Pediatric oncology discusses the classification, epidemiology, clinical features, and prognosis of childhood cancers. Some key points include: - Malignancies are a leading cause of death in children under 15 years old. It is estimated that 7,500-8,000 children in Pakistan are diagnosed with cancer each year. - Common childhood cancers include leukemia, lymphoma, bone tumors, soft tissue sarcoma, brain tumors, retinoblastoma, neuroblastoma, and Wilms tumor. - Neuroblastoma and Wilms tumor (nephroblastoma) are examples of solid tumors that can present as abdominal masses and are treated with surgery and chemotherapy. Early metastasis is common for these cancers.

1. Pediatric Oncology
Classification, Epidemiology, Clinical Features, Prognosis
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. It contains estimated 200 Billion Stars, the sun lies roughly 27,000 light-years
from the centre of the galaxy. And there are estimated minimum
100 Billion Galaxies in the Universe.

3. (God speaking to Prophet Muhammad (PBUH)
And (remember) Ayub (Job), when he called his Lord saying
“I have been afflicted by distress (disease), and
You are the most merciful of all those who have mercy”
The Holy Quran; surah Al-Anbiya 21:83
In the name of Our Creator Allah, the most Gracious, the most Merciful

4. Pediatric Oncology - Epidemiology
• Malignancies are one of the leading causes of death in
children under 15 years of age
• It is estimated that approximately 7500- 8000 children less
than 18 years get cancer, every year in Pakistan.

5. Pediatric Oncology – Types of Malignancies
Pakistan Data
Disease Percentage
Leukemia 35
Lymphoma 20
Bone Tumor 08
Soft Tissue Sarcoma 07
Brain Tumor 07
Retinoblastoma 06
Neuroblastoma 04
Wilms Tumor 04
Germ Cell Tumor 03
Others 06

7. Pediatric Oncology
Solid Tumors in Children
Neuroblastoma, Nephroblastoma
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

8. Solid Tumors in Children
• Bone Tumor (Osteosarcoma)
• Soft Tissue Sarcoma (Rhabdomyosarcoma)
• Brain Tumor (Medulloblastoma)
• Retinoblastoma
• Neuroblastoma
• Wilms Tumor (Nephroblastoma)

9. Bone Tumor (Osteosarcoma)

10. Rhabdomyosarcoma

11. Brain Tumor (Medulloblastoma)

12. Brain Tumor (Medulloblastoma)

13. Neuroblastoma

14. Neuroblastoma
Epidemiology
• Neuroblastoma arises from neural crest cells
• Origin – adrenal medulla OR paraspinal sympathetic ganglia
• Age – less than 5 years
• Metastasis are formed early

15. Neuroblastoma
Clinical Features
• Abdominal mass
• Thorax / Mediastinal mass
• Proptosis of eyes
• OMS (Opsoclonus – myoclonus syndrome)

16. Neuroblastoma
Investigations
• CBC, ESR, CRP
• LFT, RPM, LDH, Uric acid
• Coagulation profile
• VMA (catecholamine metabolites in urine)
• US abdomen
• CT scan Thorax / Abdomen
• Bone marrow Biopsy
• Excision / Needle Biopsy - Histopathology

17. Neuroblastoma
Histology

18. Neuroblastoma
Management
• Surgery
• Chemotherapy (Vincristine, Cisplatin, Etoposide)

19. Nephroblastoma
Wilm’s Tumor

20. Nephroblastoma (Wilm’s tumor)
Epidemiology
• Wilms tumor (Nephroblastoma) is the most common renal
tumor of childhood.
• Wilms tumor (Nephroblastoma) constitutes about 5% of all
cancer in children
• Wilms tumor (Nephroblastoma) metastasizes early
• Wilms tumor (Nephroblastoma) has a 5 year survival rate of
50% after treatment

21. Nephroblastoma (Wilm’s tumor)
Clinical Features
• Abdominal mass
• Pain abdomen
• Hematuria
• Fever
• Hypertension

22. Wilm’s Tumor (Nephroblastoma)
Investigations
• CBC, ESR, CRP
• LFT, RPM, LDH, Uric acid
• Coagulation profile
• Urine examination
• US abdomen
• X-ray Chest
• CT scan Thorax / Abdomen
• Excision / Needle Biopsy - Histopathology

23. Nephroblastoma (Wilm’s tumor)
Histology

24. Nephroblastoma (Wilm’s tumor)
Management
• Surgery
• Chemotherapy (Vincristine, Daunorubicin, Actinomycin - D)
• Radiotherapy