NEOPLASMS IN CHILDHOOD

Neoplasms can occur in any age group. Early treatment of malignancies carries the best prognosis. Clinical features, useful investigations, and management of common childhood malignancies are summarized in the Table below

Common childhood malignancies, their clinical features useful investigations, and line of management

Tumour Clinical features Investigations Management
Leukaemias Anaemia bone pains,
haemorrhagic
tendencies, epistaxis
and gum bleeding
Repeated infection
Haemogram
Bone marrow
Cytochemistry
Flowcytometry
Refer to haematologist/
oncologist
for
specialized care
for chemotherapy
Burkitt’s
lymphoma
Usually a jaw tumour
May also present as an
abdominal mass or
central nervous system
tumour
Biopsy of the mass;
haemogram, bone
marrow, x-ray, ultrasound
scan CT scan,
PET scan
Lumbar puncture
Refer for
specialized care
Hodgkin’s
disease
Lymph node
enlargement, usually
cervical Splenomegaly
abdominal masses
Haemogram
Chest x-ray
Lymph node biopsy for
histology and
immunohisto-chemistry
Bone marrow
Refer for
specialized care
for chemotherapy
with or without
radiotherapy
Nephroblastom
a (Wilms’
tumour)
Average age 2 years:
Embryonal tumour Early
childhood Painless loin
mass (abdominal mass)
Fast growing
Full haemogram U/E in
normal IVU (intravenous
urography) shows
displaced calices FNAC
shows malignant
embryonal tumour cells
CXR for metastasis
Refer to
specialized care
Chemotherapy
Surgery –
nephrectomy with
post surgical
chemotherapy has
good prognosis
Neuroblastoma Embryonal tumour
Abdominal mass in loin
region Markedly
elevated blood pressure
Fast growing often
crossing midline
Child is sick looking
Full haemogram IVU
shows caudally
displaced normal kidney
FNAC – malignant
embryonal cells
Ultra sound shows supra
renal tumour with normal
kidney CXR – look for
metastasis, 24 hr urine –
VMA grossly elevated
Refer to specialist
centre
Chemotherapy
Surgery
NB: Challenging
anaesthesia, has
poor prognosis
Dysgerminoma Commonest midline
tumour in neonatal
period Commonest in
ovary, testis, thymus,
sacrococcygeal (most
dramatic – teratoma)
Presents with pressure
symptoms May ulcerate
especially when
malignant
Plain x-ray may show
calcification
U/S – defines extent/site
of tumour
Foetoprotein tumour
marker
Surgical excision;
if benign, leave
alone; if malignant,
chemotherapy
Good prognosis
Rhabdosarcoma/
rhabdomyosarcoma
Tumour of muscle; can
occur anywhere
commonest in pelvis,
bladder, vagina
may present with a
fungating mass
(sarcoma botryoid) May
ulcerate and bleed
Good physical
examination:
Full haemogram U/S,
CXR
CT scan when available
Biopsy
FNAC
Surgery
Chemotherapy
Poor prognosis
Retinoblastoma Age usually below 3
years
Inherited through
chromosome 13
May be unilateral or
bilateral Yellowish
whitish reflex
Skull x-ray
Urine catecholamines
Fundoscopy
CT scan – head
Refer to
ophthalmologist
and oncologist for
specialized
treatment
CNS tumours Headache, convulsions,
vomiting Papilloedema
Disturbance of gait &
vision
skull X-ray CT scan
MRI scan
Refer to
neurosurgeon
Surgery,
radiotherapy,
chemotherapy