KANKER PADA ANAK 1

* * * * KEGANASAN PADA DEWASA DAN ANAK PADA DEWASA: PADA ANAK: KANKER PARU, PAYUDARA, USUS BESAR, PROSTAT (JARANG PADA ANAK)  KLASIFIKASI BERDASAR LETAK/ASAL ORGAN PADA ANAK: BERVARIASI, TUMOR DAPAT BERASAL DARI LOKASI PRIMER YANG BERBEDA * * * *

12 DIAGNOSIS UTAMA KEGANASAN PADA ANAK ( I I C C ) I. LEUKEMIA VII. TUMOR HATI II. KEGANASAN LIMFOMA VIII. TUMOR TULANG & RES IX. SARKOMA JAR. III. TUMOR INTRAKRANIAL IKAT IV. TUMOR SARAF SIMPATIK X. TUMOR GERM CELL V. RETINOBLASTOMA XI. TUMOR EPITEL VI. TUMOR GINJAL XII. TUMOR LAIN

Epidemiologi DI DUNIA (1991) DI RSS. (1992-1998) Tu. Hati Lain-lain Leukemia Retinoblastoma Tu. Tulang Tu. Wilm’s Tu. Otak Neuroblastoma Tu. Jar. Ikat Limfoma Neuroblastoma Tu. Hati Lain-lain Tu. Tulang Leukemia Tu. Otak Tu. Jar. Ikat DI RSS. (1992-1998) Tu. Wilm’s Retinoblastoma Limfoma

ETIOLOGI RADIASI: IONISASI, ULTRAVIOLET INFEKSI FAKTOR PRAKONSEPSI: ROKOK, RADIASI, SITOSTATIKA GENETIK KARSINOGENESIS LAIN-LAIN ETIOLOGI

KELUHAN UTAMA PADA KEGANASAN KELUHAN UTAMA KEGANASAN PUCAT, LEMAH LEUKEMIA, LIMFOMA LEHER BENGKAK LIMPHOMA, LEUKEMIA DEMAM, NYERI TULANG EWING-CA, LEUKEMIA BINTIK PUTIH MATA RETINOBLASTOMA MASA ABDOMEN TUMOR WILM’S, HATI NEUROBLASTOMA NYERI KEPALA, MUNTAH TUMOR OTAK JATUH OSTEOSARKOMA

DIAGNOSIS BANDING PANSITOPENIA INFEKSI LEUKEMIA KELUHAN/GEJALA Dx. BANDING KEGANASAN PANSITOPENIA INFEKSI LEUKEMIA PERDARAHAN KOAGULO/THROMBO LEUKEMIA LIMFADENOPATI INFEKSI LIMFOMA NYERI KEPALA MIGRAIN, SINUSITIS TUMOR OTAK NYERI TULANG INFEKSI TUMOR TULANG MASA ABDOMEN KISTE, INFEKSI TUMOR WILM’S, NEUROBLASTOMA

LIMFOMA Limfadenopati TUMOR OTAK Nyeri kepala, muntah

RETINOBLASTOMA Mata kucing Meluas ke orbita Tumor abdomen TUMOR WILM’S , NEUROBLASTOMA, TUMOR HATI

PRINSIP DIAGNOSIS ANAMNESIS EVALUASI KLINIS LABORATORIUM PATOLOGI PENCITRAAN MARKER BIOLOGI

NON KAUSA PRINSIP TERAPI SUPORTIF KAUSA SIMPTOMATIK RADIASI KOMPLIKASI SITOSTATIKA OPERASI

CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA 4/13/2018

INTRODUCTION. LEUKEMIA: 25-35% CHILDHOOD CANCER. (ALL: 80% & ANLL:20%) INTRODUCTION LEUKEMIA: 25-35% CHILDHOOD CANCER (ALL: 80% & ANLL:20%) ALL: - MALIGNANT DISEASE - PROGRESSIVE INFILTRATION OF BONE MARROW & LYMPHATIC ORGANS BY IMMATURE LYMPHOID CEL/LYMPHOBLASTS UP TO 1970: AS INCURABLE DISEASE CAN IT BE CURED ? 4/13/2018

4/13/2018

4/13/2018

4/13/2018

ETIOLOGY& EPIDEMIOLOGY RADIATION, CHEMICALS, DRUGS, VIRUSES ETIOLOGY& EPIDEMIOLOGY RADIATION, CHEMICALS, DRUGS, VIRUSES and GENETIC ABNORMALITIES INCIDENCE: 3 per 100.000 CHILDREN PEAK: 2-6 YEARS SARDJITO (1992- 1998) LEUKEMIA: 48% INDONESIA PROBLEMS: REGISTRATION, PROTOCOL, SPECIFIC DIAGNOSIS, COST (DRUGS & SUPORTIVE) 4/13/2018

75 Intensive Tx 1980’s CNS Prophylaxis 1970’s EFS (%) 100 TREATMENT OUTCOME 75 Intensive Tx 1980’s CNS Prophylaxis 1970’s 25 Combination Agent 1960’s 0 Single Agent 1950’S 1 2 3 4 5 6 10 15 20 (YEARS)   4/13/2018

CLINICAL SIGN SYMPTOMS:. Malaise, Fatique. Bleeding, Bruising. Fever CLINICAL SIGN SYMPTOMS: Malaise, Fatique Bleeding, Bruising Fever Bony pain, Lymphadenophaty (80%) Splenomegali & Hepatomegaly (70%-75%) Enlargement of the TESTES CNS: (Intracranial pressure> & cranial nerve palsies) 4/13/2018

LABORATORY & RADIOLOGY Peripheral blood: Anemia, Thrombocytopenia, Neutropenia Bone Marrow Aspirate: > 25% leukemic lymphoblasts Special stains: Biochemical, immunologic, cytogenetic Radiographic: Mediastinal mass (5-10%) 5%-10%: Diagnostically chalenging   4/13/2018 ALL 1.flv

BMP 4/13/2018

FAB CLASSIFICATION Morphological CLASSIFICATION: French-American-British (FAB)  L1, L2, and L3 L1: 80% L3: < 2% The remainder: L2 L1: Higher remission Prolonged survival than L2 and L3, L3: The worst prognosis 4/13/2018

4/13/2018

4/13/2018

4/13/2018

ALL MANAGEMENT in childhood. Four COMPONENTS. - REMISSION INDUCTION ALL MANAGEMENT in childhood Four COMPONENTS - REMISSION INDUCTION - INTENSIFICATION - CNS TREATMENT - CONTINUATION The purpose: Eradicate leukemic cells/their progenitors Preserving normal progenitors 4/13/2018

Disease Clin. Dx of ALL Made: Detectable Tx Started 1012 - A D Relapse 1010 - B 108 - Compl. Remission Achieve 106 - 104 - C Tx Stopped/Ineffective 102 - 100 -One Malignant Cell Patient Cured 10-1 - E 2 4 6 8 10 12 16 18 20 22 24 (WEEKS) Number of Leukemic Cell 4/13/2018

video csf.CSF REMISSION INDUCTION Reduce the LEUKEMIC CELL BURDEN  CLINICALLY/HEMATOLOGICALLY UNDETECTABLE LEVEL Regimens: VCR, DEXA, L-ASP, DNR & MTx intrathecally PROBLEMS: DIFFICULT DIAGNOSIS EDUCATION/INFORMATION NO COST, NO DELAY COMPLICATIONS/FAILURE 4/13/2018

CNS TREATMENT. Prolonged disease free survival CNS TREATMENT Prolonged disease free survival Protect against late bone marrow relapse CNS Tx REGIMENS: - INTRATHECAL drugs - Systemically administered drugs - Craniospinal irradiation (Now: Avoided) video.LP3 schem.flv video.lp1 tech.flv 4/13/2018 video lp.flv.flp

CESSATION THERAPY IN GENERAL: STOP 2-5 YEARS AFTER Dx CURRENT Tx: AFTER 2 YEARS OF Tx REDUCTION TO 18 MONTHS: INCREASE RELAPSE RATE RELAPSE: IN THE FIRST 12 MONTHS HIGHER THAN IN SUBSEQUENT YEARS 4-6 YEARS AFTER CESSATION Tx: RARE 4/13/2018

4/13/2018

Complications: - Infection - Bleeding - Stomatitis - Moon face - Striae - Alopecia - Malnutrition - Psychologic ALL.flv 4/13/2018

SUPPORTIVE CARE MORTALITY << & SURVIVAL >> NURSES: AWARE & OPTIMAL CARE HEMORRHAGE: Transfusions Nutrition INFECTION: - ANTIBIOTIC - SEMISTERILE ROOM - ASEPTIC CARE 4/13/2018 ALL.flv

SUPPORTIVE CARE - Asscociation of leukemia family - Education - Fund rising - Psychologic support - Drug discount 4/13/2018

INDUCTION 4/13/2018

CONSOLIDATION MAINTANANCE 4/13/2018