1. epidemiology, clinical
Cancers in childhood:
epidemiology, clinical
approach to diagnosis
And Lymphadenopathy

2. leading cause of disease-related death in children
Children cancers •
leading cause of disease-related death in children
in developed countries and remains an important public health concern because of its great physical and psychological impact on the affected children and their families
the causes of childhood cancer are mostly unknown •

3. treatment is an essential
Children cancers •
short latency periods and often grow rapidly
are very invasive
more responsive to treatment than adult tumors
timely diagnosis immediately followed by effective
treatment is an essential

4. Hereditary diseases and cancers Primary Disease
Phakomatoses neurofibromatosis tuber sclerosis
Genetics
Type of cancers AD
AD AD
CNS tu, sarcomas
syndrome
glikogenosis type
galactosemia IV AR
AR AR AR AR
Cirrhosis
hypermetioninemia
AD – autosomal dominant
AR –
autosomal recesive
AS – sex linked

5. Hereditary diseases and cancers Genetics Primary Disease
Type of cancer
disorders SR
? AD?
Leukemia,
Leukemia, ,
lymphoma
syndrome AR

6. Diagnostic criteria for neurofibromatosis type 1 (NF 1) - Memorandum
WHO
(1992)   

7. ocular
skin
CNS
NF1
signs
and
symptoms
others
bones
cancers

8. NF1 -
summary
Disease:
chronic
progressive
unpredictable

9. ,
„cafe au
4.4%
Half body overgrowth
2.9%
2.9%
Aniridia
1.1%

10. that Chief complaints Chronic drainge from ear Brain tumor lymphomas
Proptosis

11. Leukemia;
lymphoma
Bone pain
Hodgkin’s lymphoma

13. Headaches  only few of the headaches are caused by
intracranial tumors tu tu :
the headaches

14. 
Presence or onset of neurologic abnormality  
repeatedly
awaken
child
from 

15. Abdomen –
tumor
examination
examination

16. Bone pain  Bone  intermittent, and it increases in  (no bone
involvement)

17. 1.
Newborns 1. 2.
Damage during delivery 3.
Newborns diathesis, thrombocytopenia

20.    

21. • – •

23. •
unexplained fever, fatigue, and arthralgia - ??

24. • –
unexplained fever, fatigue, and arthralgia
– collagen vascular disease or serum sickness •

25. • – – –

26. Lymphadenitis (inflammation of lymph nodes)•
Lymphadenopathy:
– regional
– generalised (>= 2 lymph nodes groups)
Lymphadenitis (inflammation of lymph nodes) •
– acute:
– chronic:
< 6 weeks
> 6 weeks •
Lymphocutaneous syndromes - regional lymphadenitis
associated with a characteristic skin lesion at the site of inoculation.
Lymphangitis is an inflammation of subcutaneous lymphatic channels (acute bacterial infecton - Staphylococcus aureus and group A streptococcus. •

27. • • – – •

28. • – – –

29. • – • •

30. A. C. 1 1. 2. 3. 1. 2. B. D. 1. 2. 3. 1. 2. 3. 4.

31. lymphadenopathy: no treatment observation •
lymphadenopathy: no treatment
observation
acute bacterial cervical lymphadenitis without a known primary
infectious source –
antibiotics: adequate coverage for both S. aureus and group A β-hemolytic
streptococci
appropriate oral antibiotics: cloxacillin, cephalexin, or clindamycin – •
acute bacterial cervical lymphadenitis with a known primary
infectious source
empirical antibiotics: against the microorganism most frequently associated with that source, pending the results of the culture and sensitivity tests
cervical lymphadenopathy and periodontal or dental disease:
treatment - penicillin V or clindamycin • •

32. •
cervical lymphadenopathy and periodontal
– treatment - penicillin V or clindamycin indications for intravenous treatment: or
dental
disease: • –
toxic or immunocompromised children
those who do not tolerate, will not take,
or fail to respond to an oral medication •
fluctuant lymph node:
– incision and drainage
supportive care:
– oral analgesia – e.g. acetaminophen •

33. •

34. • •

35. • •

36. •

37. • – •

38. • • –

39. Examination: mouth, throat,
Cervical LN
Epitrochlear LN
Examination: mouth, throat,
teeth, gums, ears
Skin examination:
melanoma exclusion
Skin examination:
melanoma exclusion
Exploratory
laparotomy
Abdominal LN
biopsy/excision LN
Skin examination:
melanoma exclusion
Thoracotomy
Mediastinoscopy
Inguinal LN
Mediastinal LN

40. •

41. •
cutaneous papule or conjunctival granuloma,
lymphadenopathy localized to the draining
regional nodes
site of initial infection: •

42. • •

44. • • – • – – • –

45. • –

46. • • –

48. weeks of antibiotics, it will require incision and drainage•
LN: diameter < 1 cm = normal range
– patient (pts) can be reassured and discharged from clinic
LN: diameter 1–3 cm •
– pts
should be
treated
with an
antibiotic
with
good
anti-
staphylococcal and streptococcal cover for 2 weeks
– no improvement - investigation by ultrasound
LN: diameter > 3 cm
pts should be assessed initially with ultrasound • –
inflammatory nodes - treat with antibiotics for 2 weeks
If an abscess develops they usually resolve with intravenous (IV) antibiotics
however if the abscess is pointing on presentation, or does not resolve with 2
weeks of antibiotics, it will require incision and drainage

49. • a
node
that is
chronically
present,
but
not
enlarging, should
ultrasound be
assessed
initially with •
any
progressively
enlarging
cervical
node
should be
referred
for urgent
fine needle
aspiration biopsy
failure of regression •
after 4 to 6 weeks might
be an indication for a diagnostic biopsy

50. •
pts is suspected of having serious disease
undiagnosed LN persisting longer than 2months
worrisome
features
such as
firm,
matted, or
rapidly
enlarging LN •
the
presence of
night
sweats,
weight
loss,
bone
pain,
hepatosplenomegaly, fever of unknown etiology, or failure
to thrive
a positive PPD and/or an abnormal chest radiograph •