Leukemia is the most common type of cancer in children. It begins in blood cells and causes an abnormal increase in white blood cells. Symptoms include fever, night sweats, bruising easily, and feeling very tired. Treatment involves chemotherapy, radiation therapy, stem cell transplants, and managing risks like infection.

2. • Leukemia is the most common
type of cancer in children. All
cancers begin in cells of the
body, and leukemia is a cancer
that begins in blood cells.
Normally, cells grow and divide
to form new cells as the body
needs them.

3. • When cells grow old, they die and
new cells take their place.
Sometimes, this process does not
work right. In cancer, new cells
form when the body does not need
them, and old cells do not die
when they should.

8. • Leukemia (Greek leukos "white";
aima "blood") is a cancer of the blood
or bone marrow characterized by an
abnormal increase of blood cells,
usually leukocytes (white blood cells).

9. • Exposure to large amounts of radiation
• Exposure to certain chemicals at work,
such as benzene.
• Some types of chemotherapy to treat
another cancer
• Have Down syndrome or some other
genetic problems
• Smoking
• Hereditary factors such as the twins
one egg

10. Unknown aetiology
Somatic mutation in gene
Deactivate tumour suppressor gene

11. Malignant transformation of lymphoblast in
the bone marrow
Uncontrolled proliferation of lymphoblast in
bone marrow
Lymphoblasts replace the normal marrow
element
Leukemia

12. • Fever and night sweats.
• Headaches
• Bruising or bleeding easily.
• Bone or joint pain

13. • A swollen or painful belly from an
enlarged spleen
• Swollen lymph nodes in the armpit,
neck, or groin.
• Getting a lot of infections.
• Feeling very tired or weak.
• Losing weight and not feeling
hungry.

14. • Leukemia can be divided in to 4 types.
Leukemia is either chronic (which
usually gets worse slowly) or acute
(which usually gets worse quickly):
In chronic leukemia, the leukemia cells
come from mature, abnormal cells. The
cells thrive for too long and
accumulate.The cells grow slowly.

15. Acute leukemia,on the other hand,
develop from early cells, called
"blasts". Blasts are young cells, that
divide frequently. In acute leukemia
cells, they don't stop dividing like their
normal counterparts do.
The remain two types refer to the type
of cells in which the leukemia started
from.

16. • Myelogenous leukemia develops from
myeloid cells. The disease can either
be chronic or acute, referred as chronic
myelogenous leukemia(CML), or acute
myelogenous leukemia(ALL).

17. • Lymphocytic leukemia develops
from cells called lymphoblasts or
lymphocytes in the blood marrow.
The disease can be acute or
chronic, referred as chronic
lymphocytic leukemia (CLL), or
acute lymphocytic leukemia (ALL).

18. Checks for swollen
lymph nodes, spleen, or liver.
The complete blood count
to check the number of white blood
cells, red blood cells, and platelets.
Leukemia causes a very high level of
white blood cells. It may also cause low
levels of platelets and hemoglobin,
which is found inside red blood cells.

22. Chemotherapy is
the major form of treatment for
leukemia. This drug treatment uses
chemicals to kill leukemia cells.
Depending on the type of leukemia
client may receive a single drug or a
combination of drugs. These drugs
may come in a pill form, or they may
be injected directly into a vein.

23. Biological therapy works by
helping immune system
recognize and attack leukemia
cells.

24. Targeted therapy uses drugs that
attack specific vulnerabilities
within cancer cells. For example,
the drug imatinib (Gleevec) stops
the action of a protein within the
leukemia cells of people with
chronic myelogenous leukemia.
This can help control the disease.

25. • Radiation therapy uses X-rays or other
high-energy beams to damage
leukemia cells and stop their growth.
client may receive radiation in one
specific area of body where there is a
collection of leukemia cells, or client
may receive radiation over whole body.
Radiation therapy may be used to
prepare for a stem cell transplant.

26. • A stem cell transplant is a procedure to
replace diseased bone marrow with
healthy bone marrow. Before a stem
cell transplant, client receive high
doses of chemotherapy or radiation
therapy to destroy diseased bone
marrow. Then client receive an infusion
of blood-forming stem cells that help to
rebuild bone marrow.

27. • Risk for Infection related to neutropenia
or leukocytosis secondary to leukemia
or treatment
• Risk for Haemorrhage related to
thrombocytopenia secondary to either
leukaemia or treatment
• Fatigue related to side effects of
treatments, low haemoglobin levels,
pain, lack of sleep, or other causes

28. • Imbalance Nutrition: Less Tan
Body Requirements related to
diseased condition evidenced by
anorexia, pain or fatigue.
• Risk for Ineffective Family
Therapeutic Regimen Management
related to increased fear of death,
recurrent hospitalisations etc.

30. • Lymphoma is a type of cancer that
develops in the lymph system, part of
the body's immune system.

31. Generally, lymphoma is divided into
two categories:
• Hodgkin's disease
• non-Hodgkin's lymphoma

32. • The specific cause of lymphoma is
unknown. It is possible that a genetic
predisposition and exposure to viral
infections may increase the risk for
developing Hodgkin lymphoma. There
is a slightly increased chance for
Hodgkin lymphoma to occur in siblings
of patients.

33. • There has been much investigation
into the association of the Epstein-
Barr virus (EBV), which causes the
infection mononucleosis. This
virus has been correlated with a
greater incidence of children
diagnosed with Hodgkin
lymphoma, although the direct link
is unknown.

34. • Exposure to certain pesticides,
herbicides, and solvents such
as benzene has been
associated with lymphoma.

35. • painless swelling of the lymph
nodes in neck, underarm, groin,
and/or chest
• difficulty breathing (dyspnea) due
to enlarged nodes in the chest

36. • fever
• night sweats
• tiring easily (fatigue)
• weight loss/decreased appetite
• itching skin (pruritus)
• frequent viral infections (i.e.,
cold, flu, sinus infection)

37. • Physical exam and history: An
exam of the body to check general
signs of health, including checking for
signs of disease, such as lumps or
anything else that seems unusual. A
history of the patient’s health habits
and past illnesses and treatments will
also be taken.

38. • The removal of cells or tissues so
they can be viewed under a
microscope by a pathologist to
check for signs of cancer

39. The removal of an
entire lymph node or lump of tissue.
The removal of part
of a lump, lymph node, or sample of
tissue.
The removal of tissue or
part of a lymph node using a wide
needle.
The removal of tissue or part of a
lymph node using a thin needle.

44. The four stages of lymphoma are:
• Stage I: A single tumor which hasn't
spread.
• Stage II: More than one tumor, but the
tumors are all found in lymph nodes on the
same side of the diaphragm (all above or
all below). Stage II can also mean that a
tumor has spread to another organ, but
that it is close to the original lymph node
tumor.

45. • Stage III: More than one tumor with the
tumors found on different sides (above
and below) of the diaphragm. There may
be tumors in the spleen or more than one
tumor in nearby organs.
• Stage IV: Many tumors spread throughout
an organ such as the liver or stomach, as
well as in the lymph nodes.

46. • Chemotherapy is the most common
treatment for lymphomas. Depending
on the type and stage of disease,
various combinations of drugs are
administered in cycles to reduce or
eliminate cancer cells.

47. • Radiation therapy is sometimes
used in conjunction with
chemotherapy to treat large areas, or
to minimize discomfort caused by
cancerous lymph nodes that are
affecting nearby organs or structures.

48. • Targeted therapy is a type of treatment
that uses drugs or other substances to
identify and attack specific cancer cells
without harming normal cells.
Monoclonal antibody therapy is a cancer
treatment that uses antibodies made in
the laboratory from a single type of
immune system cell. These antibodies
can identify substances on cancer cells
or normal substances that may help
cancer cells grow.

49. • Tyrosine kinase inhibitors (TKIs)
block signals that tumors need to
grow. Some TKIs also keep tumors
from growing by preventing the
growth of new blood vessels to the
tumors.

50. • Bone marrow transplantation and
peripheral blood stem cell
transplantation are sometimes
performed. Radioimmunotherapy,
which is treatment with a radioactive
substance that is linked to an antibody
that will attach to the tumor when
injected into the body, is being tested
in clinical trials. Surgical removal of the
tumor may also be performed.

51. • Risk for impaired Gas Exchange
• Risk for infection related to
potential bone marrow depression
due to chemotherapy
• Fatigue related to side effects of
treatments, low haemoglobin
levels, pain, lack of sleep, or other
causes

52. • Try to eliminate potential food
allergens, including dairy (milk, cheese,
butter), wheat (gluten), corn, soy,
preservatives, and food additives.
• Eat antioxidant foods, including fruits
(such as blueberries, cherries, and
tomatoes) and vegetables.

53. • Avoid refined foods, such as white
breads, pastas, and sugar.
• Eat fewer red meats and more lean
meats, cold water fish, tofu (soy, if
no allergy), or beans for protein.
• Use healthy oils in cooking, such
as olive oil or vegetable oil.

54. • Reduce or eliminate trans fatty acids,
found in such commercially baked
goods as cookies, crackers, cakes,
French fries, onion rings and
processed foods.
• Avoid coffee and other stimulants,
alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water
daily.

57. • Retinoblastoma is a malignancy of the
retinal cell layer of the eye. The tumor
is composed mainly of undifferentiated
anaplastic cells -- blasts -- that arise
from the nuclear layers of the retina. It
is the most common eye tumor in
children and it usually occurs before
the age of five. It can occur in one eye
(unilateral) or in both eyes (bilateral).

58. • Random Somatic Mutation
• Family History

59. • Leukocoria / Cat’s eye reflex:
Leukocoria results when the pupil reflects
a white color rather than the normal black
or red color that is seen on a flash
photograph.
• A red and irritated eye: The diseased
eye of a child with retinoblastoma also
may become red and painful. As the tumor
grows, new blood vessels may form on the
front surface of the iris.

60. • Strabismus: A deviation of the eyes. It means
the eyes are not straight or properly aligned.
This results from the failure of the eye muscles
to work together
• Nystagmus: Causes the eyes to look
involuntarily from side to side in a rapid,
swinging motion rather than staying fixed on an
object or person.
• Heterochromia: Refers to a difference in
coloration, usually of the iris. Is a result of the
relative excess or lack of melanin (a pigment).
• Double vision

62. • Well Baby Screening
• Red reflex: checking for a normal reddish-
orange reflection from the eye's retina with an
ophthalmoscope or retinoscope from
approximately 30 cm / 1 foot, usually done in a
dimly lit or dark room.
• Corneal light reflex/Hirchberg test: checking
for symmetrical reflection of beam of light in the
same spot on each eye when a light is shined
into each cornea, to help determine whether the
eyes are crossed.

63. • Eye examination: checking for any
structural abnormalities
• Bone marrow examination or lumbar
puncture may also be done to
determine any metastases to bones
or the brain.
• Ultrasound (Echography)
• Genetic testing

64. Photocoagulation (Laser Therapy)
Laser therapy is performed on an
outpatient basis during the EUA. Laser
therapy focuses a powerful beam of light
through the dilated pupil or through the wall
of the eye onto the cancer and the
surrounding tissue. This focused and high-
powered light destroys cancerous tumors
inside of the eye. The small burns produced
by the laser destroy the blood supply to the
tumor and cause the tumor to shrink.

65. Cryotherapy (Freezing Treatment)
• Cryotherapy, which freezes small tumors, is
performed in conjunction with an EUA. A
probe (which looks like a pen) is placed on
the sclera nearest to the tumor Using a very
cold gas; the tumor is frozen and thawed
several times. This destroys the tumor cells
and leaves a flat, pigmented scar with no
signs of tumor. If tumor is evident, the
treatment will need to be repeated to
successfully destroy all of the tumor cells.

66. • Transpupillary thermotherapy: Laser
energy (through the use of infrared
light) heats up cancer cells and
surrounding blood vessels, which kills
the cells.
• Brachytherapy: Radioactive material
(little rods or pellets) is placed within
the tumor to deliver beams of radiation
to specific areas. This form of treatment
minimizes the damage to surrounding
healthy tissue.

67. Chemotherapy
Vincristine (Vincasar, Oncovin PFS)
Cycle-specific and phase-specific, which
blocks mitosis in metaphase. Binds to
microtubular protein, tubulin, GTP
dependent. Blocks ability of tubulin to
polymerize to form microtubules, which
leads to rapid cytotoxic effects and cell
destruction.

68. • Carboplatin (Paraplatin)
Inhibits both DNA and RNA synthesis. Binds
to protein and other compounds containing
SH group. Cytotoxicity can occur at any
stage of the cell cycle, but cell is most
vulnerable to action of these drugs in G1 and
S phase.
• Etoposide (Toposar, VePesid)
Blocks cells in the late S-G2 phase of the
cell cycle

69. • Immunosuppressants
The addition of cyclosporine in combination with
chemotherapy regimen of carboplatin, etoposide,
and vincristine reportedly have showed enhanced
efficacy of chemotherapy.
• Cyclosporine (Sandimmune, Neoral)
Cyclic polypeptide that suppresses some humoral
immunity and, to a greater extent, cell-mediated
immune reactions such as delayed
hypersensitivity, allograft rejection, experimental
allergic encephalomyelitis, and graft-vs-host
disease for a variety of organs. For children and
adults, base dosing on ideal body weight.

70. Localized Plaque Radiotherapy
• In this type of treatment, a small radioactive
plaque (disc) is custom made and attached
to the eye. Plaque radiotherapy has
advantages over external beam
radiotherapy in that it delivers radiation in a
more localized fashion, thereby minimizing
exposure to other eye structures. It should
be stressed that only a small percentage of
patients with retinoblastoma are candidates
for plaque radiotherapy.

71. Enucleation
Enucleation is the surgical removal
of the eyeball, leaving eye muscles
and the contents of the eye socket
intact. This procedure is done when
there is no other way to remove the
cancer completely from the eye.
Unfortunately, loss of vision for the
eye removed is permanent because
an eye cannot be transplanted.

72. PREVENTION
• Screening
• Genetic counseling
• Monitoring for recurrence
• Monitoring for other cancers

73. COMPLICATIONS
• Cataract formation
• Secondary malignancy
• Optic nerve atrophy
• Temporal bone hypoplasia after external
beam radiation

74. DIET PLAN
• Energy (calories) should be adequate to
support growth and development and to
reach or maintain desirable body weight.
• Keep total fat intake between between 25
to 35 percent of calories for children and
adolescents 4 to 18 years of age, with
most fats coming from sources of
polyunsaturated and monounsaturated
fatty acids, such as fish, nuts and
vegetable oils.

75. • Choose a variety of foods to get enough
carbohydrates, protein and other nutrients.
• Eat only enough calories to maintain a
healthy weight for height and build. Be
physically active for at least 60 minutes a
day.
• Serve whole-grain/high-fiber breads and
cereals rather than refined grain products.
• Introduce and regularly serve fish as an
entrée. Avoid commercially fried fish.
• Serve fat-free and low-fat dairy foods.

76. • Ineffective peripheral tissue perfusion
related to low haemoglobin count
secondary to anemia
• Risk for Infection related to operative
procedure
• Acute pain related to release of
prostaglandin