrent UTIs, and hematuria. Diagnosis involves blood tests, urine tests, ultrasounds, CT scans, nuclear scans, and retrograde pyelography. Treatment depends on symptoms and impairment - watchful waiting may be sufficient, but surgery like pyeloplasty is often needed and has a high success rate of 90-95%.
Cryptorchidism is the retention of one or both testes in the abdomen or inguinal canal. It has an incidence of 1-4.6% in full term males and higher in preterm infants. The exact cause is unknown in most cases but may be due to genetic and environmental factors. Diagnosis involves physical exam and imaging like ultrasound or MRI. Treatment is usually surgical orchidopexy between 6-18 months of age to lower risks of infertility, trauma, torsion, and malignancy. Surgical techniques depend on location of the undescended testis and include inguinal, scrotal, open or laparoscopic procedures. Prognosis is generally good but risks of reduced fertility and
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
- Primary pleural tumors and pleural metastases.
- Distinguishing between MPM and Talc Pleurodesis.
- Urological tumors.
- The role of FDG PET in NET.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
Gemma Wean- Nutritional solution for Artemiasmuskaan0008
GEMMA Wean is a high end larval co-feeding and weaning diet aimed at Artemia optimisation and is fortified with a high level of proteins and phospholipids. GEMMA Wean provides the early weaned juveniles with dedicated fish nutrition and is an ideal follow on from GEMMA Micro or Artemia.
GEMMA Wean has an optimised nutritional balance and physical quality so that it flows more freely and spreads readily on the water surface. The balance of phospholipid classes to- gether with the production technology based on a low temperature extrusion process improve the physical aspect of the pellets while still retaining the high phospholipid content.
GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
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Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
Resources: Provide contact information and links for further support.
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3. Neublastoma
• Background
• Neuroblastoma is the most common extracranial
solid tumor of childhood.
• Neuroblastoma is known to arise from cells of the
neural crest that form the adrenal medulla and
sympathetic ganglia.
• Tumors may occur anywhere along the sympathetic
chain within the neck, thorax, retroperitoneum, or
pelvis or in the adrenal gland.
4. Continue
• These tumors can undergo spontaneous
regression , differentiate to benign neoplasms,
or exhibit extremely malignant behavior.
Unpredictable behaviour
Retroperitoneum 75%
Adrenal 50%
paravertebral ganglia 25%
5. Incidence
• 8% to 10% of all childhood cancers.
• Annual incidence is 10 cases per million in US.
• Most common tumor of infancy.
• Median age at diagnosis is 18 months which
reduces to 9 months in familial form.
6. Embryology
• Neuroblastoma is known to arise from cells of
the neural crest that form the adrenal medulla
and sympathetic ganglia.
8. Prognostic Markers
• Intensity of chemotherapy is determined not
only by staging of tumor but also by its biologic
markers.
• Favourable markers unfavourable markers
• DNA Aneuploidy > >Amplification of the
MYCN oncogene at 2p24
> >Deletion of the short arm
of chromosome 1p,
> > 11q deletion ,
> > 17q gain
10. Shimada classification
• Stroma Rich Stroma Poor
Nodular
Intermixed Favourable Unfavourable
well differentiated
Based on the patient's age
at diagnosis, the degree of
histologic maturation, and
the mitotic rate.
13. Clinical Presentation
• Local disease
abdominal pain or a palpable mass
• Metastatic
bone or joint pain, periorbital ecchymosis.
• Thoracic lesions may produce respiratory symptoms of
cough or dyspnea.
• Neurologic deficits as a result of cord compression.
• Extrinsic compression of the bowel and bladder can
produce symptoms of urinary retention and
constipation
• Metastases are present in 70% of patients with
neuroblastoma at diagnosis.
14. • Para neoplastic syndrome.
Catecholamine mimic pheochromocytoma
VIP severe watery diarrhea and
hypokalemia.
• Unusual presentation.
acute myoclonic encephalopathy, in which patients
develop myoclonus, rapid multidirectional eye
movements (opsoclonus), and ataxia.
• It is thought to result from an interaction of antibodies
produced against the neuroblastoma to normal neural
tissues.
15. Diagnosis
• Laboratory Evaluation
urinary metabolites of catecholamines,
vanillylmandelic acid (VMA) and homovanillic acid
(HVA), are found in 90% to 95% of patients.
Anemia. In children with widespread bone marrow
involvement.
16. • Imaging
• Plain radiographs. May demonstrate a calcified
abdominal or posterior mediastinal mass.
• CT. local extent of the primary tumors and vascular
involvement. Invasion of the renal parenchyma is not
common, but it can be detected radiographically by CT.
• The finding of intratumoral calcifications, vascular
encasement, or both on preoperative CT may help
distinguish neuroblastoma from Wilms tumor.
17. • Metaiodobenzylguanidine (MIBG) scan.
Use 123I-MIBG
determine the extent of disease and detect
tumor recurrence after completion of therapy.
• Positron emission tomography (PET) can be
used if MIBG can not be used or not available.
18. • MRI. local extent & vascular involvement.
• MRI has advantages over CT in
the evaluation of intraspinal tumor extension,
relationship between the major vessels and
the tumor.
19. Screening
• Started in Japan & has been there since 20 years.
• Patients diagnosed with screening have uniform
survival of >97%.
• Before screening, 20% diagnosis before age 1 which
increased to 55% after screening implementation.
• However, the number of children older than 1 year
of age diagnosed with advanced-stage disease has
not decreased.
• Biologic differences between tumors diagnosed by
screening and those detected clinically.
21. Treatment
• Surgery, chemotherapy, and radiation therapy.
• The role of each in individual patients varies
depending on tumor stage, age, and biologic
prognostic factors.
22. Low-Risk Disease (Stages I, II, and IV-
S).
• Children with stage I neuroblastoma have a
disease-free survival rate of greater than 90%
with surgical excision alone
• Chemotherapy is indicated only in the event
of recurrence unless the child has MYCN
amplification and unfavorable histology.
• Radiation therapy has no role in this subset of
patients.
23. Intermediate and High-Risk Disease
(Stages III and IV).
• Chemotherapy Surgery
• Usually the safest approach for advanced
tumors is to defer resection until after initial
chemotherapy.
• The tumors are smaller and firmer, with less
risk of rupture and hemorrhage after
chemotherapy, resulting in a decreased rate of
complications, particularly nephrectomy.
24. • Surgery usually is performed 13 to 18 weeks
after initiation of chemotherapy, allowing
three to four courses of treatment.
• Extensive surgical resection can result in
Diarrhoea & Chylus acities.
25. RADIOTHERAPY
• Radiotherapy has a role in neuroblastoma
because tumor is radiosensitive.it is most
useful in achieving local control and palliation
of disease uncontrollable by other modalities.
• DOSE= Ranged b/w 15 and 30 Gy
26. New Innovative Biologic Therapies
• Double autologous bone marrow
transplantation. Has allowed the use of
myeloablative therpies.
• Multiple monoclonal antibodies.
27. Wilms tumor
• Wilms tumor, or nephroblastoma, is the most
common primary malignant renal tumor of
childhood. It is an embryonal tumor that develops
from remnants of immature kidney.
28. Epidemiology
• Wilms tumor accounts for approximately 6% to 7% of
all childhood cancers.
• It is the most common renal tumor of childhood,
accounting for 95% of all kidney cancers in children
under the age of 15 in the United State.
• Incidence rate of Wilms tumor is 8.0 per million.
• More than 80% of cases are diagnosed before 5 years
of age, with a median age of 3.5 years.
• It is lower in bilateral cases & in children with
syndromic predisposition.
• Incidence in East Asian population is lower than black
population.
29. Genitics
Wilms tumor
Sporadic familial
Early age, B/L
WTI(11p13)10% WT2(11p15)4% LOH 16q (20%) WTX(30%)
Mutation. DDS LOS BWS risk of relpase same pathway as WTI
Deltion. WAGR LOH 1p (10%)
risk of relpase
combined loss will result in worse replase
30. Clinical presentation
• Most common presentation is abdominal mass.
• Haematuria 20%. Gross haematuria warrants
further workup.
• Anorexia, weight loss, malaise 10%
• Hypertension 20-25%
• Asymptomatic
• Atypical presentation. Persistent vericocele,
hepatomegaly, CCF.
32. Labs
• CBC, S/E, LFTS, RFTs, S.calcium
• Coagulation profile. As 8% of newly diagnosed
patients have acquired von Willebrand
disease.
33. Diagnosis
• Ultrasound
solid mass of the kidney
• Doppler ultrasound can determine vena caval
involvement.
• Give good idea of association with spleen,
liver & other solid organs.
34. • Triphasic CT
Should be chest,abdomen & pelvis
• Arterial, venous & excretory phase
• CT chest. Lung is the most common site for
distant metastasis
• MRI. Same as CT but require sedation or
anaesthesia in children
35. Staging
• The most important determinants of outcome
in children with Wilms tumor are the
histopathology and tumor stage.
37. • Two management arms
• NWTGS/COG SIOP
• Surgery > pre op chemo
• Followed by chemo, > followed by surgery
XRT >further chemo or
• Pre op chemo only in radio if needed
selected cases.
• The overall survival in both groups is >90% in low
stage tumor & >80% in high stage tumor
38. Advantages & disadvantages
NWTGS/COG SIOP
Advantages disadvantages
Accurate histology Increased risk of
surgical
complications
Benign vs malignant Chances of tumor
spillage
Accurate stage Failure to sample
node leads to under
treatment
Advantages disadvantages
Fever surgical
complications
Modification of yumor
histology
Lower incidence of
tumor rupture
Loss of staging
information
Asses tumor response Chemotherapy in a
benign disease
Downstaging of
patient
Chemotherapy to a
different malignant
tumor
Possible role of renal
sparing surgery in the
affected kidney
International Version.
No biopsy
UK version. Pre chemo
biopsy
39. Neoadjuvant chemotherapy
• Local disease. 4 weeks, 2 drugs( actinomycin,
Vincristine)
• Metastatic disease. 6 weeks,3 drugs(Act,VCR, Dox)
• Special situations.
B/L tumor
tumor in solitory kidney
horse shoe kidney
• Where the oncologist can modify the chemo.
40. Surgery
• Role of the surgeon
Before surgery the surgeon must know.
????
• surgical approach
• Laparoscopic surgery. In selected cases.
41. Lymph nodes
• 7 locoregional lymph nodes shpuld be
sampled.
• Hilar & paraaortic lymph node should be
sampled even if not suspicious.
• Involved lymph node should be excised.
• Radical lymph node dissection is not
recommended.
• Post chemo necrotic lymph node should be
considered positive.
46. COG protocols
Stage & histology Surgery Chemotherapy Radiation therapy
I or II favourable
histo without LOH at
1p & 16q
Nephrectomy Vancristine,
Actinmomycin-D
No
I or II favourable
histo withLOH at 1p
& 16q
Nephrectomy Vancristine,
Actinmomycin-D,
Doxurubicin
No
III & IV favourable
histo without LOH at
1p & 16q
Nephrectomy Vancristine,
Actinmomycin-D,
Doxurubicin
Yes
III & IV favourable
histo with LOH at 1p
& 16q
Nephrectomy Vancristine,
Actinmomycin-D,
Doxurubicin
Cyclophosphamide,
Etoposide
Yes
47. COG high risk group management
• Focal anaplastic stage I-III Wilms tumors and diffuse anaplastic
stage I Wilms tumors
Nephrectomy followed by vincristine, actinomycin-D, and
doxorubicin in addition to local radiotherapy.
• Focal anaplastic stage IV Wilms tumors and diffuse anaplastic
stage II-III tumors
Patients undergo the same treatment, with the addition of
cyclophosphamide, etoposide, and carboplatin.
• Stage IV diffuse anaplastic Wilms tumors
More aggressive treatment is delivered; nephrectomy is followed by
initial irinotecan and vincristine administration, which in turn is
followed by actinomycin-D, doxorubicin, cyclophosphamide,
carboplatin, etoposide, and radiotherapy.
48. B/L wilms tumor
• Synchronous bilateral Wilms tumors occur in
5% to 7% of children with Wilms tumor.
• Children with bilateral tumors should not
undergo initial radical nephrectomy.
• These children should receive preoperative
chemotherapy with the goal of tumor
shrinkage and renal-sparing surgery
• Pre chemo for 6 weeks. Responders can be
allowed for surgery.
• Non responder should B/L open renal biopsy.
49. • If nephron sparing surgery is not feasible then
additional chemo is given based on biopsy
report. 2 drugs initially, if poor response then
3 drugs.
• All patients are recommended to undergo
surgical resection within 12 weeks of therapy.
• Can undergo partial nephrectomies on both
sides or radical on one & partial on other side.
• Rarely b/l nephrectomies
50. Follow up
• General well being & growth of the child
• Ultrasound
• Chest x ray
• Yearly serum creatinine if renal function is
normal
• Three monthly creatinine & S/E if renal
dysfunction
• Yearly urine R/E for protienuria