Child with Cancer: Wilms Tumor Rhabdomyosarcoma, Osteogenic Sarcoma Flashcards
Wilms Tumor
Most common primary malignant renal tumor
- rapidly growing/vascular
- fragile gelatinous capsule
- females > males
- peak age 2-3 years
- 75% by age 5 years
When Wilms occurs in older patients it more likely to be advanced and often of unfavorable histology.
Often abdominal tumors present with pain, increased BP, constipation, toddler stops walking
Prognosis related to whether or not it is encapsulated
What to avoid in Wilms Tumor
Avoid palating the abdomen for risk of spreading cancerous cells (HIGHLIGHTED)
- encourage parents to gently bath and handle the child
Wilms Tumor Stage 1
The tumor is limited to the kidney and completely excised.
The surface of the renal capsule is intact. The tumor is not ruptured before or during removal. No residual tumor is apparent beyond the margins of the excision
Wilms Tumor: Stage II
The tumor extends beyond the kidney but is completely excised. Regional extension of the tumor is present (penetration through the outer surface of the renal capsule into the perirenal soft tissues). Vessels outside the kidney substance are infiltrated or contain tumor thrombus. Biopsy may have been performed on the tumor, or local spillage of tumor confined to the flank has occurred. No residual timor is apparent at or beyond the margin on excision.
Wilms Tumor: Stage III
Residual nonhematogenous tumor is confined to the abdomen. Any of the following may occur:
- lymph nodes on biopsy are found to be involved in the hilus, the periaortic chains, or beyond
- diffuse peritoneal contamination by the tumor has occurred
- implants are found on peritoneal surfaces
- the tumor extends beyond the surgical margins either microscopically or grossly
- the tumor is not completely resectable because of local infiltration into vital structures
Wilms Tumor: Stage IV and V
IV: Hematogenous metastasis: deposits are present beyond stage III (lung, liver, bone, and/or brain)
V: bilateral renal involvement is present at diagnosis. An attempt should be made to stage each side according to the above criteria on the basis of extent of disease before biopsy
Rhabdomyosarcoma
Malignant tumor of embryonic muscle forming mesenchyme
Most common soft tissue sarcoma of childhood (HIGHLIGHTED)
Smooth muscle, fat, fibrous tissue, bone, and cartilage these tumors can occur virtually anywhere in the body.
60% are embryonal (younger ages)
20% are alveolar (adolescent)
Rhabdomyosarcoma is characterized by
ptosis and swelling
Osteogenic Sarcoma
Malignant tumor of the bone derived from bone-forming mesenchyme (connective tissue)
- results from malignant proliferating cellular stroma causing bony destruction by producing osteoid tissue or immagture bony growth
Large, long bones, usually at metaphyses, are the most common bones affected. Osteosarcoma can occur in any bone, but it is extremely rare to have disease in the bones of the hands and feet.
Treatment - chemo, and then surgery (could be amputation)
Most common sites for Osteogenic Sarcoma (HIGHLIGHTED) (3)
- distal femur
- proximal tibia
- proximal humerus
Ewing Sarcoma
Bone tumor infiltrating surrounding soft tissue
Most common sites:
- central axis: head/neck, chest wall, spine, pelvis
- extremities: femur, tibia/fibula
Ewing’s (tumor originating outside the bone) with or without bony involvement.
Retinoblastoma
8th most common childhood cancer
90% diagnosed by age 5
- most bilateral disease diagnosed <12 months of age
- median age for unilateral disease 18-30 months
- rare after age 6 years
- 20-30% bilateral
- no sex/race preference
What is unique about retinoblastoma? (HIGHLIGHTED)
childhood cancer that demonstrates patterns of family inheritance
Presentation of Retinoblastoma
Leukocoria “cat’s eye reflex”
Strabismus
Inflamed/painful eye
Long-term outcomes
Heart or lung problems
Slowed or delayed growth and development
Changes in sexual development & ability to have children
Learning problems
Increased risk of other cancers later in life
