INITIAL

EVALUATION OF
THE CHILD WITH
A SUSPECTED
MALIGNANCY
Bidasari Lubis

MOTHER WITH LEUKEMIC CHILDREN

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 INCIDENCE

Childhood cancer is relatively

uncommon.only
2% of all cancers occur in children.
In 2000, cancer was the second leading
cause of
death in children aged 1 - 14 years.
The risk of death due to certain cancers can
therefore be reduced through intensive
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monitoring, and early detection and
Significant increases in survival
rates have been reported for many
types of childhood cancers over the
last 2 years in association with
clinical trials and the development
of new treatments

(Stiller 1994; National Cancer Institute

1999).

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For example, the 5-year survival
rate in the USA for all childhood
cancers combined increased
from 55.6% in 1974-76 to 73.8%
in 1989-94

(National Cancer Institute

1999).
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cancers in children are mostly
sarcomas, which originate in
tissues such as the bone marrow,
nerve tissues, lymph nodes, bone
and muscle

(Simone & Lyons 2001).

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In children, leukaemia (a cancer of
white blood cells) is the most
common cancer, accounting for
approximately one-third of all
childhood cancers.
The majority of leukaemia cases
are acute lymphoblastic leukaemia,
which affects immature
lymphocytes
(Miller et al. 1995).
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Incidence of Childhood Cancers
Cancer Incidence (%)
Leukemia 30.2
Centralnervoussystemtumor 21.7
Lymphoma 10.9
Neuroblastoma 8.2
Soft tissue sarcoma 7.0
Renal tumor 6.3
Bone tumor 4.7
Others 11.0
Adapted with permission from Linet MS, Ries LA, Smith MA, Tarone RE,
Devesa SS. Cancer surveillance series: recent trends in childhood cancer
incidence and mortality in the United States. J Natl Cancer Inst 9
1999;91:1051-8.
PRESENTATION

HEADACHE
LYMPHADENOPATHY
BONE PAIN
PANCYTOPENIA
HYPERLEUKOCYTOSIS

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 Signs and Symptoms of Childhood Cancers and Conditions
That Can Mimic These Cancers
Sign or symptom Type of cancer Common conditions in the
differential diagnosis

Fever, Leukemia, lymphoma Infection

Vomiting Abdominal mass, brain tumor Infection, gastroesophageal

reflux
Constipation Abdominal mass Poor diet
Cough Mediastinal mass Upper respiratory infection,
reactive airway disease,
pneumonia
Bone or muscle pain Leukemia, bone tumor, Musculoskeletal injury, viral
neuroblastoma infection
Headache Brain tumor Tension headache, migraine,
infection
Lymphadenopathy (>2 cm) Leukemia, lymphoma, metastatic Lymphadenitis, systemic infection,
disease collagen vascular disease
Hematuria Wilms' tumor Urinary tract infection,
glomerulonephritis
Voiding difficulty Rhabdomyosarcoma Congenital urinary tract
abnormalities

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EVALUATION OF THE CHILD
WITH SUSPECTED
LEUKEMIA

Most of the signs and

symptoms that children with
leukemia develop result from
a lack of normal blood cell
producing bone marrow by
the leukemia cell.
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Infection have a high fever
because of a deficiency of normal
white blood
Easy bleeding or bruising poor
production of blood platelets
Bone pain accumulation of the
leukemia cells
Swelling of the abdomen
enlargement of the liver and
spleen
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Enlargement of the thymus
can lead to coughing,
shortness of breath,
suffocation and SVC syndrome
Headache, seizure and
vomiting extramedullary
spread (CNS, the
testicles, ovaries, kidney
lungs, heart, intestine or
other organs)
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 LABORATORY
STUDIES

CBC with manual differential, reticulocyte

count, periphreral blood smear (blasts)
Electrolyte, BUN, creatinine , uric acid,
LDH
SGOT, SGPT, alkaline phospatase, total
bil,
magnesium, calcium, phosphorus
Serologies : varicella, CMV, herpes,
hepatitis A,
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B, and C (obtain prior to start of therapy)
 Quantitative immunoglobulins
Coagulation studies : prothrombin
time/International normalized ratio,
activated
partial thromboplastin time, fibrin
degradation
products or D-dimers, fibrinogen
Types and cross for PRC if necessary
if febrile or ill-appearing : blood culture,
urine
culture 18
RADIOGRAPHIC
STUDIES

Chest Radiograph
(assess for mediastinal mass)
Plain bone film of sites of bone
pain
(assess for pathologic
fractures)
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 DIAGNOSTIC STUDIES

Bone marrow aspiration

a. Specimens for morfology,
immunophenotyping,
karyotype
b. Extra pulls as per protocol for biologic
studies
c. For dry taps, bone marrow biopsy for
diagnostic
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studies
BONE MARROW ASPIRATION

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 Lumbar puncture
( Platelet count > 30 50 x 109 / L )
a. Cytology, chamber count (white cells,
red
cells, protein, glocose)
CSF culture if patient is febrile

b. Initial procedure done by the

pediatric
oncology attending or fellow, after
careful
evaluation for elevated intracranial
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LUMBAR PUNCTURE

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