Acute Leukemias In Children

Introduction: This is the commonest cancer in children. Types of leukemia seen in pediatric age group are
1. Acute lymphoblastic leukemia
2. Acute non-lymphoblastic leukemia
3. Chronic myeloid leukemia

Acute lymphoblastic leukemia:
Incidence: ALL is the most common type of leukemia in children.The incidence of ALL is about 30 cases per million people per year. The peak age of developing ALL is 2-6 years.

1. Genetic factor- It is seen in identical twins, Fanconi's anamia, Down's & Klinefelter's syndrome,
2. Immunologic factor- Ataxia telangiectasia
3. Environmental factor-Exposure to radiation, chemotherapeutic agents like alkalyting agents.
4. Viral infection- Epstein-Barr virus

Clinical features:
1. Anemia (fatigue, irritability, pallor)
2. Thrombocytopenia (bleeding, petechiae)
3. Neutropenia (fever)
4. Lymphadenopathy
5. Hepatospenomegaly
6. Joint pains
7. Headache, vomitings (Brain involvement)

1, Complete blood count-Eleveted leucocyte counts
2. Serum levels of uric acid, potassium, phosphorus, and calcium, and lactate dehydrogenase
3. Bone marrow aspiration & biopsy: The presence of 30% or more blasts in marrow is s/o acute leukemia
4. Lumbar puncture
5. Cytological & Molecular diagnosis
6. Ultrasonography: testis, kidneys
7. Chest X-ray

Chemotherapy: is the mainstay of treatment
Induction, CNS prophylaxis, consolidation & Maintenance therapy

Surgical role: Central line insertion for chemotherapy

Thyroid cancer in children

Introduction: Thyroid carcinomas in children represents 1-1.5% of all tumors before the age of 15 years. The incidence of thyroid carcinoma is 2-3 times more in girls than boys & commonly occurs between 7-12 years of age. Radiation to the neck in the childhood is established causative factor in development of thyroid cancer.

Clinical presentation:
1. anterior cervical lymphadenopathy
2. asymptomatic neck mass
3. vocal card palsy (rare)
4. breathlessness or dysphagia because of compression on trachea/ esophagus (rare)
5. Family h/o thyroid cancer (Especially in Medullary cancer)

Main Types:
1. Papillary (most common in children)
3. Medullary
4. Anaplastic

Physical Examination:
1. Firm painless thyroid nodule in one or both lobes
2. may be associated with lymphadenpathy
3. signs of compression or immobility due to fixation is rare but can be present
4. hoarseness of voice due to vocal cord palsy is again rare in children

1. T3, T4, TSH ( Euthyroid)
2. Antithyroid antibodies (to rule out thyroidities)
3. Thyroglobulin levels (for postoperative monitoring)
4. Calcitonin (medullary carcinoma)
5. Ultrasonography of neck
6. Thyroid scan- cold nodules
7. needle biopsy or excision biopsy
8. Chest x-ray/ CT Chest to rule out metastasis

1. Surgery- is the mainstay of treatment
Total thyroidectomy
2. Radioiodine- For the cancer spread outside the thyroid gland
3. Chemotherapy containing low dose Doxorubicin & external irradiation are reserved for anaplastic carcinoma or recurrence of differentiated carcinomas.

Prognosis: Prognosis of differentiated carcinomas is very good & more than 90% survival has been reported.